Low back pain is one of the most common reasons that people go to see their doctors. In the UK, around 9% of adults consult their doctor each year regarding their lower back pain while more than 30 million healthcare visits in the USA are because of this condition.
While most healthcare providers base their treatment recommendations on current orthopedic guidelines, not everyone is up to date on these guidelines. Many doctors remain confused about whether or not to treat lower back pain with bed rest.
Current Guidelines For Low Back Pain
Studies from 1992 show that many doctors were recommending rest for lower back pain. This trend continued into 1997. In 2022, the Mayo Clinic and international clinical guidelines continue to work on dispelling the myth around how to treat lower back pain.
When it comes to managing lower back pain, the current research supports NOT resting. Most clinical guidelines around the world now specifically discourage the use of bed rest for lower back pain.
Research by Arnau et al. compared national guidelines from 13 different countries and reported on bed rest recommendations that ranged from “discourage even if pain is severe” to considering bed rest to be “harmful for more than 2 days”. These recommendations came from consistent conclusions that staying active leads to ”better symptomatic and functional outcomes in both the short and long term for people with acute low back pain”.
What Types Of Back Pain Actually Require Bed Rest?
With all of that being said, there are some lower back conditions that might benefit from some bed rest. One of these conditions is sciatica. Sciatica is a condition where pain travels along the path of the sciatic nerve which is a nerve that travels from the lower back through the hips and buttocks.
With sciatica, the underlying cause of pain can be a bit different from conventional lower back pain. Neural tissue is usually involved, making this a very painful disorder. Because the underlying cause is somewhat different from a traditional muscle strain or sprain, while prolonged bed rest is still not recommended, some extended rest may not be contraindicated.
Unfortunately there isn’t a whole lot of data around sciatica and bed rest, in fact the Arnau research only found 3 guidelines that had recommendations about pain that radiates from the leg.
Is Bed Rest Good For Sciatica?
Only a few studies have looked specifically at bed rest and sciatica and the findings were somewhat inconclusive but they did lean slightly towards resting. To further complicate things, sciatica is often used as a general term for low back pain whereas true sciatica often involves neurological pain which makes it a little bit different in terms of treatment.
Current definitions of sciatica consider it to be a disease of the peripheral nervous system that is consistent with “lumbar radiculopathy” and therefore it may require a different approach to management than traditional lower back pain that is more muscular in nature.
Should I Rest A Sore Back?
So, now that we know there are some lower back conditions that might require rest, how do you know if you should rest your sore back or not? Typically, guidelines and healthcare providers often follow the recommendations to NOT rest your lower back.
If you don’t have any signs of anything serious that might be going on with your back (like weakness, weight loss, fever, or loss of bladder control) you should generally try to continue your regular daily activities and stay as active and as mobile as you can.
To confirm this approach, researchers in the UK compiled a systematic review of trials that took place from 1966 to 1996. They found ten trials of bed rest and eight trials where patients were advised to stay active.
Their research showed that overall, bed rest was not an effective treatment for low back pain. Furthermore, the findings showed that bed rest may actually delay the recovery process.
The advice to stay active and to “continue ordinary activities” resulted in “faster return to work, less chronic disability, and fewer recurrent problems”. The researchers concluded that providing patients with “positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of low back pain”.
How Long Should You Rest For Lower Back Pain?
If you have hurt your back and the thought of moving around is just too much to bear, you shouldn’t lie down for longer than a day or two.
Research has found that finding comfortable sitting positions and some type of movement can actually reduce the need to lie down completely. Just doing these simple things seems to help people recover from their back pain faster than they would if they rested.
In small doses, bed rest can give you a break when standing or sitting causes severe pain. Too much rest could actually make your back pain worse. To optimize your bed rest time, you should limit the time you are lying down to just a few hours at a time, and it shouldn't be for longer than a day or two.
Why Is Resting So Bad For Your Back? What The Research Says...
A study of more than 100 Finnish patients with low back pain recovery was actually slower amongst the patients that had been told to rest compared to those who had been advised to go about their regular activities as much as possible. A different study, however, that followed military recruits found that a couple of days of rest helped them to get better faster than remaining on foot.
This conflicting information is probably what has led to some of the continuing confusion around how best to treat low back pain and why is resting so bad for your back. Generally providers feel comfortable with patients resting for a day or two, but it seems to largely depend on the intensity of the daily activities that patients are involved in, as well as how acute the injury was that caused the back pain in the first place.
In the case of military recruits, the exercise that they were participating in was particularly grueling, while most of us civilians won't have to hike miles with military gear on our backs.
Conclusions
From the research that has been done so far, it is likely that prolonged bed rest is detrimental to your health. Prolonged rest can induce both musculoskeletal and cardiovascular deconditioning and it can also have a psychological impact on patients.
It also seems that short recovery periods in relaxed postures, including lying in bed, might actually be helpful for some patients and some conditions, like sciatica.
Some things you might want to consider when trying to choose between diving under the duvet or taking a walk around the block is what sort of activities you normally do and what your baseline level is for your daily routine.
If you normally do an intense Crossfit workout or marathon training in the morning, this might be a good time to take a few days break. If, however, your routine normally involves a more gentle yoga class or walking the dog, you might not need to crash on the couch.
If you are in any doubt as to what to do, it is never a bad idea to reach out to your healthcare provider or physical therapist and see what they would recommend.