Low back pain and rest - Why this is not such a good idea

By William Brightman 

It is not uncommon for individuals with low back pain to avoid all activities. On the surface this might seem intuitive, however; in reality, it is not such a good idea.  The prevailing thought for nearly 100 years was that when you have back pain you need to rest. That might be true if the pain is moderate to severe (on a pain scale of 1-10 your pain is greater than a 6), but even with intense pain it is important to get some form of “pain free” activity. One of the most common themes of activity avoidance is that the individual will do nothing for days or even weeks. At that time, they may feel better and as soon as they go back to their “normal” activities then the pain returns. So what do they do - they rest again or take medications to try and block the pain and “work through it”. This is not the answer. 
Most of the literature today supports a gradual return to normal activities with low back pain. The focus is to do activities that help heal the pain while preventing the inevitable deconditioned syndrome. When muscles are not used they begin to atrophy and become weaker. This cycle will perpetuate itself even when the individual returns to their normal activity. The key to returning to your normal activities is to get the care you need for starters. Consult a practitioner who understands the condition and can help guide you back to your normal activities with treatment and modified activities to help strengthen and support while reducing the low back pain. 
One of the most effective treatments  for acute low back pain is spinal manipulation. The literature is overwhelming in support of this approach to managing low back pain. Usually within the first few treatments the patient is experiencing relief.  Once you are feeling around 50% better, then this is where therapeutic exercise is critical. Therapeutic exercise is a combination of flexibility, strengthening, and balance. These pain free activities are encouraged to be done daily and should be of low intensity for relief care. Once the patient is feeling significantly better then there can be a resumption of normal activities. It is highly recommended that physical activities include aerobic exercises as this form of exercise helps to mitigate low back symptoms in the long haul. 
There are studies that show that once the acute pain is better, activities that are aerobic in nature may  be effective at managing chronic low back pain. In fact, in a large scale study of 4,246 Finnish men and women (average age 34), those who engaged in multiple activities and sporting events- especially aerobic (cycling, walking, hiking, running), had reduced radiating and non radiating back pain when compared to those who just focused in on one exercise. The conclusion is that a variety of exercises and activities are probably best as opposed to just one ‘target’ exercise such as low back stretching. 
Another study analyzed 4,022 middle aged men who demonstrated a clear relationship between chronic low back pain and low physical activity level. The findings persisted even after researchers controlled for obesity which is another risk factor in chronic low back pain. 
Another study done this year analyzed 7,565 older men and the results were similar. In this study the researchers calculated total movement during the day and chronic low back pain. You guessed it. There was an inverse relationship between movement and chronic low back pain. The more they moved (within reason) the less low back pain they had. 
My advice is get the care you need, feel better, do the  basic stretches and strengthen the low back. Once you are 50% better, begin to add different modes of  aerobic and physical activity. Walking, hiking, elliptical,  rowing, cycling, weight training, theraband work and even gardening will help manage your chronic low back issues. Do these activities 4-5 times a week for 30 minutes and check in with your sports chiropractor and you will have managed your back pain conservatively, while conditioning your body. 



                        William Brightman DC, MS, MEd
                        Sports Chiropractor and Exercise Physiologist
                        Private practice in Mahopac, NY
                 Educator of Sports Medicine and Professor of Anatomy & Physiology