Active rest for back pain

One of the first things that most of us are inclined to do when we have a bout of back pain is to rest. Although rest is needed to allow the back time to recover, it can also have undesirable effects which may prolong the recovery period. Active rest is the way forward with many studies confirming the benefits of staying active while you have back pain.

Most often, back pain is related to a strain in the muscles, ligaments or joints in the back which, although they are very painful, are not very serious. Prescribing bed rest for one of these injuries used to be common practice but research has pointed out that muscles start losing their strength and flexibility within a few days when not being used, leading to more pain and potential to re-injure the tissue. You can lose up to 20-30 % of muscle strength per week with periods of prolonged immobility, making it more difficult to return to daily activities once the pain settles due to the body’s weakness and stiffness.

Active rest is when you avoid aggravating activities for the back pain such as heavy lifting, jogging etc but continue moving as much as tolerated. This can be done together with appropriate stretches and exercises to keep the muscles strong and flexible. It is recommended that if you can find comfortable, pain free positions and keep moving then no bed rest is needed at all. If the pain is too severe for even that then no more than 1-2 days of rest is advised.

Suggested forms of exercise are water aerobics, walking and Pilates among others but if in doubt then speak to your GP, physiotherapist or consultant about which may be best for you. There are other things that may help the healing process along such as ice or heat, medication, massage and joint mobilisations. If this is a recurring problem then it might be best to determine the underlying cause and prevent it from happening again.

Almost all back pain conditions will benefit from active rest when compared to bed rest although there are a few exceptions that would need further medical management:

• Back pain after a fall or accident
• Ongoing or worsening back pain after 48 hours
• Back pain with pain/tingling/ numbness in the legs
• Sudden loss of bowel or bladder function (often with numbness on the inner thighs)
• Back pain with associated fever

The following are some basic exercises to help with lower back pain and are recommended by the Chartered Society of Physiotherapy:

Pelvic tilt

1. Lie on your back with your knees bent
2. Pull your tailbone between your legs to start rounding your lower back
3. Start at the base of your spine and gently press each vertebra one at a time into the matt to flatten you lower back onto the floor.
4. Slowly return to the starting position and repeat 10 -20 times

Glutes stretch

1. Lie on your back and gently pull either one knee towards your chest and hold for 30 seconds. Repeat twice each side
2. Knee rolls
3. Lie on your back with knees bent.
4. Keep your shoulders on the floor as you take the knees across your body towards the left as far as tolerated and then over towards the right
5. Repeat a few 10 -20 times

Quads stretches

1. Standing up with your back straight
2. Bend your knee and reach behind you to grab hold of your ankle
3. Pull the legs backwards until you feel a stretch at the front of your thigh
4. Hold for 30 seconds and repeat twice each side