Back Pain Treatments – The Bed Rest Myth

Two generations of people have grown up hearing that bed rest is the best back pain treatment. But in general, the people who stay up and around are the ones who do the best.

Not even patients with sciatica, for which bed rest was widely advocated, benefit from lengthy terms of bed rest, according to a recent study published in the New England Journal of Medicine.

With extended bed rest, muscles weaken, bone mass can decline, and disks can miss out on nutrients that are “pumped” into them by physical activity. After a few days you begin losing ground instead of gaining. The drawbacks aren’t all physical, either. The longer we stay in bed, the harder it can be emotionally to return to work, wean ourselves off medication, and summon the motivation to heal. Feelings of disability and depression can take hold.

Of course, this doesn’t mean you should keep going and going until you’re a goner. We don’t want the message to go out that no matter what, someone shouldn’t have bed rest. Trauma victims need rest in order for their wounds to heal, and for some back pain sufferers, the anguish is so excruciating that lying down is the only option until the pain eases up. The point is that in most cases a day or two is usually enough; and, even then, getting up every few hours for a brief walk around the house is encouraged.

Do You Need a Physical Therapist?

Many physical therapists (also called PTs, or physiotherapists) practice in hospitals, but more than 70 percent are in private physical therapy offices, health and rehabilitation centers, sports facilities, and other venues as well. In many if not most cases, your first contact with a physical therapist will stem from a doctor’s referral. (In fact, in many states, that’s the only route allowed). On occasion, current or recovering back pain sufferers who know the value of back pain exercise – and its potential risks – initiate contact themselves prior to starting a fitness program.

Not everybody who has pain needs to see a physical therapist. When pain begins to interfere with someone’s lifestyle – their social responsibilities, family responsibilities, their work – that’s when it’s time for intervention.

Like other back-care-oriented professionals, the PT will use the first visit to take your history, review any medical records provided by your doctor, and conduct a physical evaluation. “Usually by the time we get to see a patient, the majority of red flags [of serious back injury or disease for which surgery might be necessary] have already been cleared,” says Kim Dunleavy, an orthopedic specialist who notes that the PT is thoroughly trained in what to watch for should a red flag have been overlooked, or should a new symptom appear. Of course, physical therapists can play an important role in postsurgical recuperation as well.

While a physician might focus on treatment and cure of the injury or disease, physical therapists focus on functional changes to ease the pain, prevent its return, and get you out and healthily going about on your own. What you want out of the treatment matters, too: Is it to compete in a marathon, or to be able to sit comfortably at your office desk? There are a lot of people who put up with the pain because they don’t know that they can do without it.

After the evaluation, a treatment regimen can be tailored to your individual needs. Beyond the sort of individually tailored back pain exercise program that, say, a personal trainer might design, a physical therapist also uses a great deal of passive manual therapy (meaning they do it to you) – moving or stretching a limb, applying resistance to strengthen a muscle group, manipulating joints, and other hands-on techniques to detect trouble spots, lead you in proper movement, and assess progress.

Along the way, ongoing education is provided in proper body mechanics and posture as it applies to your particular lifestyle, weaknesses, and strengths.

Depending on your condition, your preferences, your physical therapist, and your insurance coverage, among other factors, you can opt to do your exercises home alone, in group classes at the therapist’s office, in a hospital or outpatient facility, or a combination of these or other locales.

Even if you’re on the “shy” side, classes are often encouraged for their motivational power. Patients get support just from being able to talk to others with the same conditions.