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Mythbuster: ‘Back pain requires complete rest to get better’

The myth

Patients with back pain believe that rest is the best treatment for the condition and request analgesics so that they can rest comfortably until pain has subsided.

The reality

Back pain is one of the most common pain conditions worldwide,1 but it’s a common misconception that bed rest and reduced physical activity will aid recovery from an episode of back pain. Unless there are signs and symptoms that suggest a serious underlying cause, which requires specialist assessment, the patient can be advised that their back pain is not caused by serious structural damage and that they will recover from an acute episode within two to four weeks.2 

It is important to identify any specific ideas or concerns that the patient may have about the cause of their pain and any expectations they may have about managing their condition. Exploring patient beliefs may help identify unfounded fear of pain and prevent activity avoidance behaviours that could become a barrier to clinical improvement. For example, the patient may not be aware that they do not need to be pain-free before returning to usual activities or work. Once any fears and anxieties have been resolved, the patient can be positively encouraged to stay active, resume normal activities and return to work as soon as possible. 

Although some rest and activity modification may be required when the pain is severe, it is important that activity and exercise is maintained within the confines of the patient’s symptoms. Staying active and continuing normal activities ensures a faster return to work and reduces the risk of long-term physical deconditioning.3 It is often beneficial to reassure patients that although movements may produce pain and discomfort, it is not harmful. Patients may be advised that, where activity is anticipated to cause discomfort, it can be helpful to consider taking analgesia before participating in the activity.

Physical activity and exercise are recommended as part of an overall management plan for treating back pain, and reducing the risk of further episodes of back pain.5,6 However, there is currently no clear evidence that one particular type of exercise is more effective than another.7 Recommended exercises include swimming, walking, yoga or pilates.4,5,8 A personalised approach to managing back pain is therefore key and you should consider each patient’s specific needs, preferences and capabilities if recommending a particular type of exercise. Exercise should be started slowly with a gradual increase in the intensity and duration as tolerated. 

As the effects of exercise are not immediately noticeable, it is important that patients are aware of the long-term benefits of exercise and that regular exercise will help the back to become stronger and more flexible. It is recommended that exercise routines are continued to maintain levels of strength and fitness, as this will help to reduce the chances of recurrent episodes of back pain.3

 

Jennie Walker is an orthopaedic nurse at Nottingham University Hospitals NHS Trust and clinical educator at the Musculoskeletal and Neurosciences

 

References

1 Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J. and Murray C (2014) The global burden of low back pain: estimates from the global gurden of disease 2010 study. Annals of the Rheumatic Diseases, 73(6); 968-974

2 Chou, R (2014) Low back pain. Annals of Internal Medicine, (160)11. ITC6-1

3 National Institute of Health and Care Excellence Clinical Knowledge Summaries (2017) Back pain – low (without radiculopathy) 

cks.nice.org.uk/back-pain-low-without-radiculopathy#!scenario

4 Arthritis Research UK (2011) Back pain. Arthritis Research UK, Chesterfieldarthritisresearchuk.org/arthritis-information/conditions/back-pain.aspx

5 National Institute of Health and Care Excellence (2016) Low back pain and sciatica in over 16s: assessment and management. NICE

6 Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J. and Grusing S (2017). Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 166(7), pp.493-505

7 Van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW and van Tulder, MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal, 20(1);19-39

8 Wieland L, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. (2017) Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No: CD010671