COCHRANE REVIEW: BED REST VS. ACTIVITY FOR LBP

Doctors of chiropractic have long encouraged patients with low-back pain to avoid bed rest whenever possible. Now, a Cochrane review study upholds this recommendation.

“Normal daily activity seems to be the best way for patients with low-back pain to get better,” says lead author Kristin Thuve Dahm.

The comparison between bed rest and normal activity for low-back pain without sciatica used data from three studies that included 481 patients. All three found improvements in pain intensity with both treatments, with no significant differences between them.

In comparing treatments for sciatica, the reviewers analyzed data from two studies of 348 patients. No difference existed in pain or disability.

“The available evidence neither supports nor refutes that advice to stay active is better than resting in bed for people with sciatica,” Dahm notes. “However, considering that bed rest is associated with potential harmful side effects, we think it is reasonable to advise people with sciatica to stay active.”

Researcher Joel Press, MD adds that “we’re almost always better moving than not moving. Structures in your back get their nutrition from movement; they have no real vascular system and are supplied with blood by motion, soaking it up like little sponges.”

Pooled data of three studies including 931 low-back pain patients found little or no difference in pain or ability to function between patients on bed rest and those prescribed exercises.

Similarly, results of a single trial with 186 patients suggested that “exercises add no clinically relevant benefit for patients with acute low-back pain when compared to advice to stay active,” the authors wrote.

They came to the same conclusion about physiotherapy compared to either bed rest or activity for sciatica, from a single study involving 167 patients.

The Cochrane Database of Systematic Reviews – June 14, 2010:6.

www.cochrane.org

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