Rest and activity avoidance is often not the best medicine.

Anna Kelsey-Sugg

A young, fit worker develops back pain, is advised to rest and cut back activities. Three months later his back pain has not improved. Is rest really the best medicine?
Case History:

Mr B is a 29 year old baker who developed lower back pain around three months ago. There was no specific trigger for the back pain, which was reported to be of a gradual onset. He loves his job and is good at it.

Mr B's pre-injury duties require standing for long periods of time, with general shifts being of 10 hours in duration. He is also required to undertake frequent lifting of heavy items, such as baking ingredients.

It Is reasonable to assume these activities contributed to his back pain.

As his pain became worse, Mr B had difficulty sleeping, working and undertaking domestic tasks.

Trials of analgesics, massage, acupuncture and chiropractic treatment failed to provide relief of symptoms. He then attended a GP and a physiotherapist who both advised him to rest.

He was placed off work for a few days, before returning on modified duties and reduced hours, four hours per day. 

He was advised by his physiotherapist that his muscles were in bad shape and on the “point of collapsing”, and commenced a twice weekly treatment program of massage, manipulation and acupuncture.

Mr B currently remains on four hours per day, undertaking light tasks, avoiding heavy lifting or significant bending.

As well as being on modified duties at work, Mr B has also reduced his level of activity at home, and is currently doing very little domestic tasks. He has also ceased his gym and sport activities on treating advice, but was very fit and active prior to the onset of his back pain.

His pain has continued and is exacerbated later in the day, after standing for long periods or bending. Relief is obtained by sitting down for a break or lying down.

Key Learnings:

Maintaining activity levels is vital

This young and generally fit chap is struggling with back pain. His treaters have told him to be careful. He is now avoiding a range of activities and has stopped his previous gym program. He now walks and moves carefully, worried about making his problems worse.

His back pain has continued for about three months. Best medical evidence suggests that at three months the main form of treatment should be advice and explanation. Hands-on treatment can help some of the symptoms, but return to activity is vital.

People who have been advised to continue everyday activities have been shown to do better in the longer term. People who receive clear advice about continuing to do normal things are not necessarily capable of doing all of their everyday activities. However, they remain active and are less likely to avoid activity. In turn, they do significantly better, with half the rates of long term disability than those advised to protect their back.

Encouraging return to the gym and everyday activity is in line with evidence-based medicine. It also supports Mr B's general level of fitness and his sense of wellbeing.    (requires QuickTime to view)