| I thought it was about time I threw some | | | | doctors with low back pain yielded a |
| light on to a particular aspect of back | | | | "good dose of exercises and carry on at |
| pain. This particular aspect is the one | | | | work, you'll be fine." Strangely enough |
| regarding the prescription of rest.We | | | | this was not always successful as an |
| will begin with a delve back into | | | | antidote to the problem either.Today the |
| history, not too long ago may I add but | | | | pendulum of medical opinion for me as a |
| considered prehistoric to some, | | | | Chartered Physical Therapist with all |
| especially in terms of the methods of | | | | the benefits of hindsight and experience |
| treatment for back pain.The actual | | | | has brought me to the point where I |
| history of low back pain is another | | | | believe the best answer lies somewhere |
| story but let's just revisit the recent | | | | in between with a balance of CORRECTLY |
| past. The time I am referring to is when | | | | PRESCRIBED REST AND EXERCISE.I generally |
| you visited your doctor complaining of | | | | find that with acute back pain, rest is |
| back pain and the sum total of the | | | | needed to take the stress off the back |
| medical help you received was being told | | | | structures to help the inflammation and |
| to go home and lie on a board for six | | | | pain to settle and allow healing to |
| weeks. This people duly did and were | | | | beginr. This rest is not strict bed rest |
| compliant to varying degrees I am sure. | | | | but is more often than not a |
| Some I presume lasted for the whole | | | | prescription of lying down for a period |
| forty two days to the hour whether or | | | | of forty eight hours with changes of |
| not their pain had gone or whether they | | | | position allowed for, as well as breaks |
| were in sheer agony and others more than | | | | for trips to the bathroom and for eating |
| likely, lasted until the first | | | | and drinking encouraged periodically |
| piercings of boredom roused themselves | | | | during the day. With the correct |
| before dispensing with the said | | | | analgesia I find that this amount and |
| board.How long ago this practice died | | | | specificity of rest achieves a state |
| out is not easy to say. In fact I know | | | | where the back pain is settled to a |
| at least one osteopath or | | | | degree sufficient to allow movement and |
| chiropractitioner in The United Kingdom | | | | therapy to move the process on to the |
| still utilises this course of action. | | | | next level.So rest is neither good nor |
| This is for sure though now more the | | | | bad. It is just a tool for us to use in |
| exception rather than the rule.So was it | | | | our armoury. Insufficent rest will see |
| or is it effective? To a degree yes. It | | | | the exacerbation of inflammation and |
| allows the stresses of weight and | | | | continuation of pain. Excessive rest |
| movement to be taken off the injured | | | | will see an onset of joint stiffness, |
| spine so preventing further injury and | | | | muscle weakness and functional |
| enabling healing to begin with minimal | | | | disability amongst other |
| disruption. The trouble is that unless | | | | possibilities.The answer seems to lie |
| the spine is fractured the benefits of | | | | (pardon the pun) with utilising initial |
| lying down are essentially achieved in | | | | and short periods of rest of |
| forty eight to seventy two hours. After | | | | approximately forty eight hours to |
| this time the adoption of long periods | | | | reduce the effects of acute inflammation |
| of bed rest begins to have more negative | | | | and then use graded treatment and |
| than positive effects. These effects | | | | movement to return the spine to as |
| include joint stiffness, muscle wasting | | | | healthy a state as possible. This can |
| and other complications associated with | | | | take variable amounts of time depending |
| long periods of immobility.Other things | | | | on the particular problem, the details |
| to note are that advice was rarely if at | | | | of which are probably best left for |
| all dispensed as to altering the lying | | | | another time.So there we have it: to |
| posture to side or front (prone) lying | | | | rest or not to rest, that is the |
| for comfort or benefit.As with so many | | | | question. You now have the |
| things the pendulum tends to swing | | | | answer.Copyright 2006 Robert RylesRob is |
| markedly to the other extreme once the | | | | a successful International Chartered |
| seed of doubt has been planted into the | | | | Physical Therapist. He has been a |
| consciousness of significant minds. | | | | lecturer, researcher and therapist for |
| Hence the new school of thought that | | | | over two decades. His rich experience of |
| came into being approximately twenty to | | | | International and Premiership Football |
| thirty years ago was based on the | | | | underpins his specialist knowledge of |
| hypotheses that 'rest was bad and | | | | sports medicine. |
| movement was good.' So a trip to the | | | | |