While many news sources are pronouncing "Staying active is better than rest" for people with acute low back pain with or without sciatica, the data actually show that staying active is only marginally better for people with low back pain without sciatica, and not any better at all for those with sciatica.
Recently, past studies about bed rest and staying active as advice to patients experiencing lower back pain were reviewed at the Norwegian Centre for the Health Services. This review combined two previous reviews of the two separate treatments.
Bed rest had been the preferred recommendation for lower back pain patients for decades. This method is useful to decrease muscle spasms. Muscle spasms are when a muscle contracts without control as a way for the body to limit motion in an injured area.
However, bed rest for the spine means limited mobility. The spine does not have the ability to get nutrients like most parts of the body. It needs motion in order to move nutrients throughout the vertebral discs. A lack of motion can cause loss of strength and impair the spine’s ability to rehabilitate.
This new review studied this exact trade-off: is it better to keep the back at a normal activity level or to advise bed rest.
The data that was analyzed was divided into two patient groups: low back pain with and without sciatica. For this study, sciatica meant specifically “low-back pain accompanied by signs of nerve compression or damage, like numbness, tingling or weakness in the leg.” Pain levels and ability to function were compared 4 weeks and 12 weeks after the initial recommendation of either normal activity or bed rest. The study only included patients with acute low back pain, lasting less than 6 weeks, from unidentified sources (excluding patients with pain from fracture, inflammatory joint disease, osteoporosis, infection, etc.).
From the data from patients without sciatica, both groups of patients experienced less pain at both time points, but the group of patients who stayed active showed higher reduction of back pain. The difference between the two groups was not substantial. The ability to function was substantially greater in the group of patients who stayed active at both time points.
From the group of patients with sciatica, there were little to no differences between the set of these patients that were put on bed rest and the set that remained active in terms of pain reduction or ability to function after 4 or 12 weeks.
Further comparisons were made in this review comparing bed rest to prescribed exercises, bed rest to physiotherapy, and normal activity to physiotherapy. None of these comparisons resulted in a clearly beneficial treatment plan.
Since there are many different causes of low back pain, it is reasonable that one treatment would be clearly beneficial for all of the different causes. The main conclusion of this review was that there appears to be no benefit for prolonged bed rest as a treatment for low back pain and the only benefits of staying active were for low back pain patients without sciatica.