THE TREATMENT OF ACUTE LOW-BACK-PAIN - BED REST, EXERCISES, OR ORDINARY ACTIVITY

Background. Bed rest and back-extension exercises are often prescribed for patients with acute low back pain, but the effectiveness of these two competing treatments remains controversial. Methods. We conducted a controlled trial among employees of the city of Helsinki, Finland, who presented to an occupational health care center with acute, nonspe cific low back pain. The patients were randomly assigned to one of thr ee treatments: bed rest for two days (67 patients), back-mobilizing ex ercises (52 patients), or the continuation of ordinary activities as t olerated (the control group; 67 patients). Outcomes and costs were ass essed after 3 and 12 weeks.Results. After 3 and 12 weeks, the patients in the control group had better recovery than those prescribed either bed rest or exercises. There were statistically significant differenc es favoring the control group in the duration of pain, pain intensity, lumbar flexion, ability to work as measured subjectively, Oswestry ba ck-disability index, and number of days absent from work. Recovery was slowest among the patients assigned to bed rest. The overall costs of care did not differ significantly among the three groups. Conclusions . Among patients with acute low back pain, continuing ordinary activit ies within the limits permitted by the pain leads to more rapid recove ry than either bed rest or back-mobilizing exercises.