Ailing Back? Experts Say Get Out of Bed and Exercise

Getting off your back and starting to exercise is a good treatment for ordinary low back pain, experts say.

Even if the exercise hurts a bit, it may still help, according to new guidelines developed for the U.S. Public Health Service’s Agency for Health Care Policy and Research.

The recommendations from doctors, physical therapists and nurses are meant to cover most cases of low back pain. But the guidelines have limitations. They apply to adults whose problems have restricted their physical activity for less than three months.

They do not apply to people under 18, those whose problems last longer than three months, and those with specific conditions, labeled “red flags,” such as fractures, tumors, infection or severe nerve disorders.

The panel members focused on avoiding costly and unnecessary diagnostic tests and surgery. Nine of 10 patients with acute low back pain recover on their own within a month, they said.

Staying in bed is bad, the panel said. Bed rest of more than four days can weaken a person’s muscles and endurance and “is not recommended for treating acute low back problems,” it said.

Nor does bed rest ease the pain, the panel said. A study by member Richard Deyo, an internist at the University of Washington, found people who stayed in bed for seven days had no less pain than those who stayed in bed for two, and the two-day group got back to work sooner.

The panel found research to support the idea that gradually increased exercise--done in moderation--is good.

Although various forms of exercise seem to help, there is no agreement on which form is best, Deyo commented in the report.

The key is to be active, said occupational therapist Richard K. Schwartz of San Antonio, a panel member. For many people, this may be simply continuing normal activities, he said. Exercise may have special benefit for people who would ordinarily work out, because it’s their favored normal activity, he said.

Low-stress aerobics can keep muscle strength and endurance from declining in the first month after symptoms start, the report said. These activities, such as walking or swimming, later can help a patient improve, it said.

The exercise should keep no more pressure on the back than a person would have sitting up at the edge of the bed, said Dr. Stanley J. Bigos of the University of Washington, the panel’s chairman. A few weeks of this can help a patient prepare to strengthen the back muscles, the orthopedic surgeon said.

Specific exercises for the trunk, especially the paired erector spinae muscles that parallel the spinal column, can help, although the exercises may make the pain worse in the first couple of weeks, the report said.

Keeping those muscles strong can ward off fatigue and help them support the back, Bigos said.

Machines designed to exercise the back seem no better than floor exercises, the report said. The panel cited one study to show this.

The report found no adequately documented benefit to stretching. “The reality is that we didn’t have any data that showed it speeded recovery, and we had some pretty good indirect data that it slowed recovery,” Bigos said.

Although exercisers are supposed to stretch before working out, they should keep their backs straight and concentrate their stretches on their legs, Bigos said.

However, a separate expert thinks stretching makes sense even if there’s little research to support it.

“Intuitively, it makes sense,” said Dr. Curtis W. Slipman, director of the Spine Center at the University of Pennsylvania Medical Center in Philadelphia. When muscles tighten, they can pull harder against bone, whether it’s in the back or somewhere else, he said. Patients improve when they stretch, he said.