Rest First? Or Seek Treatment?
What I’m going to look at in this posting relates to how quickly one should start addressing a complaint of low back pain. Historically, people suffering from low back pain have been told to rest, sometimes for very long periods. It’s time to right this wrong.
I have treated plenty of people who 20 years ago were given a neck collar for a minor car crash and wore it for 3 months despite no evidence of any tissue damage, because “that was what they did back then”. Researchers have compared the effectiveness of early intervention (that is, treating the patient straight away) versus an “assess/advise/wait group”, who were given advice to stay active, but were given no treatment.
The conclusions – “Intervention is more effective than advice on staying active, leading to more rapid improvement in function, mood, quality of life, and general health.” We have a winner. In every respect, you are better off getting treated sooner that later.
People who were treated straight away experienced more rapid improvements in:
Function
Mood
Quality of Life
General Health
Impressive.
Another notable result was that “The timing of intervention affects the development of psychosocial features.” In a nutshell, this means the sooner treatment was started the less likely people were to develop the kind of complications that lead to chronic pain, such as depression and fear-avoidance. This is extremely important.
This study was done a couple of years ago, but I wanted to revisit it as I still talk to people who believe rest is best. This article was so significant that in the UK it heralded a change in the health service provided for patients with low back pain: “The report concluded that, although there is a high probability that an acute attack will settle, this should not be taken as grounds for complacency, inactivity, or a policy of wait and see on the part of the health professionals.”
If you haven’t figured out the take home message of this piece yet here it is – You are better off seeking treatment than waiting for something to get better.
Wand, B., Bird, C., McAuley, J. H., Dore, C. J., MacDowell, M., & De Souza, L. H. (2004). Early intervention for the management of acute low back pain: A single blind randomised controlled trial of biopsychosocial education, manual therapy and exercise. Spine, 29 (21), 2350-2356.
