I.Q. -- The Perils of Bed Rest
The chiropractic profession has long understood the need for active rehabilitation of spinal ailments. Bed rest and muscle relaxants are often prescribed for back patients by the medical profession. In recent times, research has confirmed that not only is bed rest of little effect, it has potential adverse consequences.
The paper, "Complications of Immobilization and Bed Rest,"1 published in the June, 1993 issue of the Canadian Family Physician, makes this point very clear. The paper is subtitled, "Part 1: Musculoskeletal and cardiovascular complications," which suggests that future papers will reveal additional problems to a form of treatment that is still being recommended by numerous uninformed members of the medical profession.
The paper begins:
"Bed rest and immobilization are time-honoured treatments for managing trauma and acute and chronic illnesses. Although bed rest and immobilization often benefit the acutely affected part of the body, when prolonged, they often harm the rest of the body. Only within the last four decades have clinicians become aware of the harmful effects of bed rest and inactivity and the beneficial effects of activity.2 Problems arising from immobilization can complicate a primary disease or trauma and might actually become greater problems than the primary disorder."
The summary is even more specific:
"Prolonged bed rest and immobilization inevitably lead to complications. Such complications are much easier to prevent than to treat. Musculoskeletal complications include loss of muscle strength and endurance, contractures and soft tissue changes, disuse osteoporosis, and degenerative joint disease. Cardiovascular complications include an increased heart rate, decreased cardiac reserve, orthostatic hypotension, and venous thromboembolism."
In a paper
3 that appeared recently in the Annals of the Rheumatic Diseases, Gordon Waddell, an internationally known orthopedic surgeon, reviewed the literature on bed rest:
"There are now five controlled trials of bed rest for low back pain.4-8 The only trial to suggest that bed rest was better than staying ambulant5 had serious methodological defects. The two most carefully designed and executed trials showed that two days of bed rest for low back pain were better than seven days of bed rest, whereas no bed rest at all was better than four days of bed rest."
It is important that all health care providers involved in the care of patients with spine problems be aware of the extremely limited benefits of bed rest as well as the potential hazards. The references provided below can be used to help communicate this information.
References
- Dittmer DK, Teasell R. Complications of Immobilization and bed rest. Can Fam Phys 1993;39:1428-37.
- Halar EM, Bell K. Rehabilitations' relationship to inactivity. In: Kottke FJ, Lehmann JF, editors. Krusen's Handbook of Physical Medicine and Rehabilitation. 4th ed. Philadelphia: WB Saunders Co, 1990:1113-39.
- Waddell G. Simple low back pain: rest or active exercise? Annals Rheum Diseases 1993;52:317-19.
- Coomes EN. A comparison between epidural anaesthesia and bed rest in sciatica. BMJ 1961;1:20-4
- Wiesel SW, Cuckler JM, Deluca F, Zeide MS, Rohman RH. Acute low back pain. An objective analysis of conservative therapy. Spine 1980;5:324-30.
- Gilbert JR, Taylor DW, Hildebrand A. Clinical trial of common treatments for low back pain in family practice. BMJ 1985;291:791-4.
- Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? N Engl J Med 1986;315:1064-70.
- Szpalski M, Hayez JP. How many days of bed rest for acute low back pain? Objective assessment of trunk function. European Spine Journal 1992;1:29-31.
