Staying active with nonspecific low back pain
Encourage patients with nonspecific low back pain to stay active, including adopting normal movement and physical function as much as possible, and continuing or returning to work (see Prevention of work-related disability in people with nonspecific low back pain). Compared to bed rest, staying active reduces pain, disability and time off work, and increases the rate of recovery. Prolonged bed rest or immobility is harmful as it can cause rapid physical deconditioning, which may be particularly harmful in older people and should be discouraged. Adverse effects of bed rest also include joint stiffness, prolonged pain, muscle wasting and bone demineralisation.
Reassure patients that although some pain with activity is likely, this does not imply damage to the spine (ie ‘hurt does not mean harm’), and that staying active is not associated with recurrent episodes of low back pain. Oral analgesia may be required to facilitate staying active (see Pharmacological management of nonspecific low back pain).
To assist patients with staying active, provide advice on techniques to minimise pain when getting out of bed and moving around, and how to cope with daily activities (eg lifting and carrying shopping, self-care, sleep). This advice is best provided in an environment where the patient is well known by the clinician, such as primary care, but may also be provided by other evidence-based therapists or support groups (eg Arthritis Australia). Encourage pacing of activities, and if relevant, resuming usual activities and work in a graded manner.