Acute low back pain is one of the most common reasons for consulting a primary care physician in the industrialized countries. The direct cost of medical care and the indirect costs to society of absenteeism from work due to backache are huge.1 Physicians commonly prescribe bed rest for acute low back pain, although only a few controlled trials have assessed its effectiveness.2 Among military recruits with acute low back pain, bed rest led to more rapid recovery than remaining on foot.3 In a family practice, patients presenting with acute low back pain did not benefit from either bed rest or isometric flexion exercises.4 Two days of bed rest produced as good clinical recovery as did seven days of rest and, moreover, was associated with fewer days lost from work.5 In patients with acute low back pain, back-extension exercises were superior to education about back care,6 but a study comparing exercise therapy with placebo found no difference.7
The controversy persists over the relative merits of bed rest and exercise in the treatment of acute back pain. Many leading experts suggest two days or less of bed rest,8-10 whereas others advocate back-extension exercises.6,11 The present study was designed to compare bed rest with rapid mobilization in the management of acute backache. We conducted a randomized, controlled trial of the effectiveness and costs of two days of bed rest as compared with those of light back-mobilizing exercises in patients with acute low back pain. A third group of control patients was advised to avoid bed rest, not to engage in mobilizing exercises, and to continue normal activity to the extent that they were able to tolerate it.