Common back pain treatments: helpful or harmful?

Despite your efforts to avoid it, you wake up one morning gripped by back pain. Now what do you do? Should you stay in bed? put heat on the pain? use some kind of mechanical support such as a cervical collar or corset? Do these treatments really help?

We asked back pain expert Julie Zimmerman, P.T. for her ideas on the rationales, benefits, and risks of some of the traditional and alternative treatments for back pain.

Bed rest

For the first few days of an acute back pain episode, when virtually all motion is impossible, a back pain sufferer should probably bow to the inevitable and lie down. One to two days in bed can decrease pain and inflammation and provide a psychological break.

The advice of a week to 10 days of bed rest is still given for many back complaints despite the fact that this much bed rest has been proven to be not only useless but detrimental. Inactivity causes a loss of calcium in the bones, delay of tissue healing, and a 3 percent loss of muscle strength each day. Prolonged bed rest can also cause psychological depression and dependency, and interfere with return to work. It may even make a worker more injury-prone because of his or her deconditioned status.

There is no evidence that gentle activity during the acute phase of back pain increases tissue damage. Avoidance of excessive activity and exercise is advisable, but total bed rest is neither essential nor beneficial for most back problems.

Heat

Heat alone cannot cure low back problems, but it may be effective in controlling pain so that treatment for movement limitations and abnormalities can begin. The benefits of heat (hot packs, heat lamps, ultrasound, diathermy, etc.) are thought to be increased circulation and relaxation of muscle spasm to promote healing. However, unless muscle spasm is the primary cause of pain, treatment with heat and ultrasound is not useful and may increase inflammation.

Soothing as it is, heat has even been accused of reinforcing psychological dependence. Icing versus heat is now recognized as the treatment of choice in the acute stages of an injury if inflammation is present. Heat and cold should be considered not as curative treatments, but as ways to assist active movement.

Mechanical supports

Supports such as braces, corsets, and cervical collars can immobilize a body part or correct poor alignment. Supports are also prescribed to transfer weight and movement away from the spine, increase abdominal support, increase patience awareness of correct posture or reduce muscle spasm.

Rigid braces and casts are inappropriate for many back pain patients, because the goal in treatment is to promote normal movement of the spine. Supports may increase comfort, but they don't speed healing. Braces, corsets, and cervical collars should be used as short-term solutions; they should never be prescribed without a plan to eliminate them.

Total dependency on a brace allows the soft tissues of the spine to relinquish their supporting function so that the brace becomes the sole support. A mechanical support is a temporary measure, and an exercise/posture/body mechanics program should be initiated simultaneously.

The conservative measures discussed here are frequently recommended to treat back problems. They are not effective in curing back pain, but can provide temporary, symptomatic relief and therefore may be useful in assisting active movement. However, their overuse can be more detrimental than the original problem. Back patients need individualized programs that can address the specific causes of their pain.

Julie Zimmerman, P.T., is author of the book The Almanac of Back Pain Treatments. For further information, or to order, contact Biddle Publishing Company, P.O. Box 1305, No. 103V, Brunswick, Maine 04011.