Back on track

Back pain is the No 1 cause of physical disability worldwide, and the bad news is, rest is no cure.

- Nicky Pellegrino

Bed rest used to be the advice given to those with lower back pain, but now we know that the sooner someone can get moving again, the better. Experts now tend not to recommend bed rest at all, since lying down for more than 48 hours may actually delay recovery, as the body stiffens and weakens.

With an ageing population, it is estimated that by 2050, there will be more than 800 million cases of lower back pain worldwide - a 36% increase from 2020. That number comes from research done at the University of Sydney, part of the Global Burden of Disease Study, drawing on data from more than 100 countries.

Professor Manuela Ferreira, of the University of Sydney-aligned Sydney Musculoskeletal Health, believes we have to improve our approach to lower back pain. "The spine was made to move," she says. "The fact it has so many joints should tell us something. But there is still this belief that, if you have back pain, then bed rest is a good option when, in fact, research has shown the one factor that can prevent another episode of back pain is physical activity.

"The secret is to move in a way, and to the extent or duration, that you can tolerate. Even just moving around, rather than sitting the whole day, is helpful."

Pain medications tend not to be much help for lower back pain. Paracetamol has been found to be no better than a placebo, and nonsteroidal anti-inflammatories, such as ibuprofen, are only slightly more effective. "Back pain is a complex and multifactorial condition," says Ferreira. "It's not like a toothache; it's really much more similar to cardiovascular disease in that it's about healthy lifestyle behaviour. You need to take care of your body weight, stay active and stop smoking to prevent it."