Newspaper Page Text
Bed rest may slow recovery
from low back pain
WASHINGTON D.C.
Keeping up a normal routine
as much as an aching back will
allow may be the fastest road to
recovery from acute lower back
pain, found a recent study in The
New England Journal of Medi
cine.
“Continuing ordinary activities
within the limits allowed by the
pain leads to a more rapid recov
ery” thanspecial exercises or bed
rest, noted medical researchers
in Finland. They studied 186 of
the most common treatments
doctors prescribed: bed rest, back
exercises, and avoidance of pain
ful activities.
The participants were random
ly divided into three groups. One
group was assigned two days of
bed rest before resuming a nor
mal schedule. A second group
performed back extension and
lateral bending exercises every
other hour for as many days as
the pain continued. The third
group, which served as a control,
was told to avoid bed rest and to
continue their normal daily rou
tines, avoiding as much as possi
ble any activity that caused in
tolerable back pain.
After only one week of follow
up, persons still unable toreturn
to work included 41 percent of
the bed-rest patients, 36 percent
leading cause
ahsenteeism
Houston
Crowded school hallways
might keep some students from
getting to class on time, but a
different type of obstructed pas
sageway can prevent some kids
from getting to school at all.
Asthma is the No. 1 cause of
school absenteeism, according to
Dr. Benjamin Interiano, an as
sistant professor of medicine at
Baylor College of Medicine in
Houston. Recurring coughs,
wheezing, and shortness of
breath canresultinmissed school
days.
Parents can prevent absentee
ism by making sure their chil
dren use medication regularly
before school starts, Interiano
said. And they can use a peak
flow meter, an inexpensive plas
tic device that measures breath
strength, to monitor how well
the asthma is being controlled.
“During the summer, most kids
with asthma tend to have fewer
attacks, so they slack off on tak
ing their medication,” he said.
“When they start back to school
in the fall, they will be exposed to
more allergens, so their bodies
need to be prepared for the on
slaught.”
Asthma attacks occur when
muscles in the bronchial walls
contract, causing partial obstruc
tion of the bronchi, the two main
tubes entering the lungs, and
their branches. The obstructed
airways can cause difficulty
breathing and other symptoms.
Because dust and mold aller
gies can trigger contraction of
the bronchial walls and asthma
attacks, students with asthma
might have a reaction to chalk
boards, dusty carpet, chemicals
used in art and science classes,
and other potential allergens at
school. Some children alsodevel
op asthma when they exercise.
Short-term and longer-lasting
drugs are available to suppress
asthma attacks. A physician will
consider the child’s age, aller
gies, and severity of asthma when
deciding which medication to
prescribe.
Interiano, who is medical di
rector of the Baylor Asthma In
stitute of Houston, advises par
ents to talk to their children’s
teachers and school nurse about
the symptoms of asthma and the
medications their children use
to control this chronic illness.
“A team effort among the child,
parent, and teacher can create a
positive learning environment
and decrease absenteeism,” he
said.
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of the exercise patients, but only
20 percent of those who pursued
their normal activities. The dif
ferences became even more dra
matic after two weeks. The num
ber of patients still unable to
work ranged from 19 percent of
bed-rest patients, 11 percent of
those exercising, only 2 percent
of those encouraged to continue
their regular life routines. By
three weeks these differences
waned significantly, with 94 per
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cent to 98 percent back to work in
all three groups.
At the 12-week check-up the
researchers noted that patients
assigned to bed rest recovered
significantly more slowly than
the controls in terms of the num
ber of sick days, the intensity of
the pain, the ability to work, as
well as in lower-back flexibility.
The health-care researchers were
surprised at the findings, expect
ing that special back exercises
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would have best spurred recov
ery.
However, the researchers cau
tioned against incorporating too
much physical activity into “nor
mal” routines. A study of army
recruits with low back pain found
that bed rest led to substantially
more improvement after two
weeks than a regimen in which
the recruits did not participate
in physical exercise but were on
their feet the whole day. In this
case “excessive walking and
standing delayed recovery,” the
authors noted. “This would ac
cord with ourresults, which show
that even light exercise resulted
in slower recovery.”
Since acute low back pain is
one of the most common reasons
for seeing a doctor in industrial
ized countries, the authors con
cluded that treating low back
pain by simply engaging in nor
mal activities, except for those
causing pain, could result in few
er dollars spent at the doctor’s
office and fewer days absent from
work.
Malmivaara, A., et. al. (1995).
“The Treatment of Acute Low
Back Pain — Bed Rest, Exercise,
or Ordinary Activity?” The New
England Journal of Medicine.
332(6) 351-355. 95.3 (6).
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