Should I rest or keep moving with back pain?

Why is bed rest no longer recommended for back pain?

Because people who stay in bed usually recover more slowly than people who keep up their normal activities as far as they can. MedlinePlus states plainly that bed rest is not recommended, and the UK’s NICE guideline on low back pain advises encouraging people to continue normal activities as much as possible. Long rest lets muscles stiffen and weaken and can make every later movement feel more threatening.

Rest still has a small place. Lying down for a short time to calm a bad spasm is fine, and so is a lighter day. The problem is days in bed, or avoiding all movement because of fear that something will break. For most common back pain, the spine is far more robust than the pain suggests.

Severe pain does not necessarily mean serious damage. Ordinary back pain can be intense for a few days, especially with muscle spasm, and still settle well. Intensity matters less than the warning signs listed further down this page.

What does keeping moving look like in the first few days?

It looks like small, frequent doses of easy movement rather than one big effort. Short walks several times a day, around the house or a flat stretch of the Monon Trail near Carmel City Center, are a good start. Change position at least every half hour or so if sitting or standing makes the pain build.

Heat can help you get going: a 2017 American College of Physicians guideline lists superficial heat as a first-line option for acute low back pain. Gentle movements that feel easing, such as lying on your back and rocking your knees side to side, are also worth trying. The low back pain first 72 hours guide gives a practical day-by-day routine, and our page on whether walking is good for lower back pain goes deeper on walking.

Which activities should I ease off while my back settles?

Ease off the activities that clearly provoke a sharp increase, for a few days rather than for good. For many people that means heavy or repeated lifting, long drives up US-31 or I-465 without a break, extended sitting at a desk, deep bending to garden, or the first snow shoveling of the winter.

A useful rule of thumb many therapists use: mild extra discomfort during an activity is acceptable if it settles back to your usual level within a few hours or by the next morning. Pain that is clearly worse the next day suggests the dose was too much, so scale it back, not to zero, but to a smaller amount. Our page on whether you should exercise through pain explains this pain-monitoring idea.

Which back pain warning signs mean I should stop and get checked?

Some symptoms point to a problem that needs a physician rather than self-care. Call 911 or go to an emergency department for the first three items below; see a physician promptly for the rest.

• New difficulty passing urine, loss of bladder or bowel control, or numbness around the genitals, buttocks or inner thighs
• Leg weakness or numbness that is getting worse, or foot drop
• Back pain after a significant fall, crash or other trauma
• Fever, chills or feeling generally unwell with back pain
• A history of cancer, unexplained weight loss, or pain that is worse at night and not eased by any position

When does back pain need a physical therapist rather than more self-care?

Consider seeing a physical therapist if pain is not clearly improving after a couple of weeks of staying active, if it keeps coming back, if it spreads into a leg, or if fear of moving is stopping you from working or sleeping. A therapist examines how your back moves, checks nerve function and builds a graded plan to restore strength and confidence.

In Indiana you can see a physical therapist without a referral for up to 42 calendar days. If you are in the Carmel area, the physical therapy questionnaire takes about two minutes, and the matching team proposes a therapist in the network who fits your schedule and coverage. Read more about low back pain physical therapy in Carmel or sciatica physical therapy if pain travels down the leg.