What about it?

An excellent natural history has led to the mistaken belief that acute LBP can be managed symptomatically (bed rest and medication) and left alone. (Leibonson 2012).

(Carey et al., 2000; Cherkin et al., 1996; Croft et al., 1998; van den Hoogen et al., 1998)

What does these high-quality, prospective studies  say –

Most acute episodes tend to improve rapidly, although not completely, and then run an intermittent, chronic course with less severe “flare-ups”

Results of prolonged bed rest:

Limiting bed rest in low back pain subjects will serve to minimize the adverse effects of immobility on disc nutrition. (Sehgal & Fortwin 2000)

Hypomobility could produce altered (reduced) stimulus to the metabolic activity of disc cells (Setton 2004)

Hypomobility can cause altered transport of nutrients and metabolites (Urban et al 2004)

Extended bed rest can cause perceived threat or fear associated with LBP. (Clinical guidelines for LBP, 2011)

Bottomline - So, is bed rest good or bad ? What is the optimal time for bed rest?

Growing body of evidence - More cost-effective to attempt to prevent chronicity in those at risk for it, rather than waiting to treat only those in whom it manifests (Marhold et al., 2001; Pincus et al., 2002; Thomas et al., 1999).