Rest is an Ineffective Treatment for Acute Lumbar Disc Herniation Resting Injured Limbs Delays Recovery!

Here at CMRS we often find ourselves going against conventional wisdom in our therapeutic recommendations. Our explanation for this is that we really care for patients and dig diligently for the right answers, and we are not bound by establishment blinders and the need for conformity to an established but arbitrary and often ineffective standard of orthodox care. One example of this difference is our long standing recommendation that acute injured limbs NOT be immobilized. I wrote an article in this e-newsletter some months ago that informed our readers that an establishment study had validated our view and had found that immobilization was counter-productive. I want to tell you about a review article on lumbar disk injuries that appeared in the April 2005 issue of The Physician and Sports Medicine.

Once again the “standard of care” in the non-operative management of acute lumbar disk herniation has been complete bed rest for two to 14 days. Instead, a study that compared bed rest to early activity in these patients showed that bed rest of any duration is not effective and may actually be detrimental to recovery. Although less abundant, the data on sciatica caused by disk compression also show bed rest to be an ineffective treatment. Therefore the correct initial non-operative approach to a patient with a disk herniation should be to discourage bed rest and encourage early activity, usually a progressive walking program as tolerated.

Once again, we discover that following the conventional wisdom may be hazardous to your health. Conventional wisdom also doesn’t know enough to recommend Prolotherapy, or it downplays its efficacy. So be aware, and know that what you are often told to do or not do in conventional medicine isn’t necessarily the right advice. I just wanted you to know that a lot of what we recommend may sound different, but it’s all based on a lot of clinical experience and real concern for our patients. So although we are not afraid to be out by ourselves on the cutting edge of medicine, it does makes us feel good when some of our ideas get scientifically validated (if not implemented) by orthodox medicine.

A recent issue of the Journal of Family Practice (September 2004, page 706-712) includes an article based on a literature review of studies which compared mobilization versus immobilization of injured extremities. As is commonly found, the traditional practice of medicine has not “caught up” with known study results. In this case the review of existing studies clearly showed that the common practice of resting, splinting, or casting injured limbs or joints is ill advised. Rest is part of the tragically misguided “RICE” (rest, ice, compression, and elevation) approach to musculoskeletal injuries that has been fully discussed in “Prolo Your Pain Away”.

Specifically the study concluded that:

Early mobilization decreases pain, swelling, and stiffness in the short term without any long term cosmetic or radiologic deformity. Six and 12 month follow-ups also confirm the advantages of early mobilization, including better range of motion.

Patients usually prefer early mobilization, and return to work sooner.

Rest is an overused treatment for limb injury, and the medical profession errs too conservatively on the side of immobilization. Systematic review of all upper and lower limb injuries, including fractures, consistently found in favor of early mobilization.

This is what Prolotherapists have been saying for many years based on their direct clinical experience with patients, and favorable results from early mobilization. The moral here is once again that just because something is common practice in medicine (resting an injured limb), this does not insure that it is the best approach. Chances are, this report will not have a huge effect on the average practitioner because they think they already know what is best. Although there are also many studies documenting the adverse effects of anti-inflammatory drugs in the treatment of acute sprains, and chronic arthritis, I predict it will be even longer before a change in those prescribing habits ever occurs. The medical profession in this country seems wedded to the pharmaceutical industry. So my advice for readers is, don’t assume anything, ask questions, do your own research, and always seek the opinion of a knowledgeable Prolotherapy doctor for any persistent pain from acute or chronic conditions.

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