Bed rest or keep moving? What to do when your back or joints hurt

For most acute low back pain, studies comparing bed rest with staying active have found that people who keep up their normal activities as far as they can recover a little faster and have less pain and stiffness than those told to rest in bed. Clinical guidelines around the world now advise against bed rest for back pain.

The same idea applies to most joint pain from osteoarthritis: joints and the muscles around them stay healthier with regular movement, and long periods of inactivity tend to leave them stiffer and weaker.

Muscles lose strength quickly when they are not used, and older people lose it fastest. A week or two in bed can leave an elderly person noticeably weaker on their legs and less steady, which raises the risk of a fall. Joints stiffen, and getting back to normal takes longer than the rest itself.

Bed rest also sends a message that the body is badly damaged. People then move cautiously and fearfully for weeks afterwards, and that fear is one of the strongest predictors of back pain lasting longer.

Some situations do need rest or a doctor first: a suspected fracture after a fall or accident, pain with fever or feeling unwell, back pain with numbness in the saddle area or new bladder or bowel problems (see a doctor urgently), rapidly increasing weakness in a leg, or pain after surgery where your surgeon has given specific instructions.

After a fresh sprain or strain with swelling, a day or two of relative rest, meaning avoiding the activity that hurts while keeping the rest of you moving, is reasonable. Relative rest is not the same as staying in bed.

Pain is a guide, not a stop sign. It is normal for movement to be uncomfortable at first. As a rough rule, mild pain during activity that settles within a few hours is acceptable. Pain that is much worse the next day means you did too much, so ease back a little, but do not stop.

Short, frequent walks are usually better than one long one. Change position often instead of sitting or lying in one position for hours. Gentle exercises like the ones below help, and you can build them up as the pain eases.

If pain is not improving after a couple of weeks, keeps returning, or you are unsure what is safe, a physiotherapist can assess you and set a level of activity that is right for you.