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Changing Perspectives: Bed rest

Bed rest

The lumbosacral radicular syndrome is associated with radiating pain in one or more lumbar or sacral dermatomes. Patients are treated mostly with conservative treatment first and for decades the mainstay of this conservative treatment was strict bed rest for 14 days. Clinical trials back in the 90’s already showed that bed rest in patients with a lumbosacral radicular syndrome is not more effective than ‘watchful waiting’ and ‘watchful exercise’.

The lumbosacral radicular syndrome was not the only disorder for which bed rest was recommended. After a concussion, patients were also told to stop normal activities and lay down, normally in a dark room without any stimuli. New research suggests that bed rest after a concussion hampers recovery seriously. When patients were told to take bed rest after a concussion, an increased number of physical and emotional symptoms were reported and a higher proportion of patients suffered from a post-concussion syndrome.

Bed rest is not safe: numerous adverse effects, both physical and psychological, have been reported. Besides these adverse effects people also missed out on school or work. Given these adverse events and the evidence that bed rest does not favour recovery, there is no reason to prefer this treatment over watchful waiting and graded return-to-activity.

In nowadays practice, it is not seldom that people stay in bed for days or weeks. There is no excuse for laziness among patients with a radicular syndrome or a concussion anymore: the advice is to keep calm, wait watchfully, gradually return to normal activity and forget about bed rest.

I.N van Schaik & T.J. van Trier

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