Bed rest or staying active for acute low back pain?

Bottom Line

Moderate quality evidence shows that patients with acute low back pain (LBP) may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches. For patients with acute LBP, results from two trials (N = 401) suggest small improvements in pain relief (standardised mean difference (SMD) 0.22 (95% confidence interval (CI): 0.02 to 0.41) and functional status (SMD 0.29 (95% CI: 0.09 to 0.49) in favour of advice to stay active. (S1)

The Cochrane review (2010) described this evidence as moderate quality.

The registry also contains 3 later systematic reviews or guidelines on this question (latest 2025). They are not summarised here; see the full list in Research Rail.

Sources

1. S1 Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Dahm KT, Brurberg KG, Jamtvedt G et al. · 2010 Jun 16 · The Cochrane database of systematic reviews · Systematic review / meta-analysis

This report screened 44 items (35 research or guidance records, 9 community posts); the full list is available in Research Rail.