A Warning Signal to the Body

I would like to make one critical comment, regarding the important issue of therapy, on the excellent publication (1). The authors refer to the National Disease Management Guideline, saying, “reduced activity and bed rest have been shown to have no effect or to lead to worsening of the pain…”

I would like to ask all interested colleagues which of them have ever suffered severe acute back pain. When confronting this type of pain, one longs for a stepped bed or a lateral quad position, local heat, pain medication, or perhaps even sedation—with the aim, of course, of returning to adapted mobilization swiftly, as soon as the clinical picture permits.

Pain is a warning signal to the body. Acute pain is an important acute warning signal, indicating that a cessation of activities and a period of rest are needed to prevent manifest structural damage. The authors state that 80 to 90% of cases of acute back pain have no clear patho-anatomical correlate, which is certainly important. What I see here is a beginning, acute, functional, segmental neuromuscular compartment syndrome with concomitant local inflammatory processes. If we were to ignore the pain, we would decisively reinforce this spiral of neuromuscular disturbance. What recommendations do we give to a high-performing competitive athlete who develops increasing acute pain symptoms in the thigh muscles on exertion? To carry on until complex anatomical muscle damage occurs? How do we treat acute functional torticollis? Why do we ignore all basic knowledge of muscular pathophysiology when it comes to the lumbar spine? Because there are guidelines, national or otherwise?