Rest has been a standard recommendation for low back pain (LBP) for years, especially within the medical community. This recommendation persists despite continuing evidence that prolonged rest serves no purpose and may actually delay return to work and activity.

This report of the International Paris Task Force on Back Pain outlines the role of activity in the therapeutic management of back pain. The authors incorporate numerous charts and tables to present their recommendations and summaries on:

• exercises for acute and chronic LBP;
• mobility and activities of daily living;
• exercises and intermittent LBP;
• back pain and occupational activities;
• the graded scale of mobility-related activities;
• criteria of optimal mobility in selected functional and quality-of-life indices; and
• selected criteria for optimal performance of activities of daily living.

Also included in the text are priorities for research and clinical practice. The authors present the following key points as summary to their findings:

• Bed rest is contraindicated in subacute and chronic cases of LBP.
• In acute cases of LBP, bed rest should neither be enforced nor prescribed.
• If authorized (based on pain indication), bed rest should be for the shortest duration possible.
• Patients whose pain is intense enough to justify bed rest should be referred for a specialized back pain evaluation if daily activities have not been resumed after 10 days of strict bed rest (defined as getting up only to go to the bathroom) and adequate pain therapy.

Note: This is a great paper to have in your office. It deals pragmatically with a very real issue and provides a wealth of research to support the claims made.