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I hurt my back on the job last week. The occupational physician at our worksite has encouraged me to keep working and stay active. My own family doctor advises rest and avoiding any movement or activities that make the pain worse. Now I don't know what to do. Which way should I go?

National guidelines for the management of low back pain (LBP) recommend staying as active as possible. Rest may be advised during the first 24 hours but after that, patients are encouraged to get up and keep moving. These guidelines are based on evidence from many studies of LBP patients.

Fear of movement and recurrence of pain or injury are called fear-avoidance beliefs (FABs). A high level of FAB is a risk factor for acute LBP becoming chronic LBP with resultant disability. The discovery and understanding of FABs is fairly new.

A recent study from France showed that many general practitioners (GPs) hold to FABs themselves. This leads to patient advice to take it easy when activity should really be the order of the day. According to the results of the study, older doctors in rural settings were more likely to have high scores on the FAB questionnaire.

Efforts to educate both patients and physicians are underway in the U.S. as well as other countries. Such steps may help reduce the high cost of care for disability associated with chronic LBP.

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