Olu had been resting his back for 6 months on doctor's advice. His pain was not improving — it was getting worse. Mascot Healthcare changed his management from rest to active physiotherapy, and within 8 weeks he was back at construction site visits.
Civil engineer, Gbagada. Presented with 6-month history of lower back pain radiating to the left buttock — worse with prolonged sitting and bending, better with movement. Not improved with rest. MRI: L4/L5 disc bulge without significant nerve compression. No red flag features.
Mechanical Low Back PainWhen Olu first hurt his back at a site visit 6 months ago, the nearest clinic prescribed diclofenac and told him to rest. He rested for 3 weeks. The pain did not resolve. He rested more. An MRI was ordered — L4/L5 disc bulge. "Rest and avoid bending," was the instruction. He rested for another 3 months.
By month six, Olu had gained 6 kg, was deconditioned, and his back pain was worse than at the start. He came to Mascot Healthcare for a second opinion. He carried his MRI report.
The doctor reviewed the MRI and agreed: there was a disc bulge, but no significant nerve compression. "The MRI finding is real but it's not the problem," the doctor said. "The problem is 6 months of rest causing muscle atrophy and deconditioning. The treatment is movement — not more rest."
Mechanical low back pain is one of the most common conditions globally. Counter-intuitively, prolonged rest worsens it — activity and physiotherapy are the evidence-based treatments.
Constant, dull lower back pain — aggravated by prolonged sitting, bending, and driving.
Aching radiation into the left buttock — not below the knee; suggesting referred pain rather than true sciatica.
Pain measurably worse after resting; improved with gentle movement.
Severe stiffness on waking — taking 30–45 minutes to "loosen up."
No leg weakness, no bowel/bladder symptoms, no saddle anaesthesia — no red flag features.
Prolonged bed rest and activity restriction — actively worsens mechanical low back pain by causing muscle atrophy.
Diclofenac 50 mg TDS — appropriate for flares; insufficient as the sole long-term management.
Lumbar support belt worn full-time — provides short-term relief; weakens trunk muscles when used chronically.
Private MRI (showing disc bulge) — appropriate investigation; but finding used to justify further rest rather than trigger active management.
A referral to a physiotherapist was made immediately. The physiotherapy plan included: core muscle strengthening (McGill exercises), McKenzie exercises for disc-related back pain, progressive walking programme (starting at 15 minutes, building to 45 minutes), and manual therapy for short-term pain relief during the rehabilitation phase.
A painkiller was prescribed for short-term flare management only — not daily. The lumbar belt was weaned gradually. Olu was educated on back pain neuroscience: the disc bulge does not explain his pain level; deconditioning and fear-avoidance behaviour are the main maintainers of his chronic pain.
Work return was facilitated with a graduated return plan: first 2 weeks desk-based, then progressive site visit reintroduction.
Mechanical Low Back Pain with L4/L5 disc bulge (no neurological compromise; 6-month chronification secondary to prolonged rest and deconditioning)
Physiotherapy referral (core strengthening, McKenzie protocol); graded activity programme; a painkiller as needed for flares; lumbar belt wean; back pain education; graduated work return
At 4 weeks: 40% pain reduction; returning to work desk-based. At 8 weeks: 65% improvement; attending site visits. At 3 months: back pain minimal and manageable.
At 8 weeks of active physiotherapy, Olu was back at construction site visits. At 3 months, his pain was minimal. He continues core strengthening exercises as maintenance.
Rest is not the treatment for low back pain. Movement — guided, graduated, and structured — is. Six months of rest converted an acute back injury into a chronic pain problem.
An MRI showing a disc bulge does not mean surgery. Most disc bulges improve with physiotherapy. The primary treatment should be active rehabilitation, not passive rest.
Rest makes back pain worse in the long run. The right treatment is physiotherapy and graduated activity — not bed rest.
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