Effectiveness of strengthening exercise plus activities of daily living instructions in reducing pain in patients with lumbar disc herniation: a randomized controlled trial

Abstract

Background: Lumbar disc herniation (LDH) is one of the most common causes of chronic low back pain (CLBP) with sciatica. The exercise intervention was found effective in improving CLBP, although a paucity of research evaluated the effectiveness of exercise intervention to alleviate CLBP due to LDH. This study aimed to evaluate the effectiveness of the combination of back and hip strengthening exercises and activities of daily living instructions (ADLIs) to improve CLBP with sciatica due to LDH. Method: This assessor-blinded randomized clinical trial was conducted on 70 patients with CLBP with sciatica due to LDH. The patients were randomly allocated either in the intervention group (IG) or control group (CG). Patients in IG received both back and hip strengthening exercises five days a week for six weeks. Patients in CG received pharmacological therapy for three weeks, followed by hot moist compression for another three weeks. Patients of both groups followed the ADLIs at the time of the intervention and at least three months after the intervention. Back pain intensity and perceived pain due to sciatica were measured by the Visual Analogue Scale and range of hip flexion during the Straight Leg Raising Test, respectively, at three weeks and six weeks of intervention, and three months after the intervention. Results: Back pain and sciatica improved significantly (p < 0.05) in both groups at the end of the intervention and follow-up, while the IG showed significantly better improvements (p < 0.05) at the end of the intervention. However, only ADLIs were not adequate to sustain the improvements after the intervention. Conclusion: The combination of back and hip strengthening exercises and ADLIs improves CLBP with sciatica due to LDH. Nevertheless, it is required to instruct patients to follow ADLIs and perform strengthening exercises regularly to maintain the improvements. Trial registration: ClinicalTrials.gov, NCT05021718.