The Effect of Early Isolated Lumbar Extension Exercise Program for Patients with Herniated Disc Undergoing Lumbar Discectomy

Abstract

ABSTRACTOBJECTIVE:To determine the effects of a postoperative early isolated lumbar extension muscle-strengthening program on pain, disability, return to work, and power of back muscle after operation for herniated lumbar disc.METHODS:Seventy-five patients were randomized into an exercise group (20 men, 15 women) and a control group (18 men, 22 women) to perform a prospective controlled trial of a lumbar extension exercise program in patients who underwent lumbar microdiscectomy or percutaneous endoscopic discectomy. Six weeks after surgery, patients in the exercise group undertook a 12-week lumbar extension exercise program. The assessment included measures of lumbar extensor power by the MedX (Ocala, FL) lumbar extension machine, muscle mass of multifidus and longissimus (L4–L5 cross-sectional area) by computed tomography. All patients completed the visual analog scale and the Oswestry disability index to assess pain and disability, respectively. Return to work data were also investigated.RESULTS:After the exercise program, significant improvements were observed in the exercise group versus the control group for lumbar extensor power (51.67% versus 17.55%, respectively; P < 0.05), the cross-sectional area of multifidus and longissimus muscle (29.23% versus 7.2%, respectively; P < 0.05), and the visual analog scale score (2.51 versus 4.30, respectively; P < 0.05). The percentages of returning to work within 4 months after surgery were significantly greater in the exercise group than in the control group (87% versus 24%, respectively). Although this was not statistically significant (P > 0.05), the Oswestry disability index scores in the exercise group were better than that in control group (24.6 versus 30.6, respectively).CONCLUSION:These results support the positive effects of the postoperative early lumbar extension muscle-strengthening program on pain, return to work, and strength of back muscles in patients after operation of herniated lumbar disc.