An intensive, progressive physical therapist exercise program combined with education reduces disability and improves patient function after back surgery
ALEXANDRIA, VA, November 24, 2009 — Patients who
have undergone a single-level lumbar microdiskectomy for lumbar disk
herniation experienced significant improvement in physical function
following an intensive, progressive physical therapist guided exercise
and education program, according to a research report published in the November issue of
Physical Therapy, the scientific journal of the
American Physical Therapy Association (APTA).
Low back pain continues to be the most prevalent musculoskeletal
problem, and one cause is lumbar disk herniation accompanied by
sciatica—with many cases resulting in lumbar diskectomy. Up to 35
percent of patients continue to have pain and impaired function after
surgery, which may be related to the type of postoperative care that
"An important goal of physical therapy interventions is to resolve
functional deficits associated with low back pain," said physical
therapist and lead researcher Kornelia Kulig, PT, PhD, associate
professor of clinical physical therapy in the Division of Biokinesiology
and Physical Therapy at the University of Southern California in Los
Angeles. "There is strong evidence that intensive exercise is effective
in restoring functional status in patients who have undergone lumbar
diskectomy. The exercise intervention in our study consisted of an
intensive, graded strength and endurance training program targeting the
trunk and lower-extremity musculature."
In this study, 98 participants who had undergone a single-level
microdiskectomy were randomly allocated to receive education only or
exercise and education. The education-only group received one session of
back care education 4-6 weeks after surgery. The education and exercise
group received one back care education session followed by a 12-week USC
Spine Exercise Program initiated 2-3 days after the education session.
The exercise program consisted of back extensor strength
(force-generating capacity) and endurance training as well as mat and
upright therapeutic exercises. The back extensor strength and endurance
training portion was designed to load the back extensor muscles in a
graded manner by varying the time and angle at which the trunk was held
against gravity, using a variable-angle Roman chair.
The goal of the program was for participants to be able to maintain a
horizontal body position for 180 seconds. The purpose of the mat and
upright therapeutic exercise portion of the program was to progressively
and dynamically develop strength, endurance, and control of movement by
the trunk and lower-extremity musculature.
Testing on all outcome measures began 4-6 weeks after surgery, prior
to intervention, and was repeated for comparison after the 12-week
program. Participants showed improvement in their ability to engage in
activities of daily living as well as performance on the Repeated
Sit-to-Stand Test, the 50-Foot Walk Test, and the 5-Minute Walk Test. In
addition, some participants opted out of their allocated intervention
group to pursue physical therapy care outside of the study, but agreed
to remain in the study. This allowed researchers to include a third
group. The three-group analysis still showed greater improvement in
activities of daily living scores, 5-minute walk distance, and 50-foot
walk time in the exercise and education group.
"These results suggest greater effectiveness of the current exercise
program in reducing disability and improving walking performance than
that expected from usual physical therapy," remarked Kulig. "An
intensive 12-week strength and endurance training program of the trunk
and lower-extremity musculature is safe and results in a greater
reduction in disability and a greater increase in walking performance
immediately following the intervention."
This study was funded by a grant from the Foundation
for Physical Therapy.
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility - in many cases without expensive surgery or the side effects
of prescription medications. APTA represents approximately 76,000
physical therapists, physical therapist assistants, and students of
physical therapy nationwide. Its purpose is to improve the health and
quality of life of individuals through the advancement of physical
therapist practice, education, and research. In most states, patients
can make an appointment directly with a physical therapist, without a
physician referral. Learn more about conditions physical therapists can
treat and find a physical therapist in your area at www.moveforwardpt.com.