An Intensive, Progressive Exercise Program Reduces Disability and Improves Functional Performance in Patients After Single-Level Lumbar Microdiskectomy

Kulig, Kornelia; Beneck, George J.; Selkowitz, David M.; Popovich, John M.; Ge, Ting; Flanagan, Sean P.; Poppert, Elizabeth M.; Yamada, Kimiko A.; Powers, Christopher M.; Azen, Stan; Winstein, Carolee J.; Gordon, James; Samudrala, Srinath; Chen, Thomas C.; Shamie, Arya Nick; Khoo, Larry T.; Spoonamore, Mark J.; Wang, Jeffrey C.

doi:10.2522/ptj.20080052

Cited by 44 publications

(38 citation statements)

References 34 publications

(2 reference statements)

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“…90 Clinical trials demonstrating improved outcomes following postoperative rehabilitation emphasize the use of lumbar stabilization exercise, and initiate treatment sooner in the postoperative period. 9,11,16,23,66,74,77,86,113 Additionally, morphological changes of the LM and functional impairments of the LM and TrA are related to disorders of the lumbar spine. 1,13,37,41,48,50,51,57,61,63,88 Integrating these 3 issues was the impetus in the design of the rehabilitation approach used in this case report.…”

Section: Muscle Morphologymentioning

confidence: 99%

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Hébert¹,

Marcus²,

Koppenhaver³

et al. 2010

J Orthop Sports Phys Ther

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Section: Muscle Morphologymentioning

confidence: 99%

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Hébert¹,

Marcus²,

Koppenhaver³

et al. 2010

J Orthop Sports Phys Ther

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“…The test began in a position that was 75° above the horizontal (level 1) and descended in 15° surgery alone. 3,7,12 A postsurgical therapy program should be comprehensive, including patient education, and exercises for the trunk and lower extremities, including the hips. 12 An emphasis should be placed on the lumbar extensors, which play a key role in spinal stability 17 and have been shown to be deficient following SLM.…”

mentioning

confidence: 99%

“…3,7,12 A postsurgical therapy program should be comprehensive, including patient education, and exercises for the trunk and lower extremities, including the hips. 12 An emphasis should be placed on the lumbar extensors, which play a key role in spinal stability 17 and have been shown to be deficient following SLM. 7 The landmark study by Beiring-Sorensen 2 determined that lumbar extensor endurance was better than maximal strength in predicting persons who would develop low back pain.…”

mentioning

confidence: 99%

Time Courses of Adaptation in Lumbar Extensor Performance of Patients With a Single-Level Microdiscectomy During a Physical Therapy Exercise Program

Flanagan

Kulig²,

Clinresnet³

2010

J Orthop Sports Phys Ther

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l umbar spine surgery can expedite improvements in pain and dysfunction associated with a herniated lumbar disc. 19 Consequently, over 250 000 surgeries are performed each year in the United States alone.1 A commonly used surgery is the single-level microdiscectomy ( S L M ) , in which a damaged portion of the intervertebral disc is removed. While the standard of care for therapy following a t sTuDY Design: Longitudinal single-cohort study. t MeTHoDs: Patients (n = 48) with a single-level microdiscectomy participated in a 12-week (36 sessions) comprehensive strength and endurance exercise program starting 4 to 6 weeks postsurgery. Lumbar extensor strength was quantified as the degree from horizontal on a modified Sorensen test procedure. Patients unable to assume the horizontal position were assumed to have strength deficits. Lumbar muscular endurance performance was quantified by the amount of time patients could hold the Sorensen test position at the horizontal. The time rate of lumbar muscular endurance adaptations were analyzed using longitudinal growth curve modeling.t resulTs: The adherence rate of this program was low (67%). Twenty percent of the patients were identified as having strength deficits. These deficits were corrected in all patients within 3 to 9 weeks. Linear mixed-model results suggest an improvement of 5.6 seconds in hold time per week of exercise. Both the initial level of endurance and the rates of improvements were highly individualized.t ConClusion: The time course of musculoskeletal performance adaptations in persons with a history of lumbar surgery is highly individualized. When compared to normative endurance times, the results of this study indicate that the number of sessions and duration of therapy needed to generate meaningful adaptations of the paraspinal musculature is longer than what is typically provided in the clinic postsurgery. t leVel oF eViDenCe: Therapy, level 4.

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“…After surgery, patients needed 29 s to perform five STSTS movements without vision, although healthy young individuals only needed 8 s (Claeys et al, 2012). Another study, with individuals with comparable moderate-to-high ODI scores after surgery, reported the need for 18 s after lumbar surgery but with vision (Kulig et al, 2009). Additionally, we found a comparable degree of down-weighting of lumbosacral proprioceptive signals and up-weighting of ankle proprioceptive signals in individuals with non-specific LBP without surgical history (Claeys et al, 2011), that affected STSTS performance (Claeys et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

Janssens

Brumagne

Claeys

et al. 2016

Clinical Biomechanics

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Background: Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. Methods: Patients were randomly assigned into transmuscular (n = 12) or paramedian lumbar surgery (n = 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n = 12) or usual care (n = 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. Findings: Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P b 0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P b 0.005), although not seen in the paramedian group and usual care group (P N 0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P b 0.05). Interpretation: Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery. Clinical Trial Number: NCT01505595

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An Intensive, Progressive Exercise Program Reduces Disability and Improves Functional Performance in Patients After Single-Level Lumbar Microdiskectomy

Abstract: An intensive, progressive exercise program combined with education reduces disability and improves function in patients who have undergone a single-level lumbar microdiskectomy.

Cited by 44 publications

References 34 publications

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Postoperative Rehabilitation Following Lumbar Discectomy With Quantification of Trunk Muscle Morphology and Function: A Case Report and Review of the Literature

Time Courses of Adaptation in Lumbar Extensor Performance of Patients With a Single-Level Microdiscectomy During a Physical Therapy Exercise Program

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

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