Spine. 2000 Apr; 25(8): 1015-20.

Early aggressive exercise for postoperative rehabilitation after discectomy.

Danielsen JM, Johnsen R, Kibsgaard SK, Hellevik E.

Institute of Manual Therapy, Mo i Rana; the Institute of Community Medicine, University of Tromso, and Rana Hospital, Mo i Rana, Norway. jmdanie@online.no

STUDY DESIGN: A randomized clinical trial of postoperative medical exercise therapy in patients after operation for lumbar disc herniation with blind assessment of clinical outcomes. OBJECTIVE: To assess the effect of an early regimen of vigorous medical exercise compared with an ordinary care program. SUMMARY OF BACKGROUND DATA: METHODS: Patients offered an operation for lumbar disc herniation were consecutively randomized to a training group or to a control group. The training consisted of an 8-week active rehabilitation program including a regimen of vigorous lumbar stabilizing exercises. The control subjects participated in a mild program of 2 to 3 back exercises at home, after relaxing and resting their backs for 2 months after the surgery. The outcomes were evaluated 6 and 12 months after the operation. The results are based on intention-to-treat analyses. RESULTS: Sixty-three of 65 eligible patients agreed to participate in the trial. Fifty-eight and 53 patients attended for evaluation at 6 and 12 months, respectively. There was a significantly larger improvement in the mean Roland's disability index (from 8.9 to 5.4 [P = 0.02] at 6 months and from 8. 7 to 5.3 [P = 0.03] at 12 months) and in reported pain (from 3.7 to 2.0 [P = 0.04] at 6 months and from 3.2 to 1.8 [P = 0.09] at 12 months) in the training group. A significantly (P = 0.05) higher proportion of the training group reported that they participated in daily activities as usual. There were more patients in the training group who reported improvement in self-evaluated health after surgery at both 6 (P = 0.02) and at 12 months (P = 0.05). Finally, no differences in clinical end points were observed between the groups. CONCLUSIONS: Vigorous medical exercise therapy, started 4 weeks after surgery for lumbar disc herniation, reduced disability and pain after surgery. Because no differences in clinical end points were observed, there is hardly any danger associated with early and vigorous training after operation for disc herniation.