For people who need lower back surgery for a slipped disc (also known as a prolapsed or herniated disc), the best post-surgical advice might be to get into a vigorous exercise program within a few weeks. A new review of the evidence concluded that people who started exercise programs, especially high-intensity programs, four to six weeks after surgery had less pain and disability than inactive people.
The review, published in The Cochrane Library, included data from 1,927 adults in 14 studies who had undergone their first surgery for low back (lumbar) disc prolapse. All of the studies compared groups treated with exercise programs different from each other and/or with groups that did not exercise; in most of the studies treatment started four to six weeks after surgery.
Short-term gains for exercisers
In studies where participants started exercising four to six weeks after surgery, exercisers had less pain and were more able to function than nonexercisers at the end of the treatment period. Those in high-intensity programs did better than people in low-intensity programs, and at-home exercise was just as effective as supervised exercise in these short-term trials. There was no evidence of increased rates of re-operation in exercisers, but the researchers noted that these studies provide no long-term information.
Improving post-surgical outcomes
When a lumbar spinal disc herniates or prolapses, it puts pressure on the spinal cord and nerve roots, causing pain that often radiates to the nearest buttock and down the leg. In some cases, muscles served by the involved nerves become dysfunctional. Most people recover without surgery, employing anti-inflammatory, muscle relaxing, and pain-relieving (analgesic) medications, bed rest, and sometimes physical options such as traction to relieve pressure on the disc. Laminectomy, the type of surgery used to treat this condition, involves removal of the disc or part of the disk, and is usually reserved for people with chronic and severe pain.
Reports on the success rate of back surgery range from 60 to 90%, but 10 to 40% of people who undergo back surgery continue to have symptoms, including pain, muscle dysfunction, decreased ability to function, and inability to return to work. In 3 to 12% of people who undergo disc surgery for the first time, another prolapse occurs for which almost all undergo a re-operation.
The role of physical activity in post-surgical rehabilitation programs has been controversial, as fears about re-injury, re-herniation, and instability persist. The findings of this review should help to relieve some of these fears. “None of the included studies reported that these active programs increase the re-operative rate,” the authors of the review said. “We concluded that it is not harmful to return to activity after lumbar disc surgery, and consequently that it is not necessary for patients to stay passive after [this type of] surgery.”
“For many people who undergo laminectomy, surgery has been accepted as a last resort,” commented Dr. Theresa Mundy, a chiropractor in New Hampshire. “This makes it especially important to aim postsurgical care at increasing the likelihood of success. With this in mind, the findings from this report show that a high-intensity exercise program is safe and probably helpful after laminectomy.”
(Cochrane Database Syst Rev 2008;4:CD003007)
Maureen Williams, ND