Exercise Helps Reduce Pain, Disability After Lower Back Surgery

Lumbar spine (lower back) surgery is a common treatment for a herniated or “slipped” disk, and patients need to know whether it is better to sit still or get moving during their recovery period.

An updated review from the Netherlands suggests that exercise programs starting four to six weeks after the operation could lead to more rapid pain relief and a quicker recovery from disability — without increasing the risk of additional surgery.

“Many people are operated on because of a herniated lumbar disc but there is still controversy with regard to rehabilitation,” said lead author Raymond Ostelo, Ph.D., at the VU University Medical Center in Amsterdam. “[Although] many different rehabilitation programs are available and prescribed for patients, some surgeons say that patients don’t need rehabilitation programs at all once they are discharged from the hospital.”

However, the review findings support a more active approach.

“In general, it appears that patients who participated in exercise programs recovered somewhat faster than those who received no treatment and that patients who participated in high-intensity programs reported slightly less short-term pain and disability than those in low-intensity programs,” Ostelo said.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The updated review included 14 randomized controlled trials involving 1,927 participants.

There was a great deal of variation in the programs available following surgery, ranging from only stretching and strength training at home to 90 minutes of intensive aerobic, strength and stretching exercises three times a week.

The amount of support that patients received also varied widely: from a single two-hour training session to multiple visits with a team that included physiatrists, physical and massage therapists, and social workers. Because of the large differences in treatments, the authors were unable give guidance on which kind of exercise program works better.

None of the studies reported an increase in the number of patients who required additional surgery. There were also no indications that patients should restrict their activity after surgery.

“Given the ongoing controversy regarding the type — if any — and timing of rehabilitation programs, this review highlights that it seems to be a good idea to follow an exercise program and return to daily activities as soon as possible,” Ostelo said.

“It is hard to make sweeping generalizations about all the different types of back surgeries that are done,” said Joel Press, M.D., an associate professor of physical medicine and rehabilitation at Northwestern University’s Feinberg School of Medicine in Chicago. “These results show that there was no evidence suggesting that exercise programs were increasing the rates of re-operation. Sitting too long often will hurt the patient more than getting up and moving.”