The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial

ABSTRACT

Background

Valuable impact of postoperative exercises on the clinical outcomes of patients with lumbar discectomy has been demonstrated. However, there is a lack of consensus on the best kind of postoperative exercises. This study aimed to evaluate the impact of the early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar discectomy.

Methods

In this single-blind randomized clinical trial (RCT), 90 subjects with lumbar discectomy were randomly assigned to three groups. The flexion-based and extension-based exercises were planned for the first and the second groups, respectively. The third group was considered as the control group. Subjects in the experimental groups started their exercise program at the end of the 6th postoperative week and continued exercises for 8 weeks. We used Visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Biering-Sorensen test (mBST), and Trunk Flexion Endurance Test (TFET) to evaluate back pain, disability, back and abdominal muscle endurance, respectively. The outcomes were investigated before starting the exercises program as well as at the end of the study. Moreover, return to work was evaluated at the end of the study. Data were analyzed using descriptive and inferential statistics by SPSS-24 software.

Results

Our results showed that the VAS pain diminished in all the groups. However, this reduction was most in the McKenzie group (P < 0.001). Moreover, extension-based exercises reduced ODI more than other groups (P < 0.001). We found that extension-based and flexion-based exercises had more efficacy in increasing the back and trunk flexion endurance, respectively (P < 0.001). There was not a significant difference between the three groups in the term of returning to work (P = 0.06).

Conclusions

Both flexion-based and extension-based exercises could reduce postoperative back pain and disability. However, the impact of the extension-based program was more dominant. Moreover, these exercises could increase back and abdominal muscle endurance. Therefore, prescribing such low-cost home-based exercises could be very helpful for patients with lumbar discectomy.

KEYWORDS:

• Exercises
• surgery
• intervertebral disc
• pain
• disability

Abbreviations

Visual analog scale (VAS); Oswestry Disability Index (ODI); Modified Biering-Sorensen test (mBST); Trunk Flexion Endurance Test (TFET)

Acknowledgments

We appreciate the clinical Research Development Center of Taleghani and Imam Ali Hospital for their wise advice.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and/or analysed during the current study are not publicly available due them containing information that could compromise research participant privacy/consent but are available from the corresponding author on reasonable request.The patient’s data included in this manuscript has not been previously reported

Authors’ contributions

EA, AA, and SRB had the idea for this study. EA, AA, and ZS participated in outlining the concept and design. SU and ZS did the data acquisition. EA, and AA did the statistical analysis and wrote the first draft of the manuscript. EA, SRB, AA, and ZS revised the final manuscript. All authors have read and approved the manuscript.

Ethics approval

The study received ethics approval by the Kermanshah University of Medical Science Ethics Committee. Written informed consent to participate was obtained from all patients. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Written informed consent for publication of the images was obtained from all the participants.

Additional information

Funding

There was no external source of funding.

Notes on contributors

Alireza Abdi

Alireza Abdi currently works as a faculty member, at the Department of Nursing and midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran. He has got many international publications.

Seyed Reza Bagheri

Seyed Reza Bagheri currently works as an associate professor in Neurosurgery, at the Department of Neurosurgery Kermanshah University of Medical Sciences, Kermanshah, Iran. He does research in neurosurgery, neurovascular surgery, spine surgery, and neurooncology.

Zahra Shekarbeigi

Zahra Shekarbeigi currently works as a general physician at the Kermanshah University of Medical Sciences, Kermanshah, Iran. She does research in neurosurgery, neurovascular surgery, spine surgery, and neurooncology.

Soheila Usefvand

Soheila Usefvand currently works as a specialist nurse in operating room and Neuro-ICU, at the Department of Neurosurgery Kermanshah University of Medical Sciences, Kermanshah, Iran.. She does research in nursing, neurosurgery, neurorehabilation, and neurooncology.

Ehsan Alimohammadi

Ehsan Alimohammadi currently works as an associate professor in Neurosurgery, at the Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran. He does research in Neurosurgery, neuroscience, Neurovascular Surgery, Spine Surgery, and Neurooncology. He has got many international publications.