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

K. Kulig, PT, PhD, is Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP-155, Los Angeles, CA 90089-9006 (USA).
G.J. Beneck, PT, MS, OCS, is a PhD candidate in the Division of Biokinesiology and Physical Therapy, University of Southern California, and Lecturer, Department of Physical Therapy, California State University–Long Beach, Long Beach, California.
D.M. Selkowitz, PT, PhD, OCS, DAAPM, is Professor, Department of Physical Therapy Education, Western University of Health Sciences, Pomona, California.
J.M. Popovich Jr, PT, DPT, ATC, CSCS, is a PhD candidate in the Division of Biokinesiology and Physical Therapy, University of Southern California.
T.T. Ge, PhD, is Biostatistician, Johnson and Johnson, San Diego, California.
S.P. Flanagan, PhD, ATC, CSCS, is Associate Professor, Department of Kinesiology, California State University, Northridge, Northridge, California.
E.M. Poppert, PT, DPT, OCS, is Adjunct Assistant Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California.
K.A. Yamada, PT, DPT, OCS, ATC, CSCS, is Instructor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California.
C.M. Powers, PT, PhD, is Associate Professor, Division of Biokinesiology and Physical Therapy, University of Southern California.
S. Azen, PhD, is Professor and Co-Director of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California.
C.J. Winstein, PT, PhD, FAPTA, is Professor, Division of Biokinesiology and Physical Therapy, University of Southern California.
J. Gordon, PT, EdD, FAPTA, is Associate Dean and Chair, Division of Biokinesiology and Physical Therapy, University of Southern California.
S. Samudrala, MD, FACS, is Neurosurgeon, Cedars-Sinai Spine Center, Los Angeles, California.
T.C. Chen, MD, PhD, is Associate Professor of Neurological Surgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California.
A.N. Shamie, MD, is Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Santa Monica–UCLA Medical Center and Orthopaedic Hospital, Santa Monica, California.
L.T. Khoo, MD, is Assistant Professor, Department of Orthopaedic Surgery, Santa Monica–UCLA Medical Center and Orthopaedic Hospital.
M.J. Spoonamore, MD, is Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California.
J.C. Wang, MD, is Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Santa Monica–UCLA Medical Center and Orthopaedic Hospital.
Physical Therapy Clinical Research Network (PTClinResNet) (see list of investigators in the Footnotes section).

Address all correspondence to Dr Kulig at: kulig{at}usc.edu.

Background: Restoration of physical function following lumbar microdiskectomy may be influenced by the postoperative care provided.

Objective: The purpose of this study was to examine the effectiveness of a new interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy.

Setting: The study was conducted in physical therapy outpatient clinics.

Design and Participants: Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy were randomly allocated to receive education only or exercise and education.

Intervention and Measurements: The exercise intervention consisted of a 12-week periodized program of back extensor strength (force-generating capacity) and endurance training and mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and physical measures of functional performance were tested 4 to 6 weeks postsurgery and 12 weeks later, following completion of the intervention program. Because some participants sought physical therapy outside of the study, postintervention scores were analyzed for both an as-randomized (2-group) design and an as-treated (3-group) design.

Results: In the 2-group analyses, exercise and education resulted in a greater reduction in ODI scores and a greater improvement in distance walked. In the 3-group analyses, post hoc comparisons showed a significantly greater reduction in ODI scores following exercise and education compared with the education-only and usual physical therapy groups.

Limitations: The limitations of this study include a lack of adherence to group assignment, disproportionate therapist contact time among treatment groups, and multiple use of univariate analyses.

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

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