Exercise or Encouragement: Which Works Better after Back Surgery?

Have you ever hurt your back (maybe even had back surgery)? Were you afraid to move afterwards? Perhaps afraid you'll reinjure your back? Fear of movement is a real problem after back injury and surgery for disc problems. A rehabilitation program might help.

The problem is that not much is known about exercise and rehab programs after lumbar disc surgery. Do they work? A group of physical therapists from the Netherlands did this study to measure the effect of treatment on fear of movement.

The researchers also looked at "catastrophizing" pain (making it seem worse than it is). Two types of treatment were compared: usual physical therapy care, and behavioral graded activity (BGA). Only patients having their first lumbar disc surgery were included in the study.

Usual physical therapy included exercise training, instructions for lifting, massage or soft tissue mobilization, and electrotherapy. BGA gives patients positive feedback for trying and completing activities. The exercise starts slowly and gradually builds up in time and intensity.

Patients were checked six months after surgery and again at one year. The researchers found no difference between the two groups. They had the same motion, strength, pain, and function.

The authors thought BGA would decrease patients' fear of movement and pain, allowing them to recover faster. The authors also thought the patients would have improved function after BGA.

These predictions were based on how patients with chronic back pain respond to BGA. Since the results weren't the same, the researchers suggest that patients having lumbar disc surgery are different from chronic back pain patients.

Raymond W. J. G. Ostelo, PT, PhD, et al. Behavioral Graded Activity Following First-Time Lumbar Disc Surgery. In Spine. August 15, 2003. Vol. 28. No. 16. Pp. 1757-1765.

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