Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a
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RESEARCH ARTICLE
Open Access
Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial Dejan Kernc1* , Vojko Strojnik1 and Rok Vengust2
Abstract Background: To analyze the safety and effects of early initiation of rehabilitation including objective measurement outcomes after lumbar spine fusion based on principles of strength training. Methods: The study recruited 27 patients, aged 45 to 70 years, who had undergone lumbar spine fusion. The method of concealed random allocation without blocking was used to form two groups. The strength training group started rehabilitation 3 weeks after surgery. Patients exercised twice weekly over 9 weeks focusing on muscle activation of lumbopelvic stabilization muscles. The control group followed a standard postoperative protocol, where no exercises were performed at that stage of rehabilitation. Functional outcomes and plain radiographs were evaluated at 3 weeks and subsequently at 3 and 18 months after the surgery. Results: No hardware loosening of failure was observed in the training group. Both groups improved their walking speed after 3 months (p < 0.01), although improvement in the training group was significantly greater than in the control group (p < 0.01). Moreover, the training group significantly improved after the training period in all isometric trunk muscles measurements (p < 0.03), standing reach height (p < 0.02), and pre-activation pattern (p < 0.05). After 18 months, no training effects were observed. Conclusions: The study showed that early initiation of a postoperative rehabilitation program based on principles of strength training is safe, 3 weeks after lumbar spine fusion, and enable earlier functional recovery than standard rehabilitation protocol. Trial registration: The study is registered at the US National Institutes of Health (ClinicalTrials.gov) NCT03349580. The date of registration: November 21, 2017 - Retrospectively registered. Keywords: Rehabilitation, Lumbar spine fusion, Randomized controlled trial, Strength training, Early initiation, Intra-abdominal pressure
Background Despite the significant rise in lumbar spine fusion (LSF) surgery rates in the last few decades, some 15 to 40% of lumbar fusion patients cannot expect significant improvement postoperatively according to functional ability [1–6]. The postoperative rehabilitation strategy is one of the main factors affecting the outcome. Nevertheless, only a few * Correspondence: [email protected] 1 Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia Full list of author information is available at the end of the article
studies address the effect of different protocols and timing of postoperative rehabilitation [7, 8]. The benefit of intra-abdominal pressure (IAP) on lumbar spine function is well documented [9, 10]. IAP with co-activation of the abdominal muscles provides load relief to the lumbar spine and increased stability of the trunk [10, 11]; however, IAP needs
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