Intensive Dynamic Back Exercises With or Without Hyperextension in Chronic Back Pain After Surgery for Lumbar Disc Protrusion: A Clinical Trial

Sixty-two patients with chronic low back pain occurring 14-60 months after undergoing discectomy for the first time were randomized to two physical treatment groups: 24 sessions of intensive dynamic back exercises with hyperextension or 24 sessions of intensive dynamic back exercises without hyperextension. At the conclusion of therapy and at one-year follow-up, no difference was seen between the randomized groups, with regard to the combined assessments of pain, disability and objective measurements. A difference for back exercises without hyperextension to be superior to the other treatment regimen was statistically significant at the three-month follow-up. In the patient's qualitative assessment of treatment outcome there were seen no significant differences between back exercises with or without hyperextension. There was a similar and significant improvement of the isometric endurance of back muscles in both groups, but the flexibility of the spine was significantly improved only in the group using hyperextension exercises. The overall response rate of an earlier published investigation was reproduced. It is concluded that chronic back patients after first time discectomy may benefit from an intensive rehabilitation protocol including intensive exercises. The added use of hyperextension exercises does not confer any independent benefit. Furthermore, the training had to continue for more than 2-3 months before a statistical significant decrease in back pain was reported in the patient pain diary.

62例首次椎间盘切除术后14 - 60个月出现慢性腰痛的患者被随机分为两个物理治疗组：24次包含过度伸展的强化动态背部锻炼或24次无过度伸展的强化动态背部锻炼。在治疗结束时以及一年的随访中，就疼痛、残疾和客观测量的综合评估而言，随机分组之间未发现差异。在三个月的随访中，无过度伸展的背部锻炼优于其他治疗方案的差异具有统计学意义。在患者对治疗结果的定性评估中，有或无过度伸展的背部锻炼之间未发现显著差异。两组背部肌肉的等长耐力都有相似且显著的改善，但只有进行过度伸展锻炼的组脊柱柔韧性有显著改善。重现了先前发表的一项研究的总体有效率。结论是，首次椎间盘切除术后的慢性腰痛患者可能受益于包括强化锻炼的强化康复方案。增加过度伸展锻炼并没有带来任何独立的益处。此外，在患者疼痛日记中报告背部疼痛有统计学意义的减轻之前，训练必须持续2 - 3个月以上。