Il-Hyun K im, PT, MS1), Ju-Hyun K im, PT, MS1), Jeong-Uk Lee, PT, MS1),
Mee-Young K im, PT, MS1), Bokyung K im, DVM, PhD2), Junghwan K im, PT, PhD3)
1) Graduate
Abstract. [Purpose] We investigated the changes in strength of the lumbar area and the Oswestry Disability Index
(ODI) of HNP patients in their early recovery stage after surgery before and after performance of an exercise program, minimal walking, or no exercise. [Subjects] Ninety-six (men=54, women=42) HNP patients who had received
surgery were divided into 3 groups: the self-stretching and strengthening exercise group (SG), the walking group
(WG), and the control group (CG). CG conducted no exercise. [Methods] WG walked for 10 minutes to 1 hours at
a time. SG was permitted to walk under the same conditions as WG and also conducted an exercise program for
10 to 30 minutes at a time. The lumbar extension strength and ROM were measured before and after the exercise
program. [Results] SG showed the most decreased disability and improved muscle strength and ROM. [Conclusion]
Intensive exercise, for example, stretching and strengthening exercise, was effective for trunk function. However,
more scientific research will be needed in the future.
Key words: Herniated nucleus pulposus, Back exercise, Trunk function
(This article was submitted Aug. 24, 2011, and was accepted Oct. 12, 2011)
INTRODUCTION
The medication and conservation methods, for example
complete bed rest, have generally been used for treatment
after herniated nucleus pulposus (HNP) surgery, but the
negative effects of these methods have often been reported1,2). One possible reason is that so-called deconditioning
syndrome increases pain and reduces motor functions after
surgery2,3). Actually, 2270% HNP patients after surgery
report sciatica and low back pain4) which leads to restriction
of movement inducing muscular atrophy, weakness, fatigue,
and overload on discs of the lumbar spine. Moreover, these
pathologic progresses can impair the shock absorption
mechanism of spinal processes hindering the effect of treatments2,5). Accordingly, there has been increasing interest in
early exercise within the no pain range of motion (ROM)
as a method for enhancing recovery after HNP surgery1,2,6).
However, in the early stage after surgery, patients are usually recommended to maintain complete bed rest and to limit
movements rather than early exercise. This has often resulted in delay of recovery and/or negative progress2,7). High
intensive physical therapies such as MedX, centar, and sling
have generally been used after HNP surgery but they are expensive. In spite of the beneficial effects arising from these
therapies, it is still necessary that self-exercise programs be
developed and provided to reduce the treatment costs8,9). As
a result of this necessity, self-exercise programs after HNP
167
Table 1. The change of isometric tension in the control, walking, and strength &
stretching exercise groups at different angles of lumbar flexion
0
12
24
36
48
60
72
56.0 73.3
Angle
96.0 88.2
199.8 51.3*
Significantly different from the control (*) and walking () groups (p<0.05).
ODI; Oswestry disability index.
Table 2. The change of Oswestry disability index (ODI) in the control, walking, and strength &
stretching exercise groups
Group
Total ODI
Pain Intensity
Walking
Sitting
Individual Standing
Sleeping
items
of
Sex life
ODI
Social life
Traveling
Personal care
Lifting
Control
Walking
30.63 15.17
1.45 0.86
1.33 1.10
1.39 0.88
1.55 0.98
0.60 0.66
1.83 1.52
2.13 1.30
1.52 1.19
1.47 1.09
2.47 1.17
28.49 11.73
1.04 0.35
1.04 1.06
1.44 1.19
1.08 1.00
0.68 0.48
1.88 1.89
2.04 1.02
1.28 1.17
1.60 0.96
2.71 1.37
Significantly different from the control (*) and walking () groups (p<0.05).
ODI; Oswestry disability index.
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Copyright of Journal of Physical Therapy Science is the property of Society of Physical Therapy Science and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.