Physical therapies after surgery for lumbar disc herniation- evidence synthesis from 55 randomized controlled trials (RCTs) and a total of 4,311 patients.

Introduction: The role of physical therapy after lumbar disc herniation surgery is unclear. Research question: To determine the impact of physical therapy following LDH surgery (Q1), investigate the effects of activity limitations (Q2), the best time to start physical therapy (Q3), the significance of supervised physical rehabilitation (Q4), the types of physical therapies used (Q5), and the role of additional approaches, such as education, manipulation, and acupuncture, in enhancing the effectiveness of rehabilitation (Q6). Material and methods: This systematic review searched three databases from inception to May 2024. Independent reviewers screened studies, assessed and extracted data, and critically appraised the quality of the available evidence. Results: This systematic review included 55 randomized controlled trials with 4311 patients. We demonstrated that physical therapy after lumbar disc surgery is effective in alleviating pain and improving function and quality of life after surgery for lumbar disc herniation. Exercise regimens aimed at enhancing the endurance, flexibility, and strength of the back musculature are generally efficacious, with the exception of exercises involving neural mobilization. Imposing limitations on physical activity does not yield substantial advantages; however, the occurrence rate of potential complications, the optimal timing for initiating activity and the cost-effectiveness of supervised exercise remain subjects of ongoing discourse. Concurrent application of manual therapy, acupuncture, educational interventions, and behavioral and occupational therapy has the potential to augment outcomes. Discussion and conclusion: Physical therapy improves functional outcomes after lumbar disc surgery. Further studies should address its safety, and cost-effectiveness, and provide dissemination and applicability tools.