Clinical efficacy of exercise therapy for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials.

Background: Lumbar disc herniation (LDH) is mainly characterized by pain and neurological dysfunction resulting from rupture of the fibrous ring of the lumbar disc. The incidence of LDH is increasing year by year, mainly owing to long-term sitting and immobility, improper posture, and reduced physical activity during study and work. The incidence of LDH in young people aged 18-35 years has shown a significant upward trend. LDH is one of the most common causes of back pain, affecting approximately 1-3% of the global population, and it is mainly concentrated in people aged 30-50 years. Exercise therapy, as an economically effective treatment method, can enhance the strength of core muscle groups and effectively alleviate the symptoms of LDH. However, strong evidence that proves the effectiveness of exercise therapy for LDH is still lacking. We conducted a meta-analysis of relevant clinical studies and used statistical methods to scientifically explore the effectiveness of exercise therapy for LDH. Methods: Four databases were searched, including PubMed, Embase, Web of Science, and Ovid. The search period ended on August 24, 2024. Comparisons were made between the group that used exercise therapy (treatment group) and the group that did not (control group). If heterogeneity among the studies was strong, sensitivity analysis was performed. Results: Of the 580 articles initially identified, eight (encompassing 611 patients with LDH) were included in the analysis. The results of the meta-analysis demonstrated that the treatment group exhibited superior outcomes in terms of Visual Analog Scale score, Oswestry Disability Index, range of motion, McSensory score, McTotal score, and Short Form-36 score compared with the control group. Conclusion: Exercise therapy is an economical, effective, and simple adjuvant therapy for patients with LDH. Exercise therapy enhances core muscle strength and lumbar stability, relieves lower back and leg pain, and improves patients' quality of life. However, no consensus on the use of exercise therapy for LDH currently exists, and there are no specific recommendations for exercise intensity, frequency, and activity that are suitable for patients with LDH. More high-quality clinical studies are needed to validate the application of exercise therapy as a treatment for LDH. Systematic Review Registration: The protocol was registered on PROSPERO (CRD42024586775).