Can rehabilitation therapy help after surgery for a slipped disk?

Photo of a patient doing back exercises with the help of a physiotherapist (PantherMedia / Arne Trautmann)

Rehabilitation programs that are started four to six weeks after surgery for a slipped disk can speed up the recovery process. It remains unclear whether rehabilitation programs that start immediately after surgery have any advantages or disadvantages.

A slipped disk in the lower part of the spine is a common cause of back pain. It can also lead to sciatica (pain that shoots down the leg). The symptoms usually go away again within about six weeks. Until then, people can usually cope by relieving the pain and staying as active as possible. Physiotherapy is also commonly used.

Surgery is an option if the slipped disk becomes an emergency or severe pain continues over a long time despite treatment. More than 140,000 slipped disk operations are performed every year in Germany. Some people have more than one operation.

A large number of rehabilitation programs are available for people who have had surgery. Some doctors might recommend starting physiotherapy for rehabilitation immediately after surgery. Others advise waiting at first. Opinion is also divided on how intensive rehabilitation programs should be.

Research on rehabilitation

Researchers from the Cochrane Collaboration, an international network of researchers, looked for studies that compared the advantages and disadvantages of rehabilitation programs after slipped disk surgery. The most reliable kind of study is called a randomized controlled trial (RCT). The researchers found 22 such studies. They involved almost 2,500 participants who had undergone surgery on a disk in the lower region of the spine (lumbar disk surgery).

In most of the studies, the rehabilitation program started four to six weeks after surgery. The types of exercise varied considerably from study to study. They included endurance training, special back muscle exercises, stretching, and weight training for the back and abdomen. The activities were done between once and three times a week, and lasted 30 to 90 minutes at a time. Most rehabilitation programs ran for up to 12 weeks. Most studies looked at whether rehabilitative treatment can relieve pain and improve mobility.

Rehabilitation can speed up recovery somewhat

Overall, the studies suggest that rehabilitation can relieve pain and improve mobility in the short term. There is less good-quality research on whether rehabilitation has longer-term effects.

The researchers also found one good study which looked at whether rehabilitation can shorten the time until the patient can return to work. The program they looked at had been offered by a statutory health insurance company in Belgium. During rehabilitative treatment participants saw a doctor once a month and were given advice, guidance and – if needed – were referred to a physiotherapist. The outcome:

  • Without rehabilitation, 82 out of 100 participants were able to return to work after one year.
  • With rehabilitation, 90 out of 100 participants had returned to work after the same amount of time.

The study provided no evidence that rehabilitation increased the risk of injury or needing surgery again.

There is some evidence to suggest that rehabilitative treatment is more likely to relieve pain if it is started within the first four weeks after surgery than if it is started later or not at all – without increasing the risk of side effects. There has been hardly any research into the possible advantages or disadvantages of starting rehabilitative treatment immediately after surgery. This makes it difficult to say anything about them for now.