Effects of Exercise on Pain and Disability after Lumbar Disc Herniation Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective To evaluate the effects of postoperative exercise on pain, disability, and quality of life (QoL) after lumbar disc herniation (LDH) surgery. Design We systematically searched the PubMed, EMBASE, Cochrane Library, and PEDro databases up to May 2024. Two reviewers independently selected and assessed relevant randomized controlled trials investigating the effectiveness of postoperative exercise after the surgical treatment of patients diagnosed with LDH on low back pain, disability, and QoL assessed using visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-item short-form health survey (SF-36). Results Compared with the control group, the exercise intervention group had significantly lower VAS scores both in the short-term (effect: 95% confidence interval [CI] = -1.14 [-1.69, -0.58], I² = 91.4%, n = 9 studies) and long-term follow-up (effect: 95% CI = -0.99 [-1.89, -0.08], I² = 58.9%, n = 4 studies). The exercise intervention group also showed a significant reduction in ODI in the short-term follow-up (effect: 95% CI = -5.00 [-7.72, -2.29], I² = 79.3, n = 7 studies), but not in the long-term follow-up (effect: 95% CI = -0.80 [-3.97, 2.38], I² = 0.0%, n = 4 studies). Among the SF-36 factors, physical function, pain, general health, energy and vitality, and social function significantly improved in the exercise intervention group compared with the control group. Conclusions Exercise after LDH surgery was effective in reducing pain and disability and improving QoL.