Surgery for a slipped disc: How much do exercise and rehabilitation programs help in the recovery process?

Exercise and patient education programs that are started four to six weeks after surgery for a slipped disc can speed up the recovery process. There is no evidence that high-intensity exercise programs are more effective than low-intensity exercise programs. Rehabilitation programs offered by health insurance funds can also help. 

A slipped disc in the lower part of the spine (the lumbar spine) is a common cause of back pain and sciatica, with pain that shoots down the leg. Spinal discs are made up of cartilage and act as shock absorbers between the vertebrae in our spine. If a spinal disc becomes damaged, for example due to wear and tear, it can no longer fulfill this function properly, and this could result in a slipped disc. The associated pain probably arises when the damaged spinal disc bulges out and pushes against a nerve in the spinal cord. You can read about the structure of the spine in our information “How does the spine work?".

Strictly speaking, the commonly used term “slipped disc” is not correct, because spinal discs are fixed in position and cannot actually slip out of place. Depending on the specific cause of the problem, the medical terms “herniated disc”, “prolapsed disc”, “ruptured disc” and “protruded disc” are also used. Sometimes people have the symptoms of a slipped disc although it is not diagnosed as such.

It is estimated that 1 to 2% of all people will have back pain caused by a slipped disc at some point in their lives. Slipped discs are more common in people over the age of 30, and twice as common in men as in women. This problem normally arises when inappropriate strain is put on the back, particularly when lifting heavy objects. But it can also happen if you sit too much, because that also puts a lot of strain on your back. Being very overweight can increase the risk too. Slipped discs can arise suddenly or slowly, starting with back ache that gets worse over time.

Problems with a slipped disc usually go away within about six weeks. It is often enough just to get pain relief and avoid doing things like bending down, twisting your body or lifting heavy objects. Physiotherapy is commonly used too. But sometimes slipped discs can be more severe, or they may simply not get better on their own. If that is the case, many people have surgery to “repair” the spinal disc. More than 140,000 operations like this are done every year in Germany. Some people have more than one operation.

A large number of exercise and rehabilitation programs are available for people who have had this kind of surgery. Some doctors might recommend starting a program involving physiotherapeutic training immediately after surgery. Others, however, recommend waiting first. Opinion is also divided on how intensive this kind of training program should be. Exercise and rehabilitation programs can play a very important role in recovery after surgery for a slipped disc. But exercise programs can also lead to new injuries or to back instability, making the recovery process take longer. Scientific research is needed to find out which programs are more likely to help.

Research on exercise and rehabilitation programs: Starting four to six weeks after surgery could help

Researchers at the Cochrane Collaboration in the Netherlands and Australia looked for trials to answer the question of how exercise programs can best be used to help people recover from surgery for a slipped disc. The Cochrane Collaboration is an international network of researchers that aims to analyze the results of clinical studies to assess the effectiveness of medical interventions. The most reliable kinds of studies are called randomized controlled trials. In these trials, volunteers are randomly divided into groups. One of these groups receives the treatment, while the other group or groups are given a fake medication (placebo), no treatment, or a different treatment. This makes it possible to find out what effect the treatment has on the health of the participants. You can read about why this kind of study provides more reliable answers than other kinds of research in our category “Evidence-based medicine”. 

The Cochrane researchers found 14 trials involving almost 2,000 participants who had undergone surgery on a disc in the lower region of the spine (lumbar disc surgery). About half of these trials were of low quality, but some of the trials were able to provide answers to various important questions.

Two trials of adequate quality (involving just over 100 participants) found that exercise programs that are started four to six weeks after surgery helped people to become more mobile again – at least during the trials. The people in the exercise groups also reported that they had less pain, but there is not yet enough evidence to say for sure that exercise programs relieve pain. Exercise programs did not increase the likelihood of needing further surgery either.

There was no strong scientific evidence about the effects of starting exercise programs immediately after surgery, so we do not know whether doing so tends to speed up or slow down recovery.

Different exercise programs: more intensive is not necessarily better

Two further trials of adequate quality (involving around 160 people) showed that more intensive exercise programs did not lead to greater mobility than less intensive programs. But the trials that looked into this question had contradictory findings. One trial came to the conclusion that people who did more intensive exercises were able to return to work sooner, whereas the other trials found that the exercise intensity did not make any difference. The different levels of intensity did not influence the likelihood of needing a second operation. The high-intensity exercise programs possibly helped to relieve the pain, but that is not known for sure.

The researchers found one good-quality trial which looked at a rehabilitation program offered by a statutory health insurance fund in Belgium. A total of 710 people took part in this trial. During the trial they saw a doctor once a month and were given advice, guidance and – if needed – were referred to a physiotherapist. After one year only 10% of the participants had not yet returned to work, compared to 18% of those who had not taken part in the rehabilitation program.

The programs in the trials included a personal assessment of physical disability, and the exercises were adapted to suit people’s individual needs. They also included things like back training as well as stretching and strength training. But the Cochrane researchers concluded that it is not yet clear which kinds of exercise have a bigger benefit and whether or not the programs should be supervised by a professional. They will update their review as soon as further research results become available, and then we will write about their findings here.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)