“Lumbar Stabilizing Exercises Improve
Activities of Daily Living in Patients
With Lumbar Disc Herniations
 
Summary of Key Evidence:
A total of 60 participants, ranging in age from 22-55 years, with a HLD at either the L4-L5 or L5-S1 levels participated in the study.  Herniations were clinically diagnosed and confirmed through the use of Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) Scan before participants were allowed to begin the study.  A convenience sample of patients from outpatient orthopedic clinics was used. Inclusion criteria were a history of low back pain, sciatic pain and reduced functional performance over two months due to the disc herniation.  Patients with motor or sensory dysfunction and Caudal Equine Syndrome were excluded from the study.  The participants were next randomly assigned to groups via a computer generated randomization program.
Group A participants began a four week LSE protocol followed by a four week rest period while Group B followed the same but in reverse.  The LSE protocol was comprised of exercises ranging from easy to advanced and were taught on the first session of each week by the researchers.  The participants were instructed to complete demonstrated exercises twice a day, 10 times each for the rest of the week.  Before and after the protocol and rest period, specific outcomes were measured.  The outcomes measured included: pain scale via a visual analog scale (VAS), range of trunk flexion without pain when sitting with knees extended and reaching for the toes, range of left and right straight leg raise without pain by a goniometer, and the time required to complete the ADL tasks.
Overall, the researchers discovered no significant findings for any of the outcome measures after the eight weeks between each group via a two way Analysis of Variance.  For all outcome measures, significant findings at the end of the first four week period in favor of group A were found.  Group B was reported to have the same findings after the second four week period; therefore, completion of LSE may reduce pain and improve ADL in patients suffering from HLD.  The current findings are reinforced by similar studies conducted by other researchers.
Appraisal:
With respect to internal validity of the study, blinding did occur, as the individual assessing the outcome measures was unaware of the assigned participant groups.  Activity outside of the study was somewhat limited and no daily activities were controlled; however, the participants were instructed not to perform any therapeutic exercise outside of the study and within the four-week rest period.  Three participants from Group A and five participants from Group B did not complete the full study, but data were still included in the analysis.  The researchers did not identify how many staff members collected outcome measures or how the outcome measures were selected.
The study may be generalized to most populations suffering from a HLD, which contributes to the external validity of the study.  Conditions appeared realistic and applicable to the clinical athletic training setting.  The exercises were simple to explain with illustrations provided, leading to self-sufficiency participant completion.
Application:
     The article is a great guideline and reference on how a LSE protocol may help improve daily living and quality of life for individuals with a HLD.  Researchers indicated LSE might decrease pain, improve functional performance, and help increase vertebral column stability.  Individuals with disc herniations often cease activity due to an increase in pain and often do not have adequate core and lumbar stabilizing strength to improve the condition alone.  By incorporating core and stabilization exercises with proper techniques, quality of life may improve.
The article was helpful in putting together a rehabilitation program for my patient who suffered a severe disc herniation about a year ago.  He has undergone many months of physical therapy both at the institution and at home out of season.  His pain has been fluctuating based on if and how much he is participating in his sport.  By using the article as a guide, I wish to help him maintain core stability and lumbar stabilization.  I believe the increased strength and stabilization will help him while he participates and to decrease his radicular pain and decrease the later onset of pain.
Citation:
Bakhtiary, A., Safavi-Farokhi, Z., & Rezasoltani, A. (2005). Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. Journal Of Back & Musculoskeletal Rehabilitation, 18(3/4), 55-60.