Physical Therapists Test Ways to Prescribe Exercise After Discectomy
Studies show that endurance of back muscles is more important than strength in preventing low back pain (LBP). Physical therapists (PTs) are studying ways to measure back extensor muscle endurance. They will use this information to set up the best exercise program for LBP patients after discectomy. Discectomy is the name of the operation to remove a herniated disc from between two vertebrae in the spine.
In this study, the test used was the Sorensen Test (ST). ST is a tool used to test the endurance of the lumbar extensor muscles. It is measured by the amount of time a patient can keep the upper body horizontal over the edge of a table without any support.
Improving performance on the ST is an important goal for anyone with LPB but especially after back surgery. Not everyone can do the ST. Some patients are too afraid to try it. Others have too much pain. So it was changed so that anyone can do the test safely and at their own level.
In the modified ST, patients start at a much more upright level. They gradually work their way down to an unsupported horizontal position if they can. The test can be done at six different levels and stopped when the patient cannot perform any further levels.
The six levels are from almost straight up (75 degrees) to horizontal (zero degrees). At each level, the position was held for as long as possible before fatigue, fear, or pain forced the patient to stop.
Analysis of the data showed that the ST is a reliable test when used on normal, healthy adults. The modified ST was not reliable for patients with LBP. There may be many reasons for this low reliability but it doesn't mean the test isn't useful.
By using this test, PTs will have a good starting point for therapy. Exercises can be prescribed at the right level that the patient isn't afraid to do. Endurance can increase safely and the intensity can be adjusted properly.
The authors conclude the modified ST is a useful tool for prescribing exercise after low back surgery such as discectomy. The ST is just too intense for most patients during the first four to six weeks after a single-level discectomy. The modified ST allows everyone to be tested at their own level, within the safety of their ability, pain levels, and confidence.
Sean P. Flanagan, PhD, ATC, CSCS and Kornelia Kulig, PT, PhD. Assessing Musculoskeletal Performance of the Back Extensors Following a Single-Level Microdiscectomy. In Journal of Orthopaedic & Sports Physical Therapy. July 2007. Vol. 37. No. 7. Pp. 356-363.