Therapeutic exercise following lumbar spine surgery: a narrative review

Therapeutic exercise is often part of the rehabilitation process following lumbar spine surgery. Despite this utilization, high-quality evidence and specific guidance regarding therapeutic exercise parameters and protocols following lumbar spine surgery remain sparse. The purpose of this manuscript is to provide a narrative review of the current evidence regarding exercise prescription, activity recommendations, and outcome measures following lumbar discectomy, fusion, and total disc replacement surgeries.

A comprehensive narrative review was conducted regarding postoperative exercise for lumbar spine surgery, a summary of the current available literature was provided and interpreted, and future directions for research were identified.

The findings of narrative review generally support supervised therapeutic exercise as safe and beneficial following lumbar discectomy, fusion, and total disc arthroplasty surgeries. Initial exercise prescriptions should be individualized according to patient and surgical factors, including prior level of function, comorbidities, and tissue healing timelines, to support recovery goals. These findings can be useful for surgeons and rehabilitation practitioners to provide general guidance and to counsel patients on appropriate therapeutic exercises and activity recommendations following lumbar spine surgery, with a particular focus on the safety of exercise types and when to initiate exercise postoperatively. Physical activity monitoring (eg, wearables) can be used to complement postsurgical therapeutic exercise and enhance outcomes.

This review provides the most current evidence regarding the safety and effectiveness of therapeutic exercise following lumbar spine surgery. Given the narrative format of this review, these findings are not intended to serve as clinical practice guidelines or provide specific recommendations about implementation. Thus, pragmatic implementation of exercise following lumbar spine surgery depends on the patient's distinct presentation, surgical factors, expertise and experience of the clinician, available resources, and patient preferences. Future prospective research trials and subsequent systematic reviews are needed to elucidate specific factors regarding the use of therapeutic exercise following lumbar spine surgery.