Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: the effect of surgical approach and early physiotherapy

Background. Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. Methods. Patients were randomly assigned into transmuscular (n= 12) or paramedian lumbar surgery (n= 13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n= 12) or usual care (n= 13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery. Findings. Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (p 0.05). Already eight weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P< 0.05). Interpretation. Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behaviour of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals, and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception six months after surgery.publisher: Elsevier articletitle: Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy journaltitle: Clinical Biomechanics articlelink: http://dx.doi.org/10.1016/j.clinbiomech.2015.12.011 content_type: article copyright: Copyright © 2016 Elsevier Ltd. All rights reserved.status: publishe