Marin Luca (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy), (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic)
Chiodaroli Matteo (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)
Gatti Alessandro (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy)
Carlone Nicolò (Degree Course in Physiotherapy, University of Pavia, Pavia, Italy), (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy)
Manzoni Federica (S.C. Epidemiology, Health Protection Agency of Pavia, Pavia, Italy)
Re Fabio (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)
Patanè Pamela (Laboratory of Adapted Motor Activity (LAMA), University of Pavia, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy), (Department of Industrial Engineering, University of Tor Vergata, Rome, Italy)
Abbiati Fabrizio (Department of Rehabilitation, Healthcare Institute “Città di Pavia”, Gruppo San Donato, Pavia, Italy), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)
Febbi Massimiliano (Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic), (Laboratory for Rehabilitation, Medicine and Sport (LARMS), Rome, Italy)
Conservative therapy is usually the first choice for spine disc herniation and most of patients benefit from this treatment. Microscopic lumbar discectomy (MLD) is often the best alternative when conservative therapy fails. However, in the early days post-MLD many patients show functional impairments and kinesiophobia that are associated with worse clinical outcomes.
Spinal proprioception is crucial but patients tend to use more signals coming from the ankle. Lower levels of spinal proprioception and balance lead to sensorimotor alterations and impaired motor control which are both risk factors for postural alterations, trauma and pain.
Therefore, immediately encouraging patients to be active and do core activation exercises is essential. Aim of the study is to evaluate the acute effects of two different physiotherapic methods, both involving core perception and activation, on balance and spine alignment in patients that underwent MLD.
From 20th June to 28th July 2023, 12 patients (6 female) candidates for MLD, were recruited. After signing an informed consent they were randomly assigned to one of the two Core activation exercises study group: Visual biofeedback, with stabilometric platform and inertial sensor (BF) (Riablo, Euleria, Rovereto, Italy) or squared up mirror (ES).
Both interventions lasted 10 minutes and included the same exercises, supervised by Physiotherapist. Before (T0) and after (T1) the intervention an assessment was made. Spine alignment (RMS) was evaluated with Spine 3D (Sensormedica, Guidonia, Rome), a non-invasive, three-dimensional optoelectronic detection system that uses Light Detection and Ranging technology, while balance with a stabilometric platform (FreeMed, sensormedica). In T0, participants were asked to assume the most comfortable position. In T1, they were asked to assume the most correct posture possible, using the sensorimotor information learned with the intervention.
The Bruschen-Pagan test was used to determine whether the model was parametric or not. To compare improvement between groups, while controlling for baseline levels, we used analysis of covariance (ANCOVA). Quantitative variables are expressed as mean and standard deviation. The significance was set at p<0.05. All analyses were performed using R Statistical Software (v4.1.2; R Core Team 2021).
In T1, compared to T0, all balance parameters improve slightly in BF and worsen in ES; all values aren’t significant.
Ellipse Area: BF (133.61±76.66; 216.16±229.78), ES (157.39±93.91; 143.72±67.63) p 0.091. Ellipse Eccentricity: BF (0.32±0.22; 0.25±0.24), ES (0.50±0.39; 0.59±0.18) p 0.53. Delta X: BF (12.90±4.92; 13.41±6.19), ES (16.47±9.00; 13.75±5.08) p 0.342. Delta Y: BF (11.33±3.72; 13.76±6.30), ES (13.42±2.42; 12.31±4.88) p 0.083. RMS improves in BF (5.17±3.31; 6.00±3.31) while it worsens in ES (3.50±1.38; 3.31±2.04); both values aren’t significant.
It is known that immediately after spine surgery the perceptual-motor adaptation mechanisms are reduced or absent. In addition a postural correction, greater than the usual one causes difficulties to somato-sensory system to adapt to the new position. A previous study, done on the same population and with the same methodology but without the biofeedback provided by stabilometry, had shown a worsening of balance in both groups, greater in the group that had an improvement in RMS. The acute improvements of balance and spine alignment in BF compared to ES seem to indicate that the biofeedback given by the technology is useful to improve posture and balance of patients undergoing MLD. Limitations of the study are the small number of the sample and the single session of exercises, justified by the reduced post-MLD hospitalization time. Further studies, with a significant sample size and more sessions, are needed.
1) Chen B-L, Guo J-B, Zhang H-W, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clinical Rehabilitation. 2018;32(2):146-160.
2) Gilmore, S. J., Hahne, A. J., Davidson, M., McClelland, J. A. (2020). Physical activity patterns of patients immediately after lumbar surgery. Disability and rehabilitation, 42(26), 3793–3799.
3) Hebert, J. J., Fritz, J. M., Thackeray, A., Koppenhaver, S. L., & Teyhen, D. (2015). Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function. British journal of sports medicine, 49(2), 100–106.
