Rehabilitation program with controlled load progression as a means of correcting pain and mobility of the lumbar spine in case of L5–S1 disc degeneration

Abstract

Purpose. To develop and evaluate the effectiveness of a physical rehabilitation program of reparative-regenerative orientation in individuals with degenerative changes in the L5–S1 intervertebral disc in terms of reducing pain and improving functional mobility of the lumbar spine.

Material & Methods. A pilot study was conducted with the participation of 25 individuals with clinically and instrumentally confirmed degenerative changes in the L5–S1 disc (mean age 38.3±6.2 years), who provided written informed consent. The study was performed in accordance with the provisions of the Declaration of Helsinki. The intensity of the pain syndrome was assessed using a visual analog scale (VAS) separately in the standing, sitting and moving positions. Mobility and flexibility of the lumbar spine were determined by the “forward tilt” test, the Schober test and the active back extension index (in degrees). The rehabilitation program lasted 13 weeks and was implemented in the format of a six-day training microcycle with one recovery day. The central element was a modified decompression-stabilization exercise without external weighting with a clearly regulated progression from 1 to 10 repetitions per day. Descriptive statistics and the Wilcoxon test for related samples (p<0.05) were used for statistical analysis.

Results. After completing the program, a significant decrease in pain intensity according to VAS was recorded in all functional positions: in the standing position – from 5.55±0.99 to 3.86±1.18 cm (p<0.001), in the sitting position – from 4.84±0.91 to 3.93±0.87 cm (p<0.001), in movement – from 4.84±0.91 to 3.92±0.65 cm (p<0.01). A significant improvement in flexibility and mobility indicators was noted: a decrease in the distance when leaning forward from 28.71±13.47 to 18.05±11.24 cm (p<0.01), an increase in the Schober test score from 6.45±1.63 to 7.35±1.01 cm (p<0.05), and an increase in active back extension from 14.63±6.31° to 21.95±4.37° (p<0.001).

Conclusions. The program of physical rehabilitation of reparative-regenerative orientation provides a reliable reduction of pain syndrome and improvement of mobility and flexibility of the lumbar spine in individuals with degenerative changes of the L5–S1 disc. The proposed approach can be considered as a safe and effective strategy of non-drug rehabilitation of this category of patients.