A structured exercise to relieve musculoskeletal pain caused by face-down posture after retinal surgery: a randomized controlled trial

Abstract

Face-down posture after vitrectomy physically burdens patients. Despite being of significant concern for patients, the intraoperative pain and discomfort has not been of great interest to retinal surgeons or researchers. This randomized controlled trial evaluated the effect of a 3-day novel structured exercise on reducing musculoskeletal pain from the face-down posture in 61 participants (31 in the exercise group) who underwent vitrectomy. Among the subjects, the median age was 62 years, 42 were female, 42 had macular holes, and 19 had retinal detachments. Participants in the exercise group received initial education on the exercise and performed three daily active exercise sessions. After the sessions, the exercise group had median numeric pain scores of 2, 1, and 1 at the back neck, shoulder, and lower back, respectively, while the control group had corresponding scores of 5, 3, and 4, respectively. The exercise group reported significantly lower pain scores (P = .003, .039, and .006 for the back neck, shoulder, and lower back, respectively). Application of the structured exercise would alleviate the patients' position-induced postoperative physical burden, by reducing pain and discomfort.

Figure 1

CONSORT flow diagram showing participant screening, recruitment, and randomization.

Figure 2

Patient Instructions for Proper FDP and Rehabilitation Exercise. (A) Basic FDP. Use a towel or pillow to support the forehead and reduce the load on the back neck. Use a pillow to support the upper body from the chest to the pelvis and keep them higher than the legs to reduce lower back load. Adjust pillow positioning to support the forehead and abdomen. (B) Modified FDP using a table (left), chair (middle), and walker (right). Maintaining only the basic FDP could put much strain on the neck, shoulders, and waist. Therefore, while maintaining basic FDP, modified FDP was occasionally applied, so that the physical stress is not concentrated in specific areas of the body. The following instructions were provided: (Left) Put a small table on the bed, and place the head on it. Use a towel or pillow to support your forehead, and place your arms naturally on either side of your head. (Middle) Adjust the height of the bed, place the chair at bedside, and maintain FDP while sitting. (Right) Adjust the height of the walking aids, and assume FDP in a standing position. Adjust the height of the bed, table, or walker properly, and use a pillow or towel under the forehead to avoid excessive neck or back bending. (C) Limb exercise in the basic FDP. Slowly lift one arm to shoulder level for 5–10 s, before putting it back into place. Slowly lift one leg to the level of the buttock with your straightened for 5 to 10 s, before put it back into place, to avoid straining the waist. The postures are then combined, such that the arms and legs are crossed. Each posture was maintained for 5 to 10 s and performed 10 times twice. This exercise stretches and strengthens the limbs and lower back muscles. (D) Limb exercise in standing FDP with walking aids. Walk slowly, and try not to lose balance and fall down. Each side was repeated 10 times for two to three sets. This exercise strengthens the muscles in the back and lower extremities. (E) Exercise in the hand and knee position: back stretching (left two rows), back bending, and forward bending (right two rows). With the head face down, take the hand-and-knee position. Sit back with the hips touching the heels with head maintained. Feel the stretch on your arms, shoulders, back, and buttocks; hold the position for 10–15 s; and then return to the hand-and-knee position. Repeat this for 5 to 10 times. Slowly lift the waist, making the spine round like a dome, then slower lower it, making the spine U-shaped. Maintain each posture for 5 to 10 s and performed 10 times twice. This exercise relaxes the shoulders, back, and spine, and strengthens the back muscles. The entire exercise session was repeated three times daily. During exercise, the position of the head should be maintained with the floor. This figure is created by Hani Yun from the Samsung Medical Information & Media Services, Samsung Medical Center.

Figure 3

Time trend of the overall pain scores in the exercise and control groups. The data are shown as medians with interquartile ranges (error bars). The median pain scores gradually increased in the control group. Meanwhile, the median pain score increased on postoperative day (POD) 1 and then declined on POD 2–3 in the exercise group. The median total pain score (interquartile range) on POD 3 was 11 (8–15) and 5 (2–9) in the control and exercise groups, respectively.