Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 30:23:100620.
doi: 10.1016/j.xnsj.2025.100620. eCollection 2025 Sep.

Therapeutic exercise following lumbar spine surgery: a narrative review

Ram Haddas  1 , Andréas Remis  2 , Yair Barzilay  3 , Varun Puvanesarajah  1 , Jake Keller  1 , Brian M Clifford  4 , Justin M Lantz  5 , John M Mayer  6
Affiliations

Therapeutic exercise following lumbar spine surgery: a narrative review

Ram Haddas et al. N Am Spine Soc J. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Balance effort; Low back pain; Lumbar discectomy; Lumbar fusion; Risk of falls; Therapeutic exercise; Total disc replacement; Wearables.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Examples of exercises to perform and be cautious of in early-recovery following spine surgery.
Fig 2
Fig. 2
Example of graded-progression of lumbar spine motion.
See this image and copyright information in PMC

References

    1. Cancelliere C., Wong J.J., Yu H., et al. Postsurgical rehabilitation for adults with low back pain with or without radiculopathy who were treated surgically: protocol for a mixed studies systematic review. BMJ Open. 2020;10(3) - PMC - PubMed
    1. Ebenbichler G.R., Inschlag S., Pfluger V., et al. Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation. Clin Rehabil. 2015;29(6):548–560. - PubMed
    1. Manni T., Ferri N., Vanti C., et al. Rehabilitation after lumbar spine surgery in adults: a systematic review with meta-analysis. Arch Physiother. 2023;13(1):21. - PMC - PubMed
    1. Atsidakou N., Matsi A.E., Christakou A. The effectiveness of exercise program after lumbar discectomy surgery. J Clin Orthop Trauma. 2021;16:99–105. - PMC - PubMed
    1. Taylor N.F., Dodd K.J., Shields N., Bruder A. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother. 2007;53(1):7–16. - PubMed

LinkOut - more resources