Rehabilitation with osteopathic manipulative treatment after lumbar disc surgery: A randomised, controlled pilot study

Published:November 25, 2014DOI:



      Despite growing evidence regarding the role of osteopathic manipulative treatment (OMT) for the management of low back pain, there is little evidence to support the use of OMT as a post-operative rehabilitation to improve the functional outcomes of lumbar disc surgery.


      To assess the feasibility for a future definitive randomised control trial that would indicate whether OMT improves post-operative outcomes after lumbar microdiscectomy compared to a standard exercise programme.


      Randomised controlled pilot study.


      Department of Spinal Surgery and Department of Spinal Rehabilitation at a major metropolitan spine surgery hospital, Seoul, South Korea.


      Patients who underwent lumbar microdiscectomy due to low back pain with referred leg pain resulting from a herniated disc were enrolled in the study. Thirty-three patients aged 25–65 years were randomly assigned using a random number table to the OMT (n = 16) group or exercise group (n = 17). Patients received the allocated intervention twice a week for 4 weeks. Each session was 30 min. Primary outcomes were post-surgical functional disability and intensity of low back and leg pain. Outcome measures were assessed at baseline (2–3 weeks after surgery) and post-intervention (7–8 weeks after surgery). Double blinding was not feasible in the study setting.


      Thirty-three participants were analysed. Both rehabilitation interventions improved all primary and secondary outcomes. Post-surgical physical disability improved more with OMT rehabilitation than the exercise programme (54% vs. 26%, P < 0.05). Residual leg pain decreased with OMT (53%) and exercise (17%). Post-operative low back pain decreased by 37% in the OMT group and 10% in the exercise group. Patients in both groups required less frequent use of medication and were highly satisfied with the rehabilitation interventions. No side effects or complications from any intervention were reported.


      The current pilot study shows the feasibility of a future definitive randomised control trial investigating whether rehabilitation with OMT is a viable approach for post-operative management of a lumbar microdiscectomy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal


      Subscribe to International Journal of Osteopathic Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Walker B.F.
        The prevalence of low back pain: a systematic review of the literature from 1966 to 1998.
        J Spinal Disord Tech. 2000; 13: 205-217
        • Singh V.
        • Manchikanti L.
        • Calodney A.K.
        • Staats P.S.
        • Falco F.J.E.
        • Caraway D.L.
        • et al.
        Percutaneous lumbar laser disc decompression: an update of current evidence.
        Pain Physician. 2013; 16: SE229-SE260
        • Gibson J.N.A.
        • Waddell G.
        Surgical interventions for lumbar disc prolapse: updated Cochrane Review.
        Spine. 2007; 32: 1735-1747
        • Weinstein J.N.
        • Lurie J.D.
        • Tosteson T.D.
        • Tosteson A.N.
        • Blood E.
        • Abdu W.A.
        • et al.
        Surgical versus non-operative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT).
        Spine. 2008; 33: 2789
        • Weinstein J.N.
        • Tosteson T.D.
        • Lurie J.D.
        • Tosteson A.N.
        • Hanscom B.
        • Skinner J.S.
        • et al.
        Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial.
        JAMA. 2006; 296: 2441-2450
        • Atlas S.J.
        • Keller R.B.
        • Wu Y.A.
        • Deyo R.A.
        • Singer D.E.
        Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study.
        Spine. 2005; 30: 927-935
        • Loupasis G.A.
        • Stamos K.
        • Katonis P.G.
        • Sapkas G.
        • Korres D.S.
        • Hartofilakidis G.
        Seven-to 20-year outcome of lumbar discectomy.
        Spine. 1999; 24: 2313
        • Manniche C.
        • Skall H.F.
        • Braendholt L.
        • Christensen B.H.
        • Christophersen L.
        • Ellegaard B.
        • et al.
        Clinical trial of postoperative dynamic back exercises after first lumbar discectomy.
        Spine. 1993; 18: 92-97
        • Ostelo R.W.
        • de Vet H.C.
        • Waddell G.
        • Kerckhoffs M.R.
        • Leffers P.
        • van Tulder M.
        Rehabilitation following first-time lumbar disc surgery: a systematic review within the Framework of the Cochrane Collaboration.
        Spine. 2003; 28: 209-218
        • Ostelo R.W.
        • de Vet H.C.
        • Vlaeyen J.W.
        • Kerckhoffs M.R.
        • Berfelo W.M.
        • Wolters P.M.
        • et al.
        Behavioral graded activity following first-time lumbar disc surgery: 1-year results of a randomized clinical trial.
        Spine. 2003; 28: 1757-1765
        • Häkkinen A.
        • Ylinen J.
        • Kautiainen H.
        • Tarvainen U.
        • Kiviranta I.
        Effects of home strength training and stretching versus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up.
        Arch Phys Med Rehabil. 2005; 86: 865-870
        • McGregor A.H.
        • Henley A.
        • Morris T.P.
        • Doré C.J.
        An evaluation of a postoperative rehabilitation program after spinal surgery and its impact on outcome.
        Spine. 2012; 37: E417
        • Ostelo R.W.J.G.
        • Costa L.O.P.
        • Maher C.G.
        • de Vet H.C.W.
        • van Tulder M.W.
        Rehabilitation after lumbar disc surgery an update Cochrane Review.
        Spine. 2009; 34: 1839-1848
        • Kjellby-Wendt G.
        • Styf J.
        • Carlsson S.G.
        Early active rehabilitation after surgery for lumbar disc herniation: a prospective, randomized study of psychometric assessment in 50 patients.
        Acta Orthop. 2001; 72: 518-524
        • Kjellby-Wendt G.
        • Styf J.
        Early active training after lumbar discectomy: a prospective, randomized, and controlled study.
        Spine. 1998; 23: 2345-2351
        • Danielsen J.M.
        • Johnsen R.
        • Kibsgaard S.K.
        • Hellevik E.
        Early aggressive exercise for postoperative rehabilitation after discectomy.
        Spine. 2000; 25: 1015-1020
        • van Tulder M.
        • Becker A.
        • Bekkering T.
        • Breen A.
        • Gil del Real M.T.
        • Hutchinson A.
        • et al.
        Chapter 3-European guidelines for the management of acute nonspecific low back pain in primary care.
        Eur Spine J. 2006; 15: S169-S191
        • Airaksinen O.
        • Brox J.I.
        • Cedraschi C.O.
        • Hildebrandt J.
        • Klaber-Moffett J.
        • Kovacs F.
        • et al.
        Chapter 4-European guidelines for the management of chronic nonspecific low back pain.
        Eur Spine J. 2006; 15: S192-S300
        • Savigny P.
        • Watson P.
        • Underwood M.
        • Guideline Dev G.
        Guidelines early management of persistent non-specific low back pain: summary of NICE guidance.
        Br Med J. 2009; 338
        • Licciardone J.C.
        • Brimhall A.K.
        • King L.N.
        Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials.
        BMC Musculoskelet Disord. 2005; 6: 43
        • Andersson G.B.J.
        • Lucente T.
        • Davis A.M.
        • Kappler R.E.
        • Lipton J.A.
        • Leurgans S.
        A comparison of osteopathic spinal manipulation with standard care for patients with low back pain.
        N Engl J Med. 1999; 341: 1426-1431
        • Ostelo R.W.
        • de Vet H.C.
        • Knol D.L.
        • van den Brandt P.A.
        24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery.
        J Clin Epidemiol. 2004; 57: 268-276
        • Jarski R.W.
        • Loniewski E.G.
        • Williams J.
        • Bahu A.
        • Shafinia S.
        • Gibbs K.
        • et al.
        The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study.
        Altern Ther Health Med. 2000; 6: 77-81
        • Licciardone J.C.
        • Stoll S.T.
        • Cardarelli K.M.
        • Gamber R.G.
        • Swift J.N.
        • Winn W.B.
        A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty.
        J Am Osteopath Assoc. 2004; 104: 193-202
        • Wieting J.M.
        • Beal C.
        • Roth G.L.
        • Gorbis S.
        • Dillard L.
        • Gilliland D.
        • et al.
        The effect of osteopathic manipulative treatment on postoperative medical and functional recovery of coronary artery bypass graft patients.
        J Am Osteopath Assoc. 2013; 113: 384-393
        • O-Yurvati A.H.
        • Carnes M.S.
        • Clearfield M.B.
        • Stoll S.T.
        • McConathy W.J.
        Hemodynamic effects of osteopathic manipulative treatment immediately after coronary artery bypass graft surgery.
        J Am Osteopath Assoc. 2005; 105: 475-481
        • Rönnberg K.
        • Lind B.
        • Zoëga B.
        • Halldin K.
        • Gellerstedt M.
        • Brisby H.
        Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery.
        Spine. 2007; 32: 256-261
        • Lurie J.D.
        • Berven S.H.
        • Gibson-Chambers J.
        • Tosteson T.
        • Tosteson A.
        • Hu S.S.
        • et al.
        Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation.
        Spine. 2008; 33: 2663