title: Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy.
abstract: BACKGROUND
  Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy.
  
  
  METHODS
  Patients were randomly assigned into transmuscular (n=12) or paramedian lumbar surgery (n=13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n=12) or usual care (n=13). Primary outcomes were center of pressure displacement during ankle and back muscles vibration (to evaluate proprioceptive use), and the duration of five sit-to-stand-to-sit movements, evaluated at 2 (baseline), 8 and 24 weeks after surgery.
  
  
  RESULTS
  Two weeks after surgery, all patients showed smaller responses to back compared to ankle muscles vibration (P<0.05). Patients that underwent a transmuscular surgical procedure and patients that received physiotherapy switched to larger responses to back muscles vibration at 24 weeks, compared to 2 weeks after surgery (P<0.005), although not seen in the paramedian group and usual care group (P>0.05). Already 8 weeks after surgery, the physiotherapy group needed significantly less time to perform five sit-to-stand-to-sit movements compared to the usual care group (P<0.05).
  
  
  CONCLUSIONS
  Shortly after lumbar microdiscectomy, patients favor reliance on ankle proprioceptive signals over lumbosacral proprioceptive reliance to maintain posture, which resembles the behavior of patients with non-specific low back pain. However, early active physiotherapy after lumbar microdiscectomy facilitated higher reliance on lumbosacral proprioceptive signals and early improvement of sit-to-stand-to-sit performance. Transmuscular lumbar surgery favoured recovery of lumbosacral proprioception 6 months after surgery.
  
  
  BACKGROUND
  NCT01505595.
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium. Electronic address: Lotte.Janssens@faber.kuleuven.be.
authors.forename: Lotte
authors.initials: L
authors.lastname: Janssens
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: Simon.Brumagne@faber.kuleuven.be.
authors.forename: Simon
authors.initials: S
authors.lastname: Brumagne
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven Department of Rehabilitation Sciences, Campus Brugge, Bruges, Belgium. Electronic address: Kurt.Claeys@faber.kuleuven.be.
authors.forename: Kurt
authors.initials: K
authors.lastname: Claeys
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: m.pijnenburg@fontys.nl.
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijnenburg
authors.affiliation: KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: Nina.Goossens@kuleuven.be.
authors.forename: Nina
authors.initials: N
authors.lastname: Goossens
authors.affiliation: Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium. Electronic address: Sofie.Rummens@uzleuven.be.
authors.forename: Sofie
authors.initials: S
authors.lastname: Rummens
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium. Electronic address: Bart.Depreitere@med.kuleuven.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Depreitere
mesh_terms: D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000502:physiology*; D000843:Ankle Joint; D064131:Back Muscles / Q000502:physiology*; D001416:Back Pain; D017586:Diskectomy / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000502:physiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology*; D011434:Proprioception / Q000502:physiology*; D016896:Treatment Outcome; D014732:Vibration
keywords: Low back pain; Microdiscectomy; Physiotherapy; Postural control; Proprioception; Sit to stand