Comparison Of Early Mobilization And Electrical Stimulation On Functional Recovery After Lumbar Disc Herniation Surgery (EMES-LDH)

Lumbar disc herniation is one of the most prevalent musculoskeletal conditions leading to low back pain, disability, and reduced functional capacity in adults. Surgical treatment is commonly indicated in patients with persistent symptoms or neurological deficits who do not respond to conservative management. Despite successful surgical intervention, postoperative recovery outcomes vary considerably and are highly influenced by rehabilitation strategies.

Early mobilization is considered a cornerstone of postoperative rehabilitation, as it reduces the risk of complications such as deep vein thrombosis, muscle atrophy, and joint stiffness. It also promotes faster recovery of functional independence and return to daily activities. However, early mobilization alone may not be sufficient to optimize neuromuscular recovery and pain management in all patients.

Electrical stimulation modalities, including neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS), have been increasingly utilized in rehabilitation settings. NMES facilitates muscle activation and prevents disuse atrophy, while TENS is widely used for pain modulation through neurophysiological mechanisms such as gate control theory. These modalities may provide additional benefits when combined with conventional rehabilitation approaches.

However, there is a limited number of high-quality randomized controlled trials directly comparing early mobilization alone with electrical stimulation-supported rehabilitation in patients following lumbar disc herniation surgery. This gap in the literature highlights the need for well-designed clinical trials to guide evidence-based practice.

Study Design

This study is designed as a prospective, two-arm, parallel-group randomized controlled trial. Participants will be randomly allocated using a computer-generated randomization method into one of two groups:

Group 1: Early mobilization program Group 2: Early mobilization combined with electrical stimulation (NMES/TENS) Intervention Protocol Both groups will participate in a structured rehabilitation program conducted three times per week for 6-8 weeks. The early mobilization program will include gradual ambulation, posture training, range of motion exercises, and functional activity training.

In the intervention group, electrical stimulation will be applied to paraspinal and lower extremity muscle groups. The parameters of NMES and TENS will be adjusted based on patient tolerance and clinical indications.

Outcome Measures Assessments will be performed at baseline (pre-intervention) and after completion of the intervention program.

Primary Outcomes:

Functional disability: Oswestry Disability Index (ODI) Pain intensity: Visual Analog Scale (VAS)

Secondary Outcomes:

Functional mobility: Timed Up and Go (TUG) test Walking speed: 10-Meter Walk Test (10MWT) Muscle strength: Manual Muscle Testing (MMT) Eligibility Criteria Participants aged between 18 and 65 years who have undergone primary lumbar disc herniation surgery and are in the early postoperative period (within the first 2 weeks) will be included. Patients with previous spinal surgery, severe neurological deficits, contraindications to electrical stimulation (e.g., pacemaker), or serious systemic diseases will be excluded.

Statistical Analysis Data will be analyzed using IBM SPSS Statistics software. Normality will be assessed using the Shapiro-Wilk test. Between-group comparisons will be performed using independent samples t-test or Mann-Whitney U test, while within-group comparisons will be analyzed using paired samples t-test or Wilcoxon signed-rank test. A two-way repeated measures ANOVA will be used to evaluate group-by-time interactions. A p-value of less than 0.05 will be considered statistically significant.

Expected Outcomes and Significance This study aims to provide high-quality evidence regarding the comparative effectiveness of early mobilization and electrical stimulation-supported rehabilitation. The results are expected to support clinical decision-making, optimize postoperative rehabilitation protocols, and contribute to the advancement of evidence-based physiotherapy practices.