Physical exercise reduces pain in lumbar disc herniation: meta-analysis of 13 RCTs

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Musculoskeletal care Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Linhares Diego Gama, Linhares Bruno Gama, Cordeiro Lilliany de Souza, Borba-Pinheiro Claudio Joaquim… PubMed ↗ DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider physical exercise for pain reduction in lumbar disc herniation, but interpret results cautiously due to high heterogeneity.

This systematic review and meta-analysis included 13 randomized controlled trials (12 in the forest plot) drawn from 864 identified studies, evaluating the effect of physical exercise on pain in adult patients with lumbar disc herniation. The primary outcome was pain intensity.

The pooled analysis showed a significant reduction in pain favoring the exercise intervention, with a standardized mean difference of -0.68 (95% CI: -1.11 to -0.25; p = 0.002). However, substantial heterogeneity was observed among the included studies (I² = 89%; p < 0.0001), and this heterogeneity was not explained by subgroup analysis or meta-regression. The authors used a random-effects model to account for unexplained heterogeneity.

The quality of evidence was assessed using the GRADE tool, but the specific rating was not reported. The review did not report on adverse events, serious adverse events, or discontinuations. The authors note that physical exercise is associated with a better prognosis in the treatment of lumbar disc herniation, but the high heterogeneity limits the strength of this conclusion. Clinicians should consider exercise as a potentially beneficial intervention while acknowledging the uncertainty in the evidence base.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID42215311

View Original Abstract ↓

OBJECTIVE: The aim of this study was to analyse the effects of physical exercise on pain in patients with lumbar disc herniation, regardless of whether they had undergone surgery. METHODS: A meta-analysis was conducted according to the PRISMA guidelines. Randomised controlled trials (RCTs) were selected based on the PICOS strategy, and methodological quality and risk of bias were assessed using the TESTEX scale and the RoB 2 tool, respectively. The GRADE tool was used to assess the quality of evidence. Electronic searches were performed in the PubMed, Scopus, Web of Science, Cochrane, and PEDro databases. Subgroup analyses were conducted in an attempt to explain heterogeneity. RESULTS: A total of 864 studies were identified. After applying the eligibility criteria, 13 randomised controlled trials were included in the systematic review, with 12 studies included in the forest plot, comprising 18 analyses. Pain outcomes were assessed using different measurement instruments, and the meta-analysis demonstrated a significant reduction in pain favouring the exercise intervention, with a standardised mean difference of -0.68 (95% CI: -1.11 to -0.25; p = 0.002). However, substantial heterogeneity was observed among the included studies (I = 89%; p < 0.0001). As this heterogeneity was not explained by subgroup analysis or meta-regression, a random-effects model was used for statistical adjustment. CONCLUSION: This meta-analysis concluded that physical exercise improves pain-related outcomes in adult patients. Notably, the forest plot demonstrated a significant mean difference. These findings suggest that physical exercise is associated with a better prognosis in the treatment of lumbar disc herniation.