Exercise Program after Lumbar Laminectomy and Discectomy Surgery

1
Beginning Rehab after Low Back Surgery

Low back pain can limit your function in work and recreational activities.
Your physical therpist can guide your rehab after low back surgery. Jack Ambrose, Getty Images

If you have low back pain or sciatica from a herniated lumbar disc, you may benefit from physical therapy to help manage the pain.  Sometimes, conservative treatments like PT or injections fail to fully restore normal pain free mobility in your spine, and a surgical intervention is required.

A lumbar laminectomy and discectomy is a surgical procedure that your orthopedic or neurologic surgeon may perform the help you decrease your pain and improve your mobility.  The procedure involves cutting away disc and bone material that may be pressing against the nerves coming from your spine.

You may benefit from physical therapy after a lumbar laminectomy and discectomy to help you fully recover.  The goals of low back rehab after surgery are to help you regain full range of motion and strength in your spine and to help you return to your previous lifestyle.  Your PT will also work with you to develop an exercise program that you can do to help prevent future problems with your spine.

If you have had low back surgery, here is a step-by-step guide of things you may expect to do in physical therapy.  Before starting this, or any other exercise program, check in with your doctor to make sure it is safe for you to do.

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Postural Correction

Bad sitting posture (illustration)
Attain and maintain good posture while sitting after your back surgery. Wetcake Studio/iStock Vectors/Getty Images

After back surgery, you must work to maintain proper posture when you are sitting and standing.  Postural control is essential as it keeps your low back in the optimal position to protect your healing lumbar discs and muscles.

Your physical therapist can teach you how to sit with proper posture by using a lumbar roll to maintain your spine in the best position.  Other exercises and methods to maintain proper posture for your low back include:

Remember, attaining and maintaining proper posture for your low back is one of the most important things you can do to help protect your back and prevent future episodes of low back pain.

3
Start a Walking Exercise Program

Senior couple holding hands and walking in park
Walking after low back surgery is an important component of your rehab. Paul Bradbury/Caiaimage/Getty Images

Walking is one of the best exercises you can do after a lumbar laminectomy or discectomy surgery.  Why?  Because walking helps to improve blood flow throughout your body.  This helps to bring in oxygen and nutrients to you spinal muscles and tissues as they heal.

Walking also helps to improve your cardiovascular health, keeping your heart and lungs functioning properly after lumbar surgery.

The best things about walking after back surgery is that it is an upright exercise - your spine will naturally be in a good position while you walk.  This helps to protect your discs against future problems.

Starting a walking program after back surgery sounds easy; you just go out and walk, right?  There may be more to it, so checking in with your PT to help you set up a program tailored to your specific condition and needs may be the best option after back surgery.

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Prone Press Ups

Picture of the prone press up.
The prone press up exercise can help improve lumbar extension range of motion. Brett Sears, PT

 One of the simplest, yet most effective, exercises to protect your back and lumbar discs after laminectomy is the prone press up.  This exercise compresses the back of your healing discs and helps to keep them situated in the proper place in your low back.  It also helps to improve your ability to bend backwards into lumbar extension.

To perform the exercise, lie face down on a yoga mat on the floor and place both hands flat on the floor under your shoulders.  Keep your back and you hips relaxed, and use your arms to press the upper part of your body up while allowing your lower back to remain against the floor.  You should feel a slight pressure in your low back while pressing up.

Hold the press up position for two seconds, and then slowly lower back down to the starting position.  Repeat the exercise for 10 to 15 repetitions.

Be sure to check in with your doctor before starting this exercise to ensure it is safe for you to do after your lumbar laminectomy and discectomy surgery.

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Prone Straight Leg Raise

One of your physical therapy goals after lumbar laminectomy and discectomy may be to improve the strength and stability of your low back muscles.  This can improve the support that the muscular system of your back gives to your spine.

One great exercise to help improve your low back strength is the prone straight leg raise (SLR) exercise.  To perform the exercise, lie on your stomach (prone), tighten your abdominal muscles, and slowly lift one leg up in the air.  Hold the straight leg up for 2 seconds, and then slowly lower it down.  Repeat for 10 to 15 repetitions.

The Prone SLR can be performed once or twice a day, but be sure to check in with your physical therapist before starting the exercise to ensure that it is safe for you to do.

6
Sciatic Nerve Gliding

If you had leg pain coming from your back prior to surgery, you may have been diagnosed with sciatica, or an irritation of your sciatic nerve.  After surgery, you may notice that your leg feels tight whenever your straighten it out all the way.   This may be a sign of an adhered sciatic nerve root, a common problem in people with sciatica.

After your lumbar laminectomy and discectomy surgery, your physical therapist may prescribe specific exercises, called sciatic nerve glides, to help stretch and improve the way your sciatic nerve moves in your back.  This can help free the adhered nerve root and allow for normal motion to occur.

To perform sciatic nerve gliding, lie on your back and bend one knee up.  Grab underneath your knee with your hands, and then straighten your knee while supporting it with your hands. Once your knee is fully straightened, flex and extend your ankle about 5 times, and then return to the starting position.

Repeat the sciatic nerve glide 10 times.  The exercise can be performed several times to help improve the way your sciatic nerve moves and glides in your low back and leg.

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Supine Lumbar Flexion

Lumbar flexion in lying
Perform low back flexion by pulling your knees towards your chest. Brett Sears, PT, 2013

 After your low back surgery, your physical therapist may prescribe gentle back flexion exercises.  This can help safely stretch your low back muscles.  It can also be used to gently stretch the scar tissue in your low back from the surgical incision.

Supine lumbar flexion is one of the simplest things to do to improve your lumbar flexion ROM after low back surgery.  To perform the exercise, lie on your back with your knees bent.  Slowly lift your bent knees up towards your chest, and grasp your knees with both hands.  Gently pull your knees toward your chest, and hold the position for 1 or 2 seconds.  Slowly lower your knees back down to the starting position.

You can perform the supine lumbar flexion exercise for 10 repetitions.  Be sure to stop the exercise if you are experiencing any increase in pain in your low back, buttocks, or legs.

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Posterior Pelvic Tilt

After a lumbar laminectomy and discectomy, your physical therapist may prescribe exercises to help improve your abdominal strength.  One exercise to start improving the way your abdominal and core muscles contract is the posterior pelvic tilt.

To perform the posterior pelvic tilt, lie on your back with both knees bent.  Slowly rock your pelvis backwards, as if you are trying to flatten your low back into the floor.  Tighten your abdominal muscles as you tilt your pelvis posteriorly, and hold the position for 2 seconds.

Slowly release the pelvic tilt to return to the starting position.  You can perform the posterior pelvic tilt for 10 to 15 repetitions.  This exercise can be difficult to properly perform, so be sure to check in with your PT before you start to avoid common errors that may make the exercise inneffective.  

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Hip and Core Strengthening

SLR-flexion.JPG
Engage the abdominals and slowly raise your straight leg about 12-15 inches. Brett Sears, PT, 2011

Once you have mastered the posterior pelvic tilt, you can progress your abdominal and core strengthening program.  This involves performing specific motions for your hips and legs while maintaining the pelvic neutral position.

Advanced hip strengthening exercises may be started to help you gain strength and stability in the muscles that surround your pelvic area and low back.  Your physical therapist can help you decide which exercises are best for your specific condition.  

10
Proper Lifting Techniques and Return to Work Activities

Woman with poor posture sitting at desk in chair
Diane Diederich/E+/Getty Images

Once your have gained improved lumbar ROM, hip, and core strength, it may be time to start to work on specific activities to help you return to your previous level of work and recreation.  Depending on your work, you may need to work on proper lifting techniques, or you may require an ergonomic evaluation if you spend time sitting at a desk or a computer terminal.

Be sure to work closely with your doctor and physical therapist before returning to work to ensure that it is safe for you to do and to be certain you are ready for normal work and recreational activities.

Low back surgery, such as a lumbar laminectomy and discectomy, can be difficult to properly rehab.  By working with your doctor and physical therapist, you can be sure to improve your ROM, strength, and functional mobility in order to return to your previous level of function quickly and safely.

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