Physical Therapy After Low Back Surgery

Rehab after Low Back Surgery

Low back pain can limit your function in work and recreational activities.
Take steps to limit and abolish your low back pain now.. Jack Ambrose, Getty Images

If you have low back pain or sciatica, you may benefit from working with a physical therapist to help you manage your condition.   Your PT can help you decrease your pain and improve your mobility with specific therapeutic exercises and postural correction.

If exercise, postural correction, or other physical therapy treatments fail to give you adequate relief of your symptoms, you may need to visit your doctor to consider other options.

 Occasionally, your symptoms may be so severe that you require surgery to obtain relief from your low back pain or sciatica.

A lumbar discectomy and laminectomy are common surgeries used to help give you relief from painful symptoms originating from your back.  These surgical procedures are intended to decrease pressure on the nerves coming from your back that are causing your sciatica.

If you do require a surgical procedure on your spine to manage your symptoms, you may benefit from physical therapy after surgery to help you return fully to your previous level of function.  Your surgeon can make specific recommendations about your post-operative course and can help you choose the right physical therapist for you.
Do I Even Need PT after a Lumbar Laminectomy or Discectomy?

After your lumbar surgery, you may be feeling well with little or no sciatic symptoms.  Your back may be sore from surgery, but you should quickly be feeling very little pain.

 You may start to question if you even would benefit from physical therapy after lumbar laminectomy.

Research indicates that people who participate in physical exercise after lumbar discectomy tend to have better outcomes when compared to patients who do not engage in regular exercise.  Your physical therapist can help you determine the correct exercises to perform after surgery.

When Should I Start Physical Therapy after Lumbar Laminectomy or Discectomy?

In general, you should expect to start physical therapy 4 to 6 weeks after your lumbar surgery.  If there were any post-operative complications like infection or excessive bleeding, then you may need to wait a bit longer.  Conversely, if things have been smooth sailing after your surgery, you may start PT sooner.  After your lumbar discectomy, you should have a discussion with your doctor about when to start rehabilitation

Physical Therapy Evaluation after Lumbar Laminectomy or Discectomy

Once you have your surgery and your doctor has cleared you to start physical therapy, you will need to make an appointment at a local physical therapy clinic.  During your first visit, your physical therapist will conduct an initial evaluation and assessment.  Components of the initial evaluation include, but are not limited to:

  • History taking.  Prior to any formal assessment, your physical therapist will take a written or verbal history.  Questions will be asked about how you are feeling, how your injury occurred, and if there were any complications after your surgery.  Your PT will also ask about your past medical history.  This is a good time to ask questions and to start to develop a rapport with your physical therapist.
  • Postural assessment. Since proper posture plays such an important role in maintaining a healthy spine, your PT will likely assess your posture.  He or she will look at your spine while you are sitting and standing and record findings related to your posture.  He or she can help you attain and maintain proper posture while sitting and standing.
  • Range of motion. Your physical therapist will also measure your lumbar range of motion (ROM).  A device called a goniometer or bubble inclinometer may be used to get a baseline reading of your spinal mobility.
  • Strength. Your physical therapist will measure your strength during your initial visit.  If you had weakness or muscle paralysis due to compression of a spinal nerve prior to surgery, your physical therapist will measure the strength of those muscles.  He or she may also assess the strength of your abdominal and back muscles, hip and thigh muscles, or muscles around your lower legs.
  • Scar tissue assessment. After a lumbar laminectomy or discectomy, you will have a small surgical incision in your low back.  Your physical therapist may assess the scar tissue mobility to ensure that the skin and underlying tissues are not restricting your motion.
  • Neurological screen. Your physical therapist may perform a neurological screen during your initial evaluation.  He or she may test your deep tendon reflexes with a reflex hammer, and your ability to discern light touch or pressure may be assessed.
  • Flexibility assessment. Your overall flexibility of your body may be evaluated after a lumbar laminectomy.  Muscles groups that will likely be assessed include the hamstrings, quadriceps, and the calf muscles.  Sometimes after a lumbar laminectomy and discectomy, tightness in your sciatic nerve may be present.  This is called an adhered nerve root and is caused by slight scar tissue forming around the nerve as it exits your spinal canal.
  • Functional assessment. Your physical therapist will also assess your overall function after surgery.  Are you able to work?  Can you participate in your normal recreational activities?  Are you limited functionally in any way?  Answers to these questions can help your PT work with you to develop specific rehabilitation goals after your surgery.

Physical Therapy Treatment after Lumbar Laminectomy or Discectomy

The results of your specific evaluation will help your physical therapist develop a treatment plan after your lumbar laminectomy.  Occasionally, your doctor may want you to follow a specific post-operative protocol, and your physical therapist can help you stay on track.

There may be various components of your physical therapy care, so be sure to ask questions about the treatment that you receive.  Common treatments after lumbar laminectomy and discectomy include:

Exercise. A post-operative exercise program should be one of the main focuses of your rehab following lumbar laminectomy.  Studies indicate that people who engage in exercise after back surgery have superior outcomes with compared to those who do not exercise.

Specific exercises include progressive lumbar ROM exercises and hip and core strengthening exercises.  If you physical therapist found weakness in a muscle group due to pre-operative compression of a nerve, specific exercises may focus on that muscle.  Cardiovascular exercise like treadmill walking may also be prescribed to help improve your overall functional endurance.  Your PT can teach you how to properly monitor your exercise intensity.

Your physical therapist may also prescribe exercises to increase overall flexibility in your hamstrings, calves, and quadriceps muscles.

Since postural control is such an important component of maintaining spinal health, your physical therapist should teach you how to sit properly.  Exercises like the slouch-overcorrect procedure may be useful to attain proper posture.

Physical modalities.  If you are experiencing pain following your surgery, your physical therapist may choose to use certain physical modalities to help control your pain.  Modalities like electrical stimulation and TENS may be used to help control your pain.

Heat may be used to help relax muscles and improve circulation around your back, and ice may be used to help decrease swelling and pain near your surgical site.

Care should be exercised when using physical modalities-research shows that some treatments may not offer the proposed benefits.  Your physical therapist is a movement expert, so if you are only receiving passive treatments like heat or ice, you should question whether you are receiving the best care for your back.

Scar massage.  If you physical therapist finds tightness around your surgical incision, he or she may engage in specific scar mobilization techniques.

In general, your physical therapy episode of care should last anywhere from three to six weeks.  Your physical therapist should ensure that you have a program in place to continue exercising.  He or she should also make sure you know what to do if low back pain or sciatica strikes again.

Prevention of Future Problems

An important component of your physical therapy program is to learn how to prevent future problems with your back.  Your physical therapist can help you determine risk factors that may lead to low back pain or sciatica.  Methods to prevent future back problems include:

  • Maintaining proper posture when sitting
  • Avoiding frequent forward bending
  • Avoiding heavy lifting
  • Exercising regularly

If you have had a lumbar laminectomy and discectomy to help you treat your sciatica, you may benefit from physical therapy after surgery.  Your physical therapist can work with you to help you improve your overall mobility so you can quickly and safely return to your normal activity and function.

Source: Beneck, JG, etal (2014)Intensive, progressive exercise improves quality of life following lumbar microdiskectomy: a randomized controlled trial. Clin Rehabil. 2014 Mar 14. [Epub ahead of print]

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