home physical therapy lumbar laminectomy & fusion:

Postoperative Spine Rehabilitation

PHASE II OF SPINE REHABILITATION

Goals:

7 to 12 Days Post-Operative: Start outpatient physical therapy

Back Education Program

• Reinforce neutral spine positioning
• Anatomy, Pathology & Biomechanics
• Performance of functional activities with neutral spine and protective positions

Exercises: All performed in neutral and protective positions

• Stabilization Program - Neuromuscular control of lumbar spine
  • Supine progression
    • single leg slides
    • bent and straight leg raises
    • toe tapping
    • supported dying bug
    • curl-ups with lumbar spine in protected position
    • diagonal curl-ups with lumbar spine in protected position
  • Bridging progression
    • normal bridge
    • with tiny steps
    • with lea extension
  • Prone progression
    • single arm or leg lifts
    • contralateral arm and leg lifts
    • bilateral arm and leg lifts
    • modified push-ups with neutral spine
  • Quadruped progression
    • single arm or leg lifts
    • contralateral arm and leu lifts

PHASE III OF SPINE REHABILITATION

5 Weeks from Hospital Discharge

Goals: Restore lumbar motion

• Normalize upper & lower extremity strength
• Improve cardiovascular function
• Decrease soft tissue dysfunction
• Improve positional work tolerances for return to work
• Functional Baseline Evaluation

Exercises

• Muscle Strengthening Program: to restore any upper and lower extremity strength deficit
• Dynamic Lumbar Stabilization: continue to progress with stabilization exercise as indicated
• Flexibility: continue with flexibility exercises as indicated
  • Flexibility Exercises - in neutral and protective positions
    • hamstrings
    • quadriceps
    • iliopsoas gastroc-soleus complex
    • hip interna! and external rotators
    • gluteals and hip adductors
    • iliotibial band
    • quad lumborum and paraspinals upper extremity musculature, as needed

Aerobic Conditioning

• progressive walking,
• stairmaster swimming
• stationary bicycling, upper body ergometer

Aquatic Exercise Program - to nomialize any gait deviations, and perform strengthening activities with decreased axial compression on the spine

• functional stabilization exercises
• pool walking - 4 directions

Standing Progression

• functional squats
• leg lunges

WorkTolerance Positioning and Simulation - To begin focus on return to work daily activities and function. Functional Baseline Evaluation performed.

Soft Tissue Mobilization - For scar tissue management and areas of dysfunction

Modalities - utilized only as required to meet established goals

PHASE IV OF SPINE REHABILITATION - WORK HARDENING

Goals:

• Restore lumbar motion
  • Improve/normalize gait cycle
  • Improve cardiovascular function
  • Normalize upper and lower extremity strength
  • Increase positional tolerance to 3-5 continuous full days (7-8 hours of job simulation required of his/her occupation and demonstrates physical demands of the job utilizing proper body mechanics)
  • Job specific training

Work Hardening - Progression into work hardening as appropriate (12 weeks post-op)

• Exercise: continue with flexibility, strengthening and cardiovascular exercises through a daily program
• Work Tolerance: Increase patient's ability to perform a full day of activities
• Work Simulation: Performance of work simulated tasks while reinforcing proper body-mechanics

Acknowledgement: Material courtesy of Robert Klingman, MPT, OCS, FAAOMPT, Athalon Physical Therapy Tucson AZ