Regain Your Strength: Rehabilitation Exercise Program Guide

Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)

Rehabilitation Exercise Program

A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)

Post-Surgery

The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:

• Relax their muscles to prevent muscle tensing and becoming over-cautious
• Regain full range of motion
• Strengthen their spine
• Prevent injuries

A guide on what to expect in physical therapy.

Postural Retraining

• After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
• Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
• A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
• Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.

Walking Exercise

Walking is one of the best exercises after lumbar surgery. (Johns Hopkins Medicine. 2008)

• Walking helps to improve cardiovascular health and blood circulation throughout the body.
• This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
• It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
• The therapist will help set up a program tailored to the individual’s condition.

Prone Press Up

One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.

To perform the exercise:

1. Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
2. Keep the back and hips relaxed.
3. Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
4. There should be a slight pressure in the lower back while pressing up.
5. Hold the press-up position for 2 seconds.
6. Slowly lower back down to the starting position.
7. Repeat for 10 to 15 repetitions.

Sciatic Nerve Gliding

Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.

• After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
• Nerve glides can help free the stuck nerve root and allow for normal motion.

To perform the exercise:

1. Lie on the back and bend one knee up.
2. Grab underneath the knee with the hands.
3. Straighten the knee while supporting it with the hands.
4. Once the knee is fully straightened, flex and extend the ankle about 5 times.
5. Return to the starting position.
6. Repeat the sciatic nerve glide 10 times.
7. The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.

Supine Lumbar Flexion

After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.

To perform the exercise:

1. Lie on the back with the knees bent.
2. Slowly lift the bent knees towards the chest and grasp the knees with both hands.
3. Gently pull the knees toward the chest.
4. Hold the position for 1 or 2 seconds.
5. Slowly lower the knees back to the starting position.
6. Perform for 10 repetitions.
7. Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.

Hip and Core Strengthening

Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.

Return-to-Work and Physical Activities

Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:

• Work on proper lifting techniques.
• Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
• Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.

Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.

Sciatica, Causes, Symptoms and Tips

References

Johns Hopkins Medicine. (2008). The road to recovery after lumbar spine surgery.

Johns Hopkins Medicine. (2023). Minimally Invasive Lumbar Discectomy.

Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. doi.org/10.2519/jospt.2012.3854