Rehabilitation Following Lumbar
Spinal Fusion
By: Alexandra Basciano
Lumbar Spinal Fusion
• basic idea is to fuse together the painful
vertebrae so that they heal into a single, solid
bone
• eliminates motion between vertebrae
• prevents the stretching of nerves and
surrounding ligaments and muscle
• takes away some spinal flexibility
Right after surgery…
•
•
•
•
IMMOBILIZATION!
Back brace, internal fixation
Slow gentle movements
It may be several months before the bone is
solid
• Light activity such as walking
Specificity
• Because surgeons use different techniques
and approaches during fusion (for example,
access to the spine can be achieved through
incisions in the front, the back or both), some
exercises may not be appropriate for all
patients
Acute Phase
•
•
•
•
•
Ice (no heat)
active stabilization for supporting muscles
Limit exercise to short walks
Getting out of a chair
walk as often as the surgeon allows, to the
point of minor aching, but stop if there is any
sharp pain
• Mobile scar
Acute cont.
•
•
•
•
Rehab immediately, all pain w/in tolerance!
Start working on flexion
Lateral flexion (side to side)
Hip adduction/abduction
Subacute Phase
•
•
•
•
•
Start stretching to maintain flexibility
Stabilization exercises
Static to dynamic
Low impact conditioning
Begin electro stimulation therapy and
ultrasound
• Ultrasound contraindicated with any
orthoaftercare patients with metal devices
Start stretching!
• Gentle stretching promotes flexibility
• middle back where the nerve root is located
(mobile scar)
• Very gentle stretching of the core back and
abdominal muscles, as well as the hip muscles
attached to the spine and pelvis
• 30 second holds, three repetitions, two sets
per day
Double Knee to Chest Stretch
• Lay on back, knees bent
• Pull both knees into
chest until a
comfortable stretch is
felt in lower back
• Keep back relaxed
Hamstring Stretch
• A seated hamstring
stretch can be performed
while sitting on the edge
of chair. Straighten one
leg in front with toes
pointed up and knee
straight. Push belly
forward to move into
stretch while keeping
chest high.
• Static
Quadriceps Stretch
• The quadriceps flexion
stretch is done while
lying on the stomach,
and bringing heel
toward buttocks as far
as possible
• Static
stabilization exercises
• should be completed by
moving arms and legs while
avoiding any rocking or
arching of the lower trunk
• A pelvic tilt involves lying on
your back on the floor with
knees bent and pulling the
belly in towards the spine.
This position is the basis for
keeping the lumbar spine
stable
• Static
Stabilization exercises cont.
• Bridging:
Form a bridge with
trunk raised by raising
hips from floor and
keeping a straight line
from shoulders to hips.
• Activates abs/core
muscles as well as back
muscles
• static
Dynamic
• After about 6 weeks dynamic movements can
be incorporated into the rehabilitation
program
• Up the intensity using an exercise ball or
resistance bands.
Resistance bands
• Stretch the back by
using a resistance band
wrapped around a
stationary pole or
column, and leaning
back with straight arms
Lumbar diagonal rotation
• Strengthen the
abdominals and oblique
muscles by performing
a diagonal pull with
band: with band
anchored low to
ground, and feet
shoulder width apart,
grasp band and pull
from lower right to left
shoulder. Reverse sides.
Vigorous Low Impact Conditioning for
Rehabilitation
• Regular aerobic exercise (walking/swimming)
will increase blood flow and oxygen.
• It will also burn excess calories, thus
maintaining weight and preventing added
stress on the back structures and surgical site.
Contraindicated exercises
• Jogging or running
• Some forms of dance and aerobics
• Contact sports such as basketball or football
No smoking!
• Nicotine kills the
osteoblasts that grow
bone and the
postoperative results of
patients who go back to
smoking are much worse
than of those who remain
off of nicotine.
• Smoking even after a
solid fusion is achieved
has been well correlated
to chronic low back pain.
Studies on smoking
• Research has demonstrated that habitual cigarette
smoking leads to the breakdown of the spine to such
a degree that fusion is often less successful when
compared to similar procedures performed on nonsmokers
• A study evaluated tobacco use in patients who
underwent lumbar (low back) fusion. The patients
who smoked had failed fusions in up to 40% of cases,
compared to only 8% among non-smokers. Similar
findings have been reported in other studies as well.
References
• http://orthoinfo.aaos.org/topic.cfm?topic=a0
0348
• http://www.spinehealth.com/wellness/exercise/vigorous-lowimpact-conditioning-rehabilitation