(Phase 1): 0 – 2 Weeks | Wound Healing and Protection
Mobility: Bed mobility/positioning, log rolling, transfers, and walking full weight bearing.
Restrictions
- Prevent excessive initial mobility or stress on spine.
- Avoid lifting, bending and twisting of the spine.
Progression
- Pain managed (meds/activity modification).
- Able to perform activities of daily living for self-care and hygiene.
Wound Care
- Surgical site of incision is should be clean and dry.
- Do NOT submerge. Do NOT do not apply lotion/balms/ointments/oils to incision.
- Notify the surgeon if the incision is draining or there are signs of infection.
(Phase 2): 2 – 4 Weeks | Outpatient Physical Therapy (Outpatient)
Reestablish neuromuscular recruitment of multifidus with dynamic lumbar stability exercise. Normalize gait and any extremity flexibility deficits. Return to functional activities of daily living and improve position tolerance for return to active live.
Restrictions
- Avoid twisting, and bending of the lumbar spine. Avoid lumbar loading.
Progression
- The patient is able to incorporate good body and lifting mechanics.
- Dynamic sitting, and standing tolerance of 15–30 minutes. Walking tolerance of 30 min/day.
Wound Care
- The incision should no longer have scabbing.
- Scar tissue mobilization via cupping – educate the patient on self-mobilization of the scar.
- No additional balms or ointments if scabs are still present.
Physical Therapy
Posture education: reinforce neutral spine with performance of functional activities and ways to protect spine with loading.
Driving
- Usually allowed by this point when on pain meds and ease with in/out of car.
- Train neutral spine with diaphragmatic breathing – drawing in abdomen.
- Add gentle arm and leg exercises: supine heel slides, supine leg lift, marching.
- Add lumbopelvic control with movement/instability.
- Hip and knee flexibility – quads, hamstrings, piriformis, gluts, hip flexors, calves.
- Initiate balance exercises – sitting/standing.
- Gait training.
(Phase 3): 4 – 8 Weeks | Advanced Strength Phase (Outpatient)
Advance lifting to 7+ kg. Progress with flexibility and strength. Address activities of daily living and return to work concerns. Advance stabilization and trunk control.
Restrictions
- Advance weight as tolerated based on age and bone density concerns/functional status.
- Special consideration for osteoporosis, cancer history.
Precautions
- Avoid preloading the spine in a posterior pelvic tilt.
- Focus on low load/higher reps to improve endurance rather than high load low reps for strength.
- Avoid prone upper body extension or prone leg extensions that are ballistic to avoid high compression to the weaker spine.
- Avoid sitting rowing, leg press due to anterior column loading.
Activities to avoid with osteoporosis:
- Dynamic abdominal ex’s (sit-ups).
- Twisting movements (Golf swing).
- Trunk flexion with weight (swinging kettlebell, lifting laundry).
- Explosive or abrupt loading (ATV riding).
- High impact loading – jumping.
Exercises
Thoraco-lumbar stability with increasing complexity:
- Bridging on unsteady surfaces (ball).
- Double leg/single leg, bird dog, step.
- Kneeling arm pulldowns, shuttle.
- Airex pad rowing, punchouts, chops.
- Diagonal lifts, rowing on BOSU, lunges.
- Squatting, floor to stand.
Advanced cardiovascular training
- Elliptical, arm bike.
- Avoid sitting rowing, leg press due to anterior column loading.
