Physiotherapy After Back Surgery

Low back pain can be incredibly debilitating and can impact our ability to do the things we love. Over the last decade, many research trials have been conducted to determine how to best manage this global issue. There has been a huge shift towards physiotherapy as first line treatment for acute and chronic low back. This shift is away from early referral to spinal surgeons when it may not be indicated or required.

The 2024 ACI NSW Health guidelines aid health professionals in triaging how to treat individuals who present with low back pain. These 3 main include non-specific low back pain, acute low back pain with progressive neurological loss and acute low back pain with leg pain. Within these categories there are different management pathways. It is recommended that if an individual’s falls into the category of non-specific pain that physiotherapy should be the first line of treatment. If an individual has a suspected spinal fracture or infection, is presenting with progressive loss of lower limb neurological function or has suspected cauda equina symptoms then an urgent referral to ED or to a specialist is required. From here, it may be determined that the most appropriate management is surgery to prevent serious deteriorations in function.

Preoperative Preparation:

Every case and timeline is different for individuals undergoing back surgery. If you have time to prepare, then there are several factors you should consider in order to optimise function post surgery. These include nutrition, weight reduction strategies if applicable, strength and conditioning training and reducing poor health decisions such as smoking and alcohol consumption.

Working with a physiotherapist preoperatively to maximise strength and function is important. If applicable, completing a program under the guidance of a physiotherapist is recommended as the program can be tailored to your level of function and symptoms. If the regression of your function has been quite unexpected, then you may not have as much time to prepare for your function. If this is the case, you will be informed by the medical team and physiotherapists in the hospital about what the postoperative pathway will look like.

Post-Operative Hospital Care:

Waking up following back surgery can be a daunting experience. You’re in a foreign hospital bed, there are often lots of lines and medical devices around you and there may be a lot of pain. You will be well supported by a team of nurses, doctors and physiotherapists. The physiotherapists will help to get you sitting out of bed in a chair on the first day. You will have the assistance of the physiotherapist and you may use a frame for support too. You will be given information on precautions and potential lifting restrictions that may be in place for a few weeks following your surgery. You will be encouraged to sit out of bed for as long as you can and complete frequent deep breathing and airway clearance exercises. This is to ensure you avoid developing a chest infection or hospital acquired pneumonia.

You will work closely with the physiotherapists the first few days to practice your walking and build up the strength through your legs. You will walk towards goals such as being able to go from lying down to sitting on the edge of the bed, standing up by yourself and being able to walk around independently. Once you are medically stable and have progressed in your overall function, you will either be discharged home or to an inpatient rehabilitation center, both of which will involve ongoing physiotherapy.

Rehabilitation Post Hospital:

Whether you are undergoing your rehabilitation in a rehabilitation center, with a physiotherapist at home or in a private setting, this phase of the process is crucial. Following back surgery, the rehabilitation process is very goal focused in terms of what you will be striving to get back to doing in your life. This may vary from being able to walk independently, to playing tennis or walking your dog. The program should be tailored to your individual goals and hobbies. You will also be educated on effective lifestyle modifications to prevent future low back pain and active strategies to implement into your daily routine.

Overall, restoring function in bed mobility, sitting to standing capacity, walking tolerance and daily tasks is crucial. These improvements in function come as strength, balance and confidence grows. With your physiotherapist, you will undergo a variety of muscle strengthening exercises to target the main muscle groups in your legs, as well as your core. This will also entail progressive balance exercises to restore proprioception and neuromuscular control. Flare ups along the way are a normal part of the rehabilitation process. Manual therapy techniques, dry needling and cupping may be used by your physiotherapy to aid with symptom relief and muscle spasm.

In terms of your exercise program, this will start off with simple exercises to teach specific muscle groups to activate. Here are some examples of exercises you may do early on with your physio:

  1. Core Activation > https://www.youtube.com/watch?v=o97O8LszyR0
  2. Modified Side Plank > https://www.youtube.com/watch?v=qiJkKGwOP50
  3. Side Lying Clam > https://www.youtube.com/watch?v=NNAMNQpZX2g
  4. Glute Bridge > https://www.youtube.com/watch?v=bLt3DzhtR0c
  5. Sit To Stand > https://www.youtube.com/watch?v=EMq3a_3bAkw

Evidence In Support of Physiotherapy Post Back Surgery:

There is significant evidence that supports physiotherapy post back surgery. One review found that early physiotherapy that started within 4 weeks following spinal surgery didn’t increase any adverse effects and had a moderate and statistically significant decrease in pain when compared to the control group (Ref 1). Another review conducted in 2022 (Ref 2) explored the benefits of physiotherapy following lumbar disc herniation after looking at 15 research trials. The results found significant improvements in function and pain in the group that underwent physiotherapy within the first 1-2 months following lumbar disc surgery.

Rehabilitation Journey:

The rehabilitation journey post back surgery is a gradual process that requires patience, dedication and ongoing support from your physiotherapist. If you are someone who has back pain, has had surgery or who is undergoing surgery soon, book in with one of our physiotherapists. You will be provided with a thorough rehabilitation plan and tailored exercise program to get you back doing what you love, pain free!

References:

  1. Snowdon M, Peiris CL. Physiotherapy Commenced Within the First Four Weeks Post-Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2016 Feb;97(2):292-301. doi: 10.1016/j.apmr.2015.09.003. Epub 2015 Sep 25. PMID: 26409101.
  2. Afzal K, Khattak HG, Sajjad AG, Hussain SA, Sarfraz Z, Sarfraz A, Cherrez-Ojeda I. Impact of Active Physiotherapy Rehabilitation on Pain and Global and Functional Improvement 1-2 Months after Lumbar Disk Surgery: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022 Oct 5;10(10):1943. doi: 10.3390/healthcare10101943. PMID: 36292390; PMCID: PMC9601491.
Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Phoebe has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

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