Physiotherapy after Spinal Surgery

Low back pain is the most common injury seen by physiotherapists and can affect people of all ages. While in many cases a conservative rehab approach can be taken, there are circumstances when debilitating spinal conditions may require surgical intervention and can be a transformative step in alleviating pain and restoring function.

But what must be stressed is the following:

The journey to recovery doesn’t end in the operating room. It marks the beginning of a comprehensive rehabilitation process.

Physiotherapy plays a critical role on the road to recover post back surgery and steps need to be taken appropriately in order helping patients rebuild their strength, flexibility, and mobility while minimising the risk of complications and promoting long-term spine health. Healthy aging and future proofing your clients is the name of the game. So, lets look at what this journey looks like after surgery and what to expect from your physiotherapist.

Phase 1: Acute Phase

The acute phase takes you from immediately after surgery and includes the first 3-4 weeks post op. This is such a critical period after back surgery as we can fall into the trap of thinking that now that the surgery is done, I will be back to on my feet with all my pain and symptoms resolved. This is not the case unfortunately. The primary goals of physiotherapy in this early phase are pain management, prevention of complications, the gradual restoration of mobility and ongoing education and reassurance.

Content of Phase 1:

1. Pain Management

You’ve just had invasive surgery so expect that there will be pain! Pain control is the key focus during the initial stage of recovery. Physiotherapists will help you by applying modalities such as ice on the wound site, gentle massage on the surrounding muscle structure the support the spine (like the glutes), and your doctor will provide pain medications and anti-inflammatories which should be taken consistently to alleviate discomfort and help with pain management.

2. Mobility and Ambulation

While patients are encouraged to start moving when ready its so important to not do too much too fast. Slow and steady in the early phases will help prevent spike in pain. You will be restricted from bending or twisting for at least the first 4 weeks usually. Your physiotherapist will help with techniques to get from lying, to sit, to stand and begin early walking. Early mobilisation helps prevent complications like deep vein thrombosis and help facilitates blood flow and muscle activation.

3. Education and Precautions.

Patients will receive comprehensive education on postoperative care. This will be provided by the hospital at first. It can include proper movement pattern techniques, restrictions on lifting, twisting and bending, and guidelines for wound care. Adherence to these precautions in the early phase is critical for preventing strain on the surgical site and minimizing the risk of complications down the track. Your long term outcomes will be much better if adherence in the early phases takes place.

4. Core Activation and Breathing Exercises

Especially in the first few days of recovery at the hospital gentle core activation exercises and diaphragmatic breathing techniques are often taught to help rebuild base stability and support for the spine. We want these exercises performed within pain-free ranges and aim to gradually strengthen the deep stabilising muscles of the back and abdomen over time.

Phase 2: Reconditioning Phase

The reconditioning phase will typically span several weeks to months following back surgery, focusing on progressive strengthening, flexibility, and functional capacity. During this phase, the emphasis shifts from basic mobility to more targeted exercise program aimed at rebuilding overall spine health and function.

Content of Phase 2:

1. Manual Therapy and Hands-On Techniques

In the early phases you will likely receive manual therapy techniques such as joint mobilisations, soft tissue massage, and other adjunct treatment like dry needling or cupping. These techniques all serve as an early pain circuit breaker and help address residual stiffness, improve joint mobility, and enhance tissue extensibility. This will help the with the pain cycle and be important in ensuring we can optimise movement patterns and reduce compensatory behaviours once exercise begins.

2. Progressive Exercise Program

Your physiotherapists will design and individualised exercise program, supervised to start then independent as you progress. This program will be tailored to the patient’s specific condition, functional goals, and surgical outcomes. These programs may include a combination of stretching, strengthening, and stability exercises targeting the core, back, and surrounding muscle groups.

3. Functional Training and Ergonomics

Future proofing your body after back surgery is about making sure patients engage in functional training activities that simulate real-life movements and tasks, promoting the integration of strength, stability, and coordination into daily activities. Constant education on ergonomic positions is key to minimise strain on the spine and facilitate proper body mechanics during work and recreational activities.

4. Cardiovascular Conditioning

Incorporating cardiovascular exercises such as walking, cycling, or swimming can improve overall cardiovascular fitness, promote weight management, and help build endurance levels. We will always start with low impact activities to start, making we sure we stay in low to zero pain thresholds to minimise stress on the spine while maximising aerobic capacity.

Phase 3: Return to Activity Phase

The final phase of physiotherapy after back surgery is about ‘Future Proofing’ your body and transitioning to higher-level activities and functional independence. During this phase, patients focus on building long term strength, endurance, and mobility while gradually reintegrating into work, sports, and recreational goals.

Content of Phase 3:

1. Sport-Specific Training

After back surgery your goal will be to return to previous levels, be it in sport or recreational activities. Your physiotherapist will develop, and individualised and specific training program aimed at targeting the requirements of your chosen activity, whether its improving agility, power, and sport-specific skills while minimising the risk of reinjury.

2. Dynamic Stability and Proprioception

Dynamic stability exercises and proprioceptive training become part of long term back health. If you can master and be consistent with neuromuscular control, balance, and improve proprioceptive awareness, you can keep your body in better positions. These types of exercises challenge the body’s ability to maintain equilibrium and adapt to various environmental stimuli, which in turn will help reducing the risk of falls and injury.

3. Pain Management Strategies

While most patients experience significant improvement in pain following surgery and rehabilitation, some individuals may continue to grapple with ongoing discomfort or episodic flare ups. It important for your physiotherapists to help by utilising approaches such as manual therapy, therapeutic exercise, and pain science education to address persistent pain and optimise functional outcomes.

4. Long Term Maintenance and Prevention

Your physiotherapist is there to create for you a long term management exercises plan and injury prevention strategies as patients transition to independent self management. Emphasis is placed on ‘Future Proofing’ your back by adopting a holistic approach to spine health, encompassing proper nutrition, stress management, sleep hygiene, correct ergonomics, and a regular physical activity program.

If you are suffering from low back pain or have just has spine surgery, it’s important to understand this process and to have a team around you to support you through the recovery journey. Your physiotherapy rehabilitation after back surgery is extensive and can be a long road. By progressively working through the above phases with the help of your physiotherapist, you can have success along your journey toward restored spinal health and functional independence. Effective communication, collaboration, and patient empowerment are the key pillars of successful rehabilitation and ‘Future Proofing’ your body as you live a life of healthy aging.

Joel Adelman – BeFit Training Physio Coogee

Joel Adelman – BeFit Training Physio Coogee

Joel Adelman is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Joel 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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