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Rehabilitation after Spine Surgery

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Rehabilitation after Spine Surgery

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Spinal pain is a serious subject. As you recover from a spinal injury, whether to your neck or back, it is important that you begin to learn how to safely strengthen your spine to help prevent injuries in the future. To help you strengthen your spine and learn how to protect your spine, your doctor may have you see a physical therapist who will design a rehabilitation program just for you.

Your physical therapist will evaluate your condition to determine the best way to help ease your pain and help your spine move better. You will also be given ways to take care of your spine so you can avoid pain and prevent further injury.

Your First Visit

During your first visit to a physical therapist (PT), he or she will gather information about your spine condition. You may be asked questions about when your condition started, where you hurt, and how your symptoms affect your day-to-day activities. The information you provide will help your PT to begin zeroing in on the source of your problem and to know what will be needed to help relieve it. The information you give will also be used to help measure the success of your treatment.

Therapy Exam

After reviewing your answers, your PT will do an exam that may include some or all of the following checks:

Posture/observation:
Your PT will begin by checking your posture to see whether your pain is coming from changes in your posture. Imbalances in the position of your spine can put pressure on sore joints, nerves, and muscles.

Range of motion (ROM):
Your PT will check the ROM in your spine. This is a measurement of how far you can move your spine in different directions. Your ROM is written down to compare how much improvement you are making with your treatments.

Nerve tests:
Your PT may need to do some tests to check how the nerves coming from your spine are working. This includes your reflexes, sensation, and strength. The results of these tests can help your PT know which area of your spine may be causing problems for you and can guide the type of treatment that will be best for you.

Manual exam:
Your PT may carefully move your spine in different positions to make sure that the joints are moving smoothly at each level. Muscle and soft tissue flexibility is also tested. This will help guide treatment to the joint that is tight (called a hypomobility) or where a joint may have been injured and is moving too much (called a hypermobility).

Ergonomics:
Ergonomics involves where and how you do your work or hobby activities. By understanding your ergonomics, your PT can begin to learn whether the way you do your activities is making your condition worse. Sometimes even simple corrections of your hobby or workstation can make a big difference in easing spine problems.

Palpation:
Palpation involves feeling the soft tissues around your spine. This is done to check your skin for changes in temperature or texture, which could tell whether you have inflammation or nerve irritation. Palpation also checks whether there are tender points or spasms in the muscles near your spine.

Care Plan

Your PT will evaluate your answers and your exam results to determine the best way to help you. Your PT will then write a plan of care, which lists the treatments to be used and the goals that you and your PT decide on to do your daily activities safely and with the least amount of discomfort. Your plan will also include a prognosis, which is your PT’s idea of how well your treatments will work and how long you'll need therapy in order to get the most benefit.

Treatment

The main goal of spinal rehabilitation is to make sure you have ways to take care of future spine pain or problems. You'll be shown ways to help control pain or symptoms if they don't go completely away and if they return in the future. Because you've experienced spine pain, there is a possibility you may have soreness in the future. You may be encouraged to continue with some of the exercises to help keep your spine healthy over time.

Controlling Pain and Symptoms

Your PT may choose from one or more of the following treatments to help you control your spine pain and symptoms.

Rest:
Resting painful joints and muscles can help calm soreness, giving your spine time to heal. If you are having pain with an activity or movement, it should be a signal that there is still irritation going on. You should try to avoid all movements and activities that increase your pain. In the early stages of your problem, your doctor or PT may have you wear a brace to limit movement.

Specific Rest:
Specific rest encourages safe movement of your joints and muscles on either side of a painful area, while protecting the sore spot during the initial healing phase. If a brace was prescribed, you may be instructed to take it off a few times each day so you can do some gentle and controlled exercises.

Positioning:
Your PT will work with you to find ways to position your spine for the greatest comfort while sleeping or resting. You may receive advice on positions that reduce stress on your spine while you are at work.

Ice:
Ice makes blood vessels decrease in diameter (called vasoconstriction), which decreases blood flow. This helps control inflammation, muscle spasm, and pain.

Heat:
Heat makes blood vessels increase in diameter (called vasodilation), which increases blood flow. This helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.

Ultrasound:
Ultrasound can reach tissues that are over two inches below the surface of your skin. The ultrasound machine directs high-frequency sound waves toward the sore area. As the waves pass through your body's tissues, they vibrate molecules. The vibration causes friction and warmth. The remaining sound waves are converted to heat in the deeper tissues of your body. This heating effect helps flush the sore area and brings in a new supply of blood that is rich in nutrients and oxygen.

Phoresis:
Phoresis means to "carry or transmit." There are two methods of phoresis that PTs can use to transmit substances across your skin. Phonophoresis uses the high frequency sound waves of ultrasound to "push" a steroid medication (cortisone) through your skin. Iontophoresis uses a small machine that produces a mild electrical charge, which is used to carry medicine, usually a steroid, through the skin. The steroid is a very strong antiinflammatory medication that actually stops the pain, causing a chemical reaction within the cells of the sore tissue in your body. Either type of phoresis may be used in place of a cortisone injection.

Electrical Stimulation:
Electrical stimulation is a gentle treatment used to stimulate nerves. The current passes through pads applied on your skin. Some people say it feels like a massage on their skin. Electrical stimulation can ease pain by sending impulses that are felt instead of pain. Once your pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.

Soft Tissue Mobilization/Massage:
PTs are trained in many different forms of massage and mobilization. Massage has been shown to calm pain and spasm by helping muscles relax. Massage brings in a fresh supply of oxygen and nutrient-rich blood, and can help flush the area of chemical irritants that come from inflammation. Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease.

Joint Mobilization:
Graded pressures and movements for joint mobilization may be performed by skilled therapists. Gentle graded pressures help lubricate joint surfaces, easing stiffness and helping you begin to move with less pain. As your pain eases, more vigorous grades of mobilization may be used to lengthen tissues around the joint in order to restore better movement in your spine.

Traction:
Sore joints and muscles often feel better when traction (pull) is used. PTs apply traction manually or with a traction machine. There are also traction devices that can be issued to you for use at home. The amount of pull that is used will depend on your condition. A gentle on/off pressure may be better early on to help control arthritis pain. More vigorous traction can help take away pain if a spinal joint is mildly sore or tight.

Therapeutic Exercises

Specialized treatments and exercises can help maximize your physical abilities, including flexibility, stabilization, coordination, and fitness conditioning exercises.

Flexibility:
Exercises that increase flexibility help to reduce pain and make it easier for you to keep your spine in a healthy position. Flexibility exercises are helpful for establishing safe movement. Tight muscles cause imbalances in spinal movements. This can make injury of these structures more likely. Gentle stretching increases flexibility, eases pain, and reduces the chance of re-injury.

Stabilization:
Depending upon what part of your spine is affected, one of the therapeutic exercises you will likely focus on in physical therapy is strengthening your “core” muscles. The "core" muscles you'll be working on are closer to the center of your body and act as stabilizers. These key muscles are trained to help you position your spine safely and to hold your spine steady as you perform routine activities. These muscles form a stable platform, letting you move your limbs with precision. If the stabilizers aren't doing their job, your spine may be overstressed with daily activities.

Coordination:
Strong muscles need to be coordinated. As the strength of your spinal muscles increases, it becomes important to train these muscles to work together. Learning any physical activity takes practice. Muscles must be trained so that the physical activity is under control. Spine muscles that are trained to control safe movement help reduce the chance of re-injury.

Fitness Conditioning:
Improving your overall fitness level aids in recovery of spine problems. Fitness conditioning involves safe forms of aerobic exercise. The term aerobic means "with oxygen." When using oxygen as they work, muscles are better able to move continuously, rather than in spurts.

Exercise has other benefits as well. Vigorous exercise can cause chemicals, called endorphins, to be released into your blood. These chemical hormones act as natural pain relievers in reducing your pain. Examples of aerobic exercise include:

  • Swimming laps
  • Walking on a treadmill
  • Using a cross country ski machine
  • Using a stair stepper

If you decide you want some extra conditioning, always check with your doctor or PT before beginning a program on your own. It is important that you choose an aerobic activity you enjoy. This will help you stick with it, ensuring you the long-term benefits that come with a well-rounded fitness program.

Home Program

Once your pain is controlled, your range of motion is improved, and your strength is returning, you will be progressed to a final home program. Your PT will give you some ideas to help take care of any more soreness at home. You'll be given some ways to keep working on your range of motion and strength, too. Before you are done with physical therapy, more measurements will be taken to see how well you're doing now compared to when you first started in therapy.

Functional Training
PTs use functional training when you need help doing specific activities with greater ease and safety. Examples include posture, body mechanics, and ergonomics.

Posture
Using healthy posture keeps your spine in safe alignment, reducing strain on the joints and soft tissues around your spine. The time and effort you take to use good posture are vital to spine care, including prevention of future spine problems. As you gain strength and control with your stabilization exercises, proper posture and body alignment will be easier to remember and apply with all your activities.

Body Mechanics
Think of body mechanics as putting the safe, neutral spine posture into action. It's one thing to sit or stand with good posture. It's another to keep safe posture as you actually move with activity. You want to keep your body in its safest alignment as you go about your daily tasks, such as:

  • Getting out of a chair
  • Taking out the trash
  • Getting clothes out of the dryer
  • Brushing your teeth
  • Lifting
References

IMPORTANT SAFETY INFORMATION
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if spine treatment is right for you.

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