Post Op Rehabilitation

THE “LOG ROLL”

Your hips and shoulders must roll over together as a unit (or like a log) so that the spine does not twist.

Do not shuffle the hips back and forth; try to roll in one smooth movement.

Once on your side, drop your legs off the edge of the bed and push up through your side using your elbow and hands.

Once sitting, resist the urge to shuffle the hips forward one side at a time to get your feet on the ground- instead, slide your bottom forward by leaning back on your hands. Move symmetrically.

To return to bed, the process is reversed.

You should sit in a straight-backed chair with armrests. A higher chair is much better than a lower chair. Never sit in a recliner chair with your legs up, as this puts the spine in an unnatural posture causing undue strain.

Sitting may be restricted (check with your surgeon); otherwise, over the next 4-6 weeks, you may gradually start to build up your sitting tolerance. Be guided by your comfort.

Sitting will make you stiff, so getting up and moving around regularly is wise. A small cushion or rolled towel positioned behind your lower back (a “lumbar roll”) helps to

maintain correct spinal alignment – use this if it makes you more comfortable.

Keep your computer screen or reading material at eye level when working at a desk.

Significantly delays bone and tissue healing. To optimise your outcome, you should not smoke.

You should lower yourself slowly and with a straight back. You may want to use a raised toilet seat or “over toilet frame” initially (please ask your therapist about this if you are not managing the standard toilet in the hospital). It may help to brace with your hands on your upper thighs as you sit down. Ensure you do not strain on the toilet.

For the first three months post-surgery you should avoid bending, twisting your back excessively. You will need to modify the way you perform your activities to ensure that you are looking after your back.

• Stand up in the shower
• Stand on a towel to dry your feet instead of bending down
• Choose clothes that fasten at the front and are easy to get into and out of
• Do not stoop down to the tap. Use a face-washer to wash your face, and use a cup of water to rinse your mouth when brushing your teeth
• Wear shoes that you can slip on easily, i.e. elastic-sided. Avoid reaching your feet.
• You may need help/aids with socks and shoes or for picking up objects from the floor (ask your therapist about this if you need them).

• Ensure that bench heights are suitable (so that you do not have to stoop over). Perhaps sit on a high stool to work on the bench
• Avoid lifting heavy saucepans – slide them across benches
• Double handles distribute the load more evenly.

• Make use of home delivery
• Do not lift heavy bags
• Push rather than pull a trolley.

You should not lift anything heavier than about 5kg for six weeks. Abide by the basic rules of lifting:

• Bend your knees and keep your back very straight. The muscles of your spine are quite small compared with the large thigh and buttock muscles, so use these
• for lifting.
• Hold objects very close to your body. If held further out, more strain is placed on your back muscles, joints, and ligaments
• Never lift and twist – move your feet to step around
• Pushing is better than pulling – keep your back straight and use your leg strength to move an object. Pulling places a huge strain on your back.
• Divide a heavy load into two smaller loads if possible e.g. shopping bags
• Modify your environment to minimise the need to lift and move things.
• Get help if the item is heavy.

Returning to driving depends on your functional level and comfort after surgery. Your surgeon will advise you when it is safe to return to driving. (To drive against your surgeon's advice could affect your insurance coverage, so it is important to clarify this prior to discharge).

Try to avoid car travel altogether in the first month; however, if you must be a passenger, get in carefully, as shown below. Once in, recline the seat 30-45 degrees. Use a small lumbar roll if the car seat does not provide adequate support. Return the backrest to vertical upon arrival, swing your legs out, and stand up.

Sleep in a firm bed if possible. Lying with a pillow under the knees is usually comfortable. If lying on your side, place a pillow between the legs to help maintain a straight spine.

May be undertaken any time if comfortable. Lying on your back is generally easiest for the first few weeks.

Depending on the surgeon's preference and your particular surgical procedure, you may or may not be fitted with a brace post-surgery. The brace is usually to be worn for the first 6-12 weeks following your surgery. You do not need to wear the brace in bed, and you may remove the brace for showering, however it must be worn at all times when walking or moving around.

A brace is prescribed to:

• Protect against unexpected knocks/jarring/falls, which may interfere with bone healing
• Prevent excessive spinal movement
• To maintain correct posture while walking and sitting

There are many ways of applying the brace. Follow the instructions given to you by your orthodontist, who fits the brace to you. Commonly patients are instructed to apply the brace while standing against a wall. The brace may be applied over light clothing. Ensure that you practise applying the brace yourself so that you are competent with this before discharge from the hospital. Please also ensure that the brace is well-fitting and comfortable. If there are problems with the brace, please inform your Physiotherapist immediately. The Orthotist may be asked to come and review it if necessary.

A period of rehabilitation may be required post-surgery to aid your recovery and to ensure a good return to independence and regular daily activities. Epworth has rehabilitation centres in Richmond, Brighton and Camberwell. There are also other private facilities in Melbourne and regional centres around Victoria.

Where you go will depend on where you live and your specific needs. In rehabilitation, you will generally have two physiotherapy sessions daily, which may include hydrotherapy as appropriate.

You should bring casual, comfortable clothes, such as tracksuits and comfortable, supportive shoes.

It is important to exercise daily. It is well-known that early activity after back surgery results in better recovery. Walking is the exercise of choice. Wear a pair of sensible, thick-soled shoes and walk on good footpaths and reasonably level ground. Have 2-3 exercise sessions per day, every day, and very gradually increase the amount of walking you are doing, i.e. by 2-5mins per session per day. It is important that you start with a distance you can comfortably manage. Remember, pain may come on after (and not necessarily during) exercise, so it is wise to start any new activity slowly and build up your endurance. It is best to exercise regularly every day rather than a lot one day and nothing the next.

Being overweight puts extra strain on your back and other joints and can place you at risk of further injury. As well as the cardiovascular benefits of keeping trim and fit, this is another good reason to get into a daily walking program! (The Heart Foundation recommends walking 30-45 minutes most days of the week).

Your wound should fully heal before entering a pool (usually 2-3 weeks). You should consult your surgeon first before commencing swimming. You may start with walking in chest-depth water. Please be advised by your surgeon as to when you may commence lap swimming (usually after six weeks).

Generally, physiotherapy is not required in the first six weeks post-surgery. After your 4-6 week review with your surgeon, you may wish to attend the physiotherapist to assist in progressing your exercises and general fitness, to advise and support you in returning to work or to assist with returning to sport or other physical activity.

You should get clearance from your surgeon first before attending the physiotherapist. Most private practice physiotherapists are familiar with spinal surgical patients and will be able to treat you effectively and safely.

Returning to work depends on the type of work you do. Some people may not be able to return to the same roles they had before the surgery (i.e. very heavy work or work involving repetitive bending and rotation under stress) or will have to wait at least three months. Further discussion with your surgeon is necessary.

For office-based jobs, it depends on your functional level and comfort. A graduated return is recommended with certain duties modified so that you can perform them, for example, interspersing short (15-30 mins) periods of sitting and typing with standing or walking tasks. A workplace assessment could be organised through your employer or community physiotherapist. This looks at your work environment (i.e. desk/ office/ workshop set-up) and various tasks you must perform.

You should not participate in high-impact activities (including golf) until after your surgical review in 4-6 weeks. Gentle walking is the best exercise. A physiotherapist can advise you down the track if you wish to return to sport.

This is generally at 3-6 weeks, but for country patients, may be longer than this.

X-rays are taken on arrival.

This appointment is a good opportunity to ask any questions you may have of the surgeon, such as when you may return to certain activities. Keeping a list of questions that may come up over the initial post-operative period is a good idea.

If you want to consult a physiotherapist after this appointment, you should get clearance from the surgeon and take any documentation you have about your surgery to the physiotherapist.

Regular walking is crucial to a good recovery. Gradually increase the time and distance covered each day. You may start with just one or two short walks on your first day up and progress to hourly walks before discharge from the hospital (this may vary).

The deep muscles of the abdomen and the muscles lining your pelvic floor both play important roles in stabilising and protecting your back.

Lie on your back with both knees bent up.

1) Locate the deep abdominal or “TA” (transversus abdominus) muscle by feeling the front of your bony hip crest on both sides with your fingers. Then move your fingers in slightly, off the bone and towards your belly button about 1-2cm. Do a small cough or throat clear to confirm that you can feel the right muscle under your fingers.

2) Gently draw your belly button in and down so your lower stomach flattens. You should feel the TA muscle below your fingers swell out. You should also draw the muscles of your pelvic floor up and in at the same time. These muscles help control bladder and bowel function, so to activate them, squeeze up and in as if you were preventing the flow of urine.

Do not “suck in” your stomach by taking a big breath; instead, your chest should remain relaxed, and you should continue breathing!

HOLD for 5-10 sec, Repeat x 10, 5 times a day.

Generally, physiotherapy is not required in the first six weeks post-surgery. After your 4-6 week review with your surgeon, you may wish to attend the physiotherapist to assist in progressing your exercises and general fitness, to advise and support you in returning to work or to assist with returning to sport or other physical activity.

You should get clearance from your surgeon first before attending the physiotherapist. Most private practice physiotherapists are familiar with spinal surgical patients and will be able to treat you effectively and safely.

Returning to work depends on the type of work you do. Some people may not be able to return to the same roles they had before the surgery (i.e. very heavy work or work involving repetitive bending and rotation under stress) or will have to wait at least three months. Further discussion with your surgeon is necessary.

For office-based jobs, it depends on your functional level and comfort. A graduated return is recommended with certain duties modified so that you can perform them, for example, interspersing short (15-30 mins) periods of sitting and typing with standing or walking tasks. A workplace assessment could be organised through your employer or community physiotherapist. This looks at your work environment (i.e. desk/ office/ workshop set-up) and various tasks you must perform.

You should not participate in high-impact activities (including golf) until after your surgical review in 4-6 weeks. Gentle walking is the best exercise. A physiotherapist can advise you down the track if you wish to return to sport.

This is generally at 3-6 weeks, but for country patients, may be longer than this.

X-rays are taken on arrival.

This appointment is a good opportunity to ask any questions you may have of the surgeon, such as when you may return to certain activities. Keeping a list of questions that may come up over the initial post-operative period is a good idea.

If you want to consult a physiotherapist after this appointment, you should get clearance from the surgeon and take any documentation you have about your surgery to the physiotherapist.

If you can maintain a good contraction while breathing normally, then slowly slide one leg

down. Keeping the lower stomach tight, slowly slide the leg back up and repeat with

the other leg.

The legs should only be moving IF you have a stable middle and good TA contraction – you may need to stop and rest after a few repetitions

Progress to continuous movement for 1-2 minutes, five times daily.

Squeeze your bottom and thighs, rise slowly on your toes, and SLOW down.

Repeat ………  x3 times a day.

Keep your back vertical as you slowly bend your knees.  Keep your bottom and thighs tight.

Repeat ……. x3 times a day.