Lumbar decompression rehab protocol

Question 1

pre-op phase:

Answer 1

1 pre-op visit

1-2 weeks prior to surgery

Question 2

pre-op visit goals:

Answer 2

assess etiology and onset of symptoms

physical exam as tolerated:
> assess incisions
> neuro screen
> gait screen
> ROM/mobility for total spine motion as tolerated
> strength as tolerated - usually LEs
> balance

establish goals both rehab and personal

education and answer questions regarding surgery and expectations
> reinforce pre-op instructions
> re: incision care and ability to shower 5 days post
> post op precautions

Question 3

phase I:

Answer 3

day 1 up to 4-6 weeks post depending on complexity of surgery

Question 4

phase I goals:

Answer 4

incision/wound management

protection of surgical site/spine

pain management

return to self-care and ADL’s

increase sitting tolerance to 30 minutes

increase walking to 15-20 minutes

return to driving once comfortable and safe to do so (recommend to be off pain narcotics)

gradually return to light duty job = IF SURGEON agrees

Question 5

phase I precautions (discharge instructions leaving hospital):

Answer 5

return to ADLs as tolerated

return to light duty work if surgeon agrees

change seated position frequently - every 20-30 minutes

use good body mechanics

avoid lifting over 10lbs

may shower 5 days post-surgery - not soaking incision until fully healed

continue instructed exercises from pre-op visit

Question 6

first post-op visit:

Answer 6

2 weeks post-op

Question 7

first post-op visit goals:

Answer 7

assess incision

physical exam

assess/address functional goals set at pre-op visit

education
- incision care
- body mechanics
- pain management
- gradual return to activity
- progression of activity and lifting
- instruct in walking and CV exercise daily

assess for rehab needs to start now or further along in recovery

Question 8

phase II:

Answer 8

4-6 weeks post depending on complexity of surgery

Question 9

phase II goals:

Answer 9

return to house chores with good body mechanics

return to light-medium job tasks

gradual return to recreation/leisure/sport activity depending on intensity

Question 10

phase II precautions:

Answer 10

use of good body mechanics

work on improving motion and mobility

start strengthening program with specific lifting program if returning to heavy lifting

caution patient on graduated return to higher intensity activities

Question 11

second PT post-op visit:

Answer 11

4-6 weeks post depending on complexity of surgery

Question 12

second PT post-op visit goals:

Answer 12

assess incision

physical exam

assess level of self-care in managing symptoms and spine protection

assess any return to function needs

assess need for structured rehab

use modified low back pain questionnaire (Oswestry)

Question 13

phase III:

Answer 13

starts 6-8 weeks post

more consistent rehab/PT depends on pt’s continues needs and goals

Question 14

phase III goals:

Answer 14

return to all prior activities - focused on personal goals

work all levels light to heavy
sports
recreation/leisure

Question 15

phase III precautions:

Answer 15

none unless specified by surgeon

Question 16

exercises to be started immediately after surgery for 2-3 days:

Answer 16

quad sets

ankle pumps

buttock squeezes

Question 17

exercises to be started 2-3 days after surgery:

Answer 17

single knee to chest stretch

lower abdominal tightening

standing back bend stretch

Question 18

use of ice:

Answer 18

decrease swelling and improve recovery time

ice back to surgical area 15-20 minutes at a time

many times a day

Question 19

activity level:

Answer 19

keep day evenly active

no one position for too long

walking = god

2-3 short walks - 3-5 minutes and gradually build up

Question 20

sitting positions:

Answer 20

sit with back supported

lumbar pillow support or towel to support low back

shoulders relaxed

avoid rounded back

hips level with knees and avoid crossing legs

stand up and move every 20-30 minutes

Question 21

sleeping positions:

Answer 21

lie on pack with pillow under knees

lie on side with pillow between knees

Question 22

movement precautions:

Answer 22

first couple weeks = bend with knees when getting something from down low

Question 23

post op rehab plan:

Answer 23

first visit = 10-14 days post op

second visit = 4-6 weeks post op

Question 24

phase I exercises:

Answer 24

single knee to chest stretch

trunk rotation stretch

hamstring stretch

abdominal stretching

back extension stretch

wall slide

calf stretch

standing back bend

hamstring stretch

seated trunk rotation stretch

forward bend stretch

Question 25

walking program

Answer 25

walk 5-15 minutes, 3x a day - gradually build

Question 26

phase II exercises:

Answer 26

lower abdominal strengthening

curl up

bridge

cat-cow stretch

bird dog

sit to stand squat

Question 27

phase III:

Answer 27

lower abdominal strengthening

bridge with march

upper body lift

lunge

cross body chop

band sideways walk