Lumbar fusion rehab protocol Flashcards
pre-op phase:
pt attends a pre-surgical education class
> usually 4-6 weeks prior to surgery
some cases - pt participate in PT prior to surgery to maximize strength
phase I:
0-3 weeks post-op for 1-2 level fusions
0-6 weeks post-op for 3+ level fusions or fusion with an anterior approach
phase I goals:
incision/wound management
protection of surgical site/spine
pain management
> ice
> comfort with supported positioning
> change position frequently
return to self-care and basic ADL’s
walk starting 3-5 minutes, 2-3x a day as tolerated with AD if needed
increase sitting tolerance to 20-30 minutes
phase I precaution/instructions leaving hospital:
no lifting over 10lbs - will be discussed/updated at first post-op visit
no bending through the spine
> bend with hips and knees or use a reacher to assist picking up something light
> use good body mechanics - keep objects close to the body
no twisting/rotating through spine
normal to experience symptoms similar to pre-op
first PT post-op visit:
weeks post-op for 1-2 level fusions
6 weeks post-op for 3+ level fusions or fusion with an anterior approach
first PT post-op visit goals:
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
> incision care
> post op precautions
> surgery site/spine protection/pain management
- change positions frequently
- use support for positioning
- proper body mechanics
- gradual return to activity with precautions
- use of ice
- home TENS
assess need for more structured rehab 6+ weeks post-surgery
administer Modified Low Back Pain Questionnaire (Oswestry)
phase II:
3 weeks post-op for 1-2 level fusions
12 weeks post-op for 3+ level fusions or fusion with an anterior approach
phase II goals:
gradual return to light-medium house chores
gradual return to light-medium job tasks
increase walking/cardiovascular activity - no running yet
phase II precautions/activity:
continue limited bending, twisting, and heavy lifting
work on improving motion and mobility
start a strengthening program
caution patient about higher level activities with the need of gradual return to rehab
second post-op visit:
6 weeks post-op for 1-2 level fusions
12 weeks post-op for 3+ level fusions or fusion with an anterior approach
second post-op visit goals:
assess incision
assess change in symptoms
physical exam
assess knowledge of self-care to determine needs in pain and prevention strategies
assess any return to function needs
determine need of starting more structured rehab program
administer Modified Low Back Pain Questionnaire (Oswestry) - if needed
phase II:
12 weeks post-op for 1-2 level fusions
14+ weeks post-op for 3+ level fusions or fusion with an anterior approach
phase II goals:
gradual return to prior activities - focus on personal goals
return to running, skiing, or other impact sports = 4+ months post with physician input
phase III precautions/activity:
able to further progress bending, twisting, and heavy lifting
progression is gradual
impact sports = may start training for - best to wait for full healing of fusion for full return - which is usually a year
third post-op visit:
12 weeks post-op for 1-2 level fusions
14+ weeks post-op for 3+ level fusions or fusion with an anterior approach
