Exercise programme following surgery of the lumbar spine

The aim

This leaflet is designed to provide information about lumbar surgery.

The information will help you understand how long it typically takes to recover after surgery.

To aid your rehabilitation and become more active, we have detailed below several exercises to start this process.

The Spine

The spine is split into three curvatures or sections. The cervical curve is the upper part of your spine, your neck. The thoracic curve is the middle section of your back, and the lumbar curve is the lower portion of your back.

You have had surgery to the lumbar section of your back. This may have been to help with pain, altered sensations or your movement. In some cases it may have been a combination of these factors.

The Lumbar Spine

The lumbar area has the largest bones and bears most body weight. The spine is made up of vertebrae which have intervertebral discs which lie between each vertebral level. Spinal nerves exit the spinal column, pass between the vertebrae and supply the lower limbs to enable sensation and movement.

Surgery

This lumbar spine surgery will be completed under a general anaesthetic. You will have a breathing tube placed in your throat to protect your airway and you will be positioned flat on your stomach. Muscles are cautiously moved aside to access the spine so the relevant structure – bone, intervertebral disk or ligament – can be operated on.

After Surgery

Normal side effects from the general anaesthetic include drowsiness, dry mouth and a sore throat. Sensitivity over the wound site and discomfort in the general back area is normal and should reduce with time and mobility. Some patients find that previous leg symptoms have reduced, but this varies from person to person. However, as a rough guide, start the exercises explained in this leaflet as soon as possible.

The structures that have been operated on are healing, so it is normal for symptoms to persist until the swelling reduces . These are expected to improve with time.

Please note the following:

• Only sit for as long as is comfortable. If discomfort increases, this is your body signalling movement is needed.
• Regular walks are great for increasing your activity level and general fitness. If discomfort increases, take a short rest before continuing. Note how far you managed to walk and aim to increase or match this next time.
• Keep on top of your pain relief to keep the discomfort at bay to enable the completion of your exercises.
• Returning to sport should be as gradual and as graded as your pain allows. If returning to swimming, allow your wound to heal and vary the stroke if you feel discomfort.
• Experiencing fatigue is normal; this will reduce the more you do.
• Continue to complete exercises; they should be getting easier
• Think about contacting your employer and discussing adaptations needed to return to work, such as a phased return.
• Return to hobbies and recreational sport, but be guided by how your back feels.

Returning to driving is likely to vary depending on your recovery, but could be from 2 to 6 weeks after surgery, provided you have no altered sensation or weakness in your legs or unless you are advised otherwise. If in doubt, discuss driving with your GP or await your clinic appointment with your consultant.

It is also advisable that you contact the DVLA (Driver and Vehicle Licensing Agency) for advice regarding returning to drive. The DVLA can be contacted on 0300 790 6801.

Exercises

Purpose: To help the nerves in your back legs move freely and to help circulation. With your legs straight, bend and straighten ankles repeatedly. Repeat . . . . . times, . . . . . . per day.

Purpose: To reduce pain and increase movement in your back. Lying on your back with your knees bent towards the ceiling, and keeping your feet on the bed, slowly roll both legs from side to side. Repeat . . . . . times, . . . . . . per day.

Purpose: To help the nerves in your back and legs move more freely, reduce pain and increase back movement. Lying on your back with a cushion under your head, pull your knee to your stomach with your hands. Hold for 10 seconds then straighten your leg. Repeat with the other leg. Repeat . . . . . times, . . . . . . per day.

Purpose: To increase the strength of the muscles that surround your hips and lumbar spine. With knees pointing to the ceiling and lower abdomen pulled in, move one knee slowly outwards whilst keeping the other knee still, and then bring it back to the middle. Repeat with the other leg. Repeat . . . . . times, . . . . . . per day.

Purpose: To increase the strength of the muscles that surround your lumbar spine and hips. Lying on your back, knees bent, feet flat on the bed, pull your lower abdomen in and lift your pelvis and lower back off the bed. Squeeze your buttocks together and hold for 5 seconds. Slowly lower your body to return to the starting position. Repeat . . . . . times, . . . . . . per day.

Purpose: To increase the strength of the muscles that surround your lumbar spine, and to improve lumbar movement. On all fours, pull your lower abdomen in and arch your back. Hold for 5 seconds then lower slowly. Repeat . . . . . times, . . . . . . per day.

Purpose: To reduce and increase movement in your back. Standing up straight, feet together, slide your left hand down the outside of your left thigh. Repeat on your right side. Repeat . . . . . times, . . . . . . per day.

Goals

In order to aid your recovery back to full fitness, goal setting is really important to establish a focus.

Please write down three realistic goals – one short-term, one mid-term and one long-term – to aid focus for your rehabilitation.

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2.

3.

Can you think of any barriers which may prevent you from achieving these goals?

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3.