Rehabilitation following laminectomy.

[sibbles53]

I have a patient who is keen to return to the gym following laminectomy.Currently she is 3 months post-op and has just been permitted to gradually remove her back brace.Has anyone had any experience progressing someone like this back to the gym?ie.What types of gym equipment are appropriate and at what stage?What type of exercise program would be appropriate prior to prepare her for the Gym? She has been using the treadmill with brace on since 6weeks post-op and recently begun without. Any guidance here would be much appreciated!

[scottthephysio]

I would suggest lots of core stability work, initially working on just transversus abdominis activation which back pain patients often find extremely difficult to maintain the contraction or indeed even get a contraction! I have found that starting in prone then progressing onto supine with knees flexed has been good. Combine this with multifidus strengthening. Then progress onto dynamic trans. abs activity. Once the patient can maintain contraction of trans abs I get them working on core stability with the Swiss/Gym ball, and this is fantastic for low back pain patients progressing their rehab after gaining the ability to use trans abs and multifidus as a 'corset' around the back. Also do lower back extensions on the gym machines but emphasise that it is a controlled small extension with pelvis maintained in neutral with trans abs and multifidus contraction, and of course the same with abdominal machines, I feel the important thing is that as long as they maintain a good neutral alignment with good 'corset' effect of the trans abs and multifidus then they can do alomost anything at the gym. (phy510@aol.com)

[NARSTR]

I am amazed that a surgeon would put someone into a back brace for three months for standard lami - or was it a very unstable spine? Nobody here (four surgeons) would brace anyone - even three levels because of the inhibitory effect. Good luck,and I agree with scottthe physio - lots of trans abs, pelvic floor and multifidus work. Forget the old style back extensor regime and oblique abs, etc. Also lots of postural control retraining in sitting and standing and walking.