I am in the process of making up an exercise program for patients who have undergone a laminectomy / discectomy and am interested to hear from physios opinions on this topic.
hi, i think its very interesting to built up a protocol for this cases. but it often depends on the condition of the pat. it makes a big defference if a pat. is fit and does a lot od sports or if he is adiopose etc.
but basically i start treatment (after history taking of course) with kind of a back/spine school. show the pat. on a skeleton what the surgons have done, what happend before etc. second stepp is the show them how to deal with their back, i.e lift up and carryíng things, how to bent over. also how to go to bed and to get up again.
give them working sectors, first without rot. later include rot.
also strengthening of core muscles deep transverse, mulifidi etc. firstly more static then dynamic exercises.
my experience is that with a proper teaching and training of their back its easier for pat to understand the importance of movement muscles stability and so on.
good luck with your work!!
Hi why don't you start by asking your spinal surgeons what they want and don't want.
Then you can stay within their guidelines.
No point developing something they won't let you use on their patients!
And like Wutti says, it depends on the patient, the levels involved, the amount of movement or control restrictions they have etc
it is important to consider some back muscles stretching before strengthening because, most patients do not stretch after surgery and develop adhesions or what is called post-laminectomy syndrome and ANR(adherent nerve root).
also swimming is a good excercise for these patients.
if you have some background about McKenzie, it sure helps with back cases.
Well i m treating a patient who is abt 45 yr old
and he is sufferig form Ankylosing spondylities and his spine is completly fuse and form bambo spine , he come to me for the post opp treatment of leminactomy cause he was hit by a car ....
My treatment protocol is :
1)Venous pumping activities
2) Static Quards
3) Static Glutie
4) supine lying position and i put a thin pillow below his lumber and thoracic spine
5)cycling while he is supine
6) Daily ambulate patient with the help of walker
Do u like to tell me what else i can do .....
Usually the patient following this type of surgery is discharged 5-7 days postoperatively. The patient is mobilized, ambulated and taught the protective techniques and posture and importance of maintaining the lumbar Lordosis. The pateint is taught a programme of strengthening exercises for his lumbar extensor and abdominal muscles. A scheme of stretching exercises for tight hamstrings and hip flexors is added as they found to be tight. If abdominals are weak they need to be strengthened. Any fault in poor posture and pelvic tilt is corrected and taught. If lower limb muscles are weak, they need to be strenghtened. Infact, a stronge and mobile lower limb provide a suitable background for activity. Perform the tests for detecting the neural tension and if you find any sensitive nerve root or nerve, mobilize it by the nerve mobilizing techniques for lower quarter or lower limb. Teach a proper gait training to the patient. Assess the suitability of any walking aid or assistive device if required postoperatively. Beware of post laminectmy syndrome. Let the patient know the importance of exercises in maintaining the strength, mobility, flexibility and endurance of the back and the body.
find the follow text:
Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician:
JeMe Cioppa-Mosca, Janet B. Cahill
Rehabilitation for the Postsurgical Orthopedic Patient: Lisa Maxey, Jim Magnusson.
After 2nd spinal stenosis Laminectomy opp just 2 weeks ago today i still have numbness, left foot ankle and heel, day by day getting weeker, as yet no referal to physio yet should be soon. in the meantime what excersizes can i do,
If the numbness &/or weakness is getting worse go back to your surgeon straight away. A physiotherapist needs to look at your individual case and do a full assessment before advising you on exercises.
but i want to add
u should take the permission of suergeon about when the pt should come out of bed
then use the lumber support and walker and teach the patient the proper way to get out of bed and go back to bed
and acc to the patient fitness we gradual the sterngthening ex ob abdomen and back
and we can start walking program in locomation machine in gradual duration and speed