Written by Tom Bianco; originally published in Princeton Brain, Spine and Sports Medicine
As a physical therapist, one of the most challenging patients to work with is someone who has had spinal surgery. Whenever the lumbar or cervical spine has had surgical intervention, a therapist knows, in order to be safe, that they have to slowly bring that patient back to their normal functional level.
At the start of physical therapy, a complete evaluation is performed that includes a medical history, surgical history, physical examination and special spine tests. Post-operation protocols, provided by the surgeon, are taken into account when designing the rehabilitation program.
The physical examination includes a posture observation, movement analysis of the spine and lower and upper extremities, reflex, sensation and strength testing, spinal mobility palpation and flexibility measurements. The main purpose of the physical examination is to determine what muscle, ligament, nerve or bony imbalances are present and what exercises and other treatment options are needed to improve the body’s functional level.
A pain assessment is also completed. There are varying degrees of pain that can be present following spinal surgery. Some pain is understandable and other pain does not always make sense to all patients. The physical therapist can assist the patient in understanding and managing their pain both in the clinic and at home.
What to expect… Your initial assessment and examination will require you to move more than you might have since your surgery. This may cause you to be sore from the examination. This is normal though not intentional. Usually the physical therapist will advise you on home techniques to manage your pain after the examination.
A thorough evaluation will take about an hour and includes some gentle exercises for you to do at home. No matter what the frequency of your visits, your home exercise program is vital for you to return to your previous level of functioning.
Do not compare apples to oranges… Recovering from spinal surgery takes time. Every surgery is different and every person heals differently. Many times patients will compare themselves to other people that they know who have had a similar surgery. And when their recovery does match the pace of the other person, the patient can become frustrated. It takes patience and courage to fully recover from a spinal surgery.
Sometimes your pain will fluctuate in intensity, type, and location. One moment you might feel a manageable dull ache in your low back; then the next moment it becomes a sharp intense pain. This is normal, expected and can be difficult to understand and manage.
Treatment… Physical therapy treatment includes modalities such as ultrasound and electric stimulation to help reduce pain and breakup scar tissue. Massage and other manual techniques reduce muscle tension and improve range of motion. Assisted stretching improves flexibility in the spine and extremities. Home exercises increase trunk stability and upper and lower extremity strength and functioning.
Overall, it is important to remember that spinal surgery is a significant medical intervention. The rehabilitation, which includes physical therapy, may take up to one year for a patient to fully heal and return to full functional capacity.