Spinal Rehabilitation After Fusion Surgery

General Considerations

Rest: It is important that you give your body time to rest after surgery to give the spine and surrounding soft tissue time to heal. It is also important that you avoid all movements and activities that cause increased pain. Pain is the body's way of letting you know you are either doing too much or causing irritation to healing tissue. Although the use of the brace will help restrict most movements, it will not limit all potentially damaging movements or overuse.

Ice and heat: Both of these treatments can help very much in controlling the amount of pain, tightness and pain medication needed. For the first 3-5 days post-op, using ice bags, bags of frozen peas, or commercial ice packs for 15 minutes 3-5 times a day can be very beneficial. You want the area to actually constrict enough for it to go numb which decreases the swelling of the surrounding tissue and decreases pain. After at least 5 days, moist hot packs for 15 minutes can be beneficial when the area feels tight or stiff, but ice is still recommended at the end of the day to control the swelling that takes place during the day.

Relaxation: Relaxation can aid in decreasing pain, improving healing potential and decrease the stress of post-op pain and restrictions. Practice breathing exercises with smooth inhalation through the nose and full exhalation through lightly pursed lips. This allows oxygen to move more efficiently through the body. This is also very important when performing any activity which requires an exertion or bending. By actively exhaling with effort, the strain onto the spine is considerably less. Practice this when getting up from sitting or lying down or lifting anything.

Postures: There are a number of things to take into consideration when dealing with the different positions we need to get into during the day.

Sitting: The spine should be in what we call "neutral" positioning. This means that the weight of the upper body should be centered over the hips and the head centered over the shoulders. This is not "military posture" which is sitting up too straight, but rather a position of comfort where no real sense of stress or strain is felt. It is important that you choose a chair which is fairly flat backed and straight, such as a kitchen or dining room chair. It is also helpful to use a small pillow or towel roll behind your lower back for extra support. Avoid soft couches or chairs as they place a lot of stress on the spine. Keep the feet flat on the floor when sitting and knees preferably slightly lower than hips. Avoid sitting with feet up on an ottoman or coffee table as this will increase pressure on the spine and nerves. Try to avoid sitting longer than 15-30 minutes during a 4 hour time period and less if soreness develops.

Standing: Similar principles apply in standing as in sitting. The upper body should be centered over the hips and legs, the knees should be unlocked, the abdominals lightly pulled in and your head centered over your shoulders. Think of standing tall as if a string was pulling you up by the top of the head.

Lying down: Soft mattresses or couches will increase your soreness; a firm support is best. The height of your mattress should be at least equal to your mid-thigh, as anything lower increases stress onto the lower body. Do not lie in too much of a fetal or curled-up position or any position which puts a twist on your spine. Pillow propping to hold you in a comfortable position will be most comfortable when lying down and a pillow between the knees when lying on your side is also helpful.

Getting up from lying down: One of the most stressful movements to the spine is sitting up straight from a lying down position. Use the "log roll" technique where you roll your whole body to one side as a unit (like a log), then you can easily let your legs off the side of the bed or couch and push yourself up into a sitting position.

Lifting: It is important that careful attention is placed on the restrictions set up by your surgeon post-op. However, when restrictions have been lifted, then there are a couple of important considerations:

• Bend at the knees
• Keep the weight close to the body
• Do not bend forward or round out through the spine when lifting
• Go onto one knee as necessary for things on the floor
• Exhale as you lift

Nutrition: As with every aspect of human health, nutritional intake has a dramatic effect on healing tissue. It is best to get in the habit of good nutritional practices even before your surgery, but afterwards is essential to give your body what it needs to repair. Most of the time, good nutrients can all be achieved in a well-balanced diet. However, due to decreased appetite following surgery and other factors, it is sometimes difficult to get everything you need from food. Therefore, supplementing with a good multi-vitamin with minerals can be beneficial in making sure your body is getting everything it needs.

Exercises

Three to five times a day, it is good to go through a few easy exercises to make sure certain important postural muscles are working. It is important to not overexert when performing these, but rather listen to the body and feel the muscles engaging. Make sure to breathe smoothly when performing and not hold your breath.

Deep abdominal contractions: Learning to find the deep muscles that protect the spine is also very important to help protect the spine. The deep abdominal muscles can be recruited by practicing the "drawing in" concept. During the breathing cycle, after you inhale into your lower ribs, draw in on your abdominals like you are bringing your naval towards your spine while you exhale. You should picture these muscles contracting in to push the air out. Perform 20-30 repetitions and also think of these muscles when doing any activity which requires any effort. This will help stabilize the spine even during basic movements.

Pelvic floor contractions: Perform a Kegel contraction, as if you are trying to stop urinating in mid stream. Hold for 5 seconds and repeat 20-30 times.

Shoulder blade retraction: Sitting in a good postural position with your head centered over your shoulders, lightly pinch your shoulder blades back and down like you are putting them in your hip pockets. Do not arch the back or hold your breath while performing. Hold 5 seconds and repeat 20-30 times.