Lumbar Fusion Rehabilitation Protocol
Objective: To facilitate the return of function by providing an organized and systematic approach to the rehabilitation of individuals who have undergone an instrumented lumbar fusion procedure.
Phase 1 – Protective (0-4 weeks post surgery)
Goals: 1. Decrease pain and muscle guarding.
2. Decrease nerve sensitivity improve mobility.
3. Minimize aerobic de-conditioning.
4. Initiate mobility of hips and back.
5. Minimize general and spinal muscle atrophy.
If supplied with a lumbar corset or brace, it is to be worn for comfort and support whenever out of bed, except when showering or using the toilet.
Ice applied the low back region may be utilized for 20-30 minutes several times per day to assist with pain control.
A graduated daily walking program should be initiated (1-2 blocks, 3-4 x/day, progressing as symptoms allow).
A lifting restriction of 8 lbs. is recommended unless otherwise specified by the surgeon.
Activities of daily living are modified as per the Black Hills Surgical Hospital home care instruction sheet.
Gentle mobility exercises are to be performed on a daily basis as provided by the hospital physical therapist.
Instruct the patient in the application and use of TENS to assist with pain management.
Phase 2 – Protective Reactivation (3-4 weeks duration)
Goals: 1. Decrease residual pain and muscle guarding.
2. Decrease nerve sensitivity & improve mobility.
3. Gentle progression & restoration of lumbar mobility.
4. Introduce and progress lumbar stabilization / strength.
5. Progress aerobic conditioning.
6. Improve lower extremity flexibility and strength.
Treatment is initiated upon the receipt of the physician referral.
Review appropriate postures and body mechanics as related to activities of daily living.
Use modalities to assist with pain control. Continue TENS use at home as necessary.
Utilize manual therapy and therapeutic massage to address mechanical and myofascial dysfunctions involving the lumbo-pelvic and thoraco-lumbar regions.
Progress nerve mobility exercises addressing appropriate lower extremity distributions.
Initiate gentle lumbar mobility restoration exercises including pelvic rocking and single knee to chest in non-weight bearing positions such as supine, side lying, and quadruped.
Initiate basic lumbar stabilization including isometric contraction of lumbar multifidis and transverse abdominal muscles.
Progress lumbar stabilization exercises in multiple positions advancing from limited spinal load to full weight-bearing load.
Aerobic conditioning may be progressed as appropriate using treadmill, stationary bike, recumbent bike, elliptical trainer, and upper body cycle.
Initiate exercises to address lower extremity strength and flexibility deficits demonstrated upon clinical examination.
A job site analysis may be appropriate to determine specific work related goals for the strengthening phase of rehabilitation.
Phase 3 – Strengthening (3-4 weeks duration)
Goals: 1. Progress trunk stabilization and strength.
2. Emphasize any lower extremity functional strength deficits
3. Address residual nerve mobility issues.
4. Address residual lumbar mobility deficits.
5. Advance aerobic conditioning.
6. Initiate work conditioning / hardening as appropriate.
Advance lumbar stabilization utilizing external resistance such as exercise band, dumbbell weight, medicine balls etc. Functionality of exercise may be advanced by adding spinal movement and speed as appropriate.
Incorporate closed kinetic chain lower extremity strengthening and flexibility exercise to address deficits and minimize potential stress to the lumbar region.
Progress nerve mobility exercises as necessary for any observed residual deficits.
Continue with gentle lumbar mobility restoration exercises taking care to avoid excessive shear or torsion to the fused segments.
Progress aerobic conditioning as related to work and leisure pursuits. Surgeon clearance is required prior to release to specific sporting and leisure activities (swimming, bowling, golf, hunting, horse riding) and return to work.
Educate as to proper lift technique and appropriate body mechanics utilization.
Initiate and progress work simulation activities incorporating dynamic strength such as lifting, carrying, pushing and pulling in order to optimize safe return to work.
Note: A functional capacity or physical work performance evaluation (PWPE) may be appropriate at the conclusion of phase 3 to determine patient work readiness and appropriate work levels.
Reviewed and approved by Dr. Stuart Rice, Dr. Tim Watt, Dr. Robert Ingraham and Dr. Jonathon Wilson.
Revised: 10/2013