Post surgical rehabilitation is essential for maximizing outcomes of surgical intervention. Surgery is aimed at correcting a structural problem within the spine, however the musculature is left often times in a weakened state. It is essential for the post surgical patient to be educated in a proper exercise program to completely regain functional use of the spine.
PDR has developed several MedX post surgical protocols that have been successful in allowing patients to regain full motion and strength following surgery. Physical rehabilitation following spinal surgery is necessary to restore strength and range of motion while protecting the surgical site and improving repair. Avoiding physical activity can result in muscular fibrosis, adaptive tissue shortening, loss of function, and increased risk of re-herniation.
Axial strengthening is necessary to return patients to physically demanding activities in their daily life or occupation and avoids re-injury. Typically, along with the disc injury there is also a soft tissue injury, specifically to the paraspinal musculature. The MedX equipment allows us to isolate and administer calculated doses of exercise to the paraspinal muscles at a therapeutic level without compromising or overloading a post-surgical disc. Isolated mechanical loading allows us to safely break up random alignment of the collagen fibers (myofacial adhesions). Continued loading during the healing process stimulates the new collagen fibers to lie down along the lines of mechanical stress, thus forming a stronger and more functional repair.
Inducing controlled segmental motion also produces facet motion, breaks up capsular adhesions, promotes the production of synovial fluid, and ultimately normalizes facet range of motion. Reintroduction of controlled activity also allows us to address the fearful patient and demonstrate that post-exercise muscle soreness is not injurious pain. Several studies have demonstrated that exercise increases levels of encephalin, endorphins, serotonin, and norepinephrine that help control pain.
Phase I: Reintroduction of Spinal Motion
The goal of phase I is to reduce inflammation and pain while slowly reintroducing normal inter-segmental spinal motion. The patient is instructed in proper postures and body mechanics to safely return to light activities of daily living.
Phase II: Restoration of Spinal Strength and Function
The goal of Phase II is to promote spinal AROM, continue cardiovascular conditioning, and introduce extremity and spinal extension exercises. Progressive resistance exercises (PRE’s) are used. During this phase it is crucial to restore motion at the level of the disc, promote imbibition of fluids, and to restore normal facet motion. Specific stretches are instructed to prevent adaptive shortening of soft tissues.
MedX equipment is introduced in this phase to safely exercise the extensor muscles while ensuring proper segmental loading. The patient’s AROM can be limited to avoid excess flexion, which would increase hydrostatic pressures on the posterior aspect of the disc. Limiting forward flexion therefore decreases the risk of posterior disc re-herniation.
Phase III: Restoration of Lumbar Strength and Function
After 4 weeks of successful phase II rehabilitation without significant peripheralization, rehabilitation may become more aggressive. The goal of Phase III is complete restoration of lumbar AROM and strength. This phase includes more aggressive lumbar MedX strengthening, cardiovascular, and total body strengthening exercises. Rotary torso MedX strengthening may be introduced at week 9 if lower extremity symptoms are minimal and lumbar discomfort is controlled. If return to work is anticipated, job specific (work conditioning) exercises may be ordered. A functional capacity evaluation can be performed at the completion of the program to objectively determine safe work restrictions.