Suggested Home Maintenance for the Postsurgical Patient 17-1

Maxey: Rehabilitation for the Postsurgical Orthopedic

Chapter 17: Lumbar Spine Disc Replacement

Suggested Home Maintenance for the Postsurgical Patient

The patient can use the following home program during the rehabilitation process. The contents of the home maintenance program may vary depending on the patient’s prior level of function, single versus multilevel TDR and tolerance and ability to complete the exercises properly without the onset of pain symptoms or aberrant motions.

Inflammation and Reparative Phases I and II (Weeks 1 to 3)

Goals For This Period: Protection of the surgical site, decrease pain and edema, understand proper body mechanics and posture, increase walking tolerance, speed, and endurance. Extension exercises past neutral should be avoided during this phase of the healing process.55

  1. Protection of the surgical site
  1. Manage swelling/edema in lower extremities
  2. Ankle pumps
  3. Compression stockings
  4. Leg elevation
  1. Bracing as needed during seated and standing activities to encourage healing
  1. Knowledge and understanding the need for regaining normal lumbar spine ROM
  1. Gentle flexion exercises encouraged,56 performed after 2 weeks in supine
  2. Hook lying isometric abdominal contractions emphasizing transverse abdominis and multifidus recruitment55
  3. Bed mobility
  1. Lower extremity strengthening for quadriceps and gluteal muscles
  2. Sit to stands
  3. Minisquats
  4. Heel raises
  5. Daily walking program
  1. Neuromuscular reeducation
  2. Tandem balance
  3. Single-leg balance

Remodeling Phase IIIa (Weeks 4 to 8)

Goals For This Period: Increase lumbar spine ROM in all directions and begin to return to normal activities of daily living

  1. Increase lumbar flexion mobility
  2. Progress abdominal strengthening with hip dissociation, (i.e., hip flexion, hip internal/external rotation in hook lying)
  3. Single knee to chest stretch
  4. Quadruped rocking
  1. Begin upper extremity and lower extremity strengthening exercises with proper abdominal bracing
  2. Rows
  3. Bicep curls
  4. Hamstring curls
  5. Step-ups
  6. Squats
  1. Begin lumbar extension, side bend, and rotation ROM exercises between week 6 and 8 as long as incision site has healed; begin progressing to end of range movements after 6 weeks55
  2. Prone press ups
  1. Nerve gliding
  2. Nerve gliding for those experiencing radicular symptoms (i.e., sciatica) into lower extremities postsurgery.55 Perform with caution, careful not to stretch the nerve.
  1. Cardiovascular
  2. Progress walking program
  3. Recumbent bike
  1. Return to performing basic activities of daily living including reaching, stooping, and squatting Avoid heavy lifting and high impact activities such as jumping and running.

Remodeling Phases IIIb (Weeks 9 to 12)

Goals For This Period: Progress lower extremity strength, aerobic capacity, and functional activities.

  1. Progress abdominal, erector spinae and gluteal strength
  2. Planks (initiate near end of phase)
  3. Pointer Dog
  4. Abdominal bicycles (must have enough muscle control to perform correctly)
  5. Latissimus dorsi pull downs
  6. Bosu ball squats
  7. Lunges
  8. Single-Leg reach

Remodeling Phase IIIc (Weeks 13 to 24)

Goal For This Period: Independence with progressive home exercise program, return to sport.

  1. Continue previous exercises and progress reps and weights as tolerated
  1. Begin sport-specific drills
  1. Increase walking speed and distance
  1. Preparations for running and more aggressive exercises may begin at week 12
  1. Lifting mechanics with weight; twisting and bending may begin after 12 weeks if ready

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