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I start physical therapy today, dont know what to expect

jade10025jjade10025 Posts: 42
edited 06/11/2012 - 8:45 AM in Recovering from Surgery
anyone got any idea of what they might have me do or how uncomfortable physical therapy was for you after a lumbar fusion?

i am excited cause i get to leave the house and exercise, but i have no idea what to expect.


  • Some day soreness. Some times just tightness,but it is always good to do excerises.
  • Of course, everyone is different and every situation is unique.

    Your PT will do an evaluation looking at range of motion, strength, location and intensity of pain, swelling, sitting/standing tolerance, and how much assistance/level of independence with activities of daily living (ADL's~dressing, shopping ,cooking, cleaning ,etc).

    After this, a plan will be developed for your treatments to help you regain your strnegth, range of motion and independence.

    Your PT should be willing to discuss all of this with you. You may want to ask what their ratio is of PT's and PT assistants/PT techs.

    PT doesn't have to hurt. Generally the rule of thumb is if it hurts, back off! But, that isn't to say later that day or the following day you won't be sore. If the pain continues past the next day, you might have pushed too hard.

    You want to be a good partner to your PT, so you will want to be in tune with your body, stay focused as you do your exercises so that you maintain correct form and listen to your body. You will want to communicate is you experience pain and from one session till the next.

    I kept a log, rating the level of pain/discomfort I felt, where I felt it and what helped or didn't help. Turns out this log provided excellant info for something I couldn't have forseen.

    I hope this has been helpful! don't be nervous, this is the fun part! This is the return to the part of your life you had to give up due to your need for fusion!
  • dilaurodilauro ConnecticutPosts: 9,868
    Physical Therapy 101

    I've been going to different therapist and therapy centers for over 30 years. The past 7 , I have finally found one that does everything that I expect.

    Here are some extras regarding Physical Therapy:

    1 - Find a center that is associated with a local hospital. Generally, they will have additional staff and access to more equipment.

    2 - Ask your doctor for their personal recommendations. I know in the past, some of my doctors had preferences as to what center to to go.

    3 - Visit the center prior to your first appointment. Talk to the Administrative staff, tell them you are thinking about coming to them. Ask to be shown around the facility. Find out how many fully licensed therapist they have, how many technicians and how many students. Check for various equipment. Any good center will be willing to share this information with you.

    4 - Your first visit will probably be the evaluation. Here is where they go up/down/side to side on you, take measurements (range of motion), identify pain levels, etc. This can take anywhere from 30 minutes to an hour.

    5 - Ask if the person doing the evaluation will be the person doing your treatments. If not, still find out who will be doing your treatments and what can of schedule does that person have. It is so very important to stick with one therapist during your times going there. There will be a bond between patient and therapist that sometimes is stronger than between patient and doctor. The therapist might get to know your body better than you do.

    6 - Know when to say enough is enough. I am a firm believe in Physical Therapy. It is one of the major ingredients in successful recovery. However, there are times when the therapy can go too far. I had too many sessions, where I allowed the therapist to push me more than what should have been pushed. As a result, I suffered and had setbacks. Now, I am at a point and experienced enough to tell the therapist, just how far I can go.
    They know I will work and I will push hard, but they totally respect my judgment.

    Last thing, dont give up! The first couple of sessions can look so dark and gloomy. You may question yourself as to why you bother to go in the first place, you are hurting more.

    In a few short sessions, you should begin to see
    improvement. They may be little to start with but over time, that should always continue.

    Good luck
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • i had a tlif l4/l5/s1 on march 19.
    i started p.t. july 12, and i am in more pain.
    remember there is a difference between good pain and bad pain,
    some of what i feel is good pain, and some is bad pain. i told the therapist and she has noticed it, and has tapered off alittle,
    just make sure you tell them, the level you reach where the pain worsens.
    like shari said back off if it hurts.

    best of luck
  • Thanks. :)

    All great advise. I am a believer in physical therapy, but Ive never really done it my self. I had thought of going to a local hospital's program, but it is a bit outta the way from anything in my life, and all my treatment is through private insurance, and i imagine the hospital ones are more expensive and will have a larger co-insurance cost. I found a place close to home and work recommended by a friend. Now i will check it out and ask the questions listed above to make sure its where I wanna stay in my treatment.
  • I haven't had PT post fusion yet-still very early post op. But please come back and share how it went for you.

    I've had lots of PT for other issues, but I'm thinking this is going to be whole other ballgame :?

    I like the idea of the log too, mentioned by jayhawk. That's a good idea.
  • One final note,

    Everyone has given you terrific feedback, but on the "what to expect" portion I just wanted to add that you will probably start out very slowly. After my fusion my exercises were mostly done lying on my back and then progressed to sitting and standing exercises as my pain levels improved and I got some strength built back up. It made me sore, but it was a good kind of sore.

    Another question you might want to ask is how much experience they have with post-surgical spine rehab, and if there is a specific therapist who does spine cases. There is a huge range in the quality of physical therapy, and from my experience I have found it makes a difference to see someone who does mainly spines rather than a PT who does everything from knees to shoulders to backs.

    Also, the main difference I have found between chain PTs and PTs associated with hospitals is that the chains tend to rely much more heavily on PTA's and may employ only 1 or 2 actual physical therapists. I go to a hospital affiliated PT now and they don't even have PTAs, and the cost is actually cheaper than some of the chain PTs around me because the hospital is in network. You can probably either call the PT place or your insurance to compare costs. I went to a chain for awhile and got great care there, too, and it was with a therapist who worked exclusively on spines. You may or may not be comfortable doing this, but if the PT place employs a lot of PTAs you can refuse to be scheduled with a PTA. Not to put PTAs down, but it costs the same whether you see an actual physical therapist or the PTA, so why wouldn't you insist on working with someone who has extensive training?
  • is that some days when I went in for a session, I was having a particularly bad lower back pain day. I told my PT about it the minute I saw him and that's when he noticed that my hips and spine were out of alignment, so the PT session was more manipulation and massage oriented than physical exercise.

    So be sure that if you're having more than usual pain as you walk into PT that you tell them so they can figure out why before they go into the normal routine. With lumbar surgery, sometimes our bodies misalign themselves without our knowing, but it causes increased pain and the PT seems to see it easily. I guess that's what they're paid for.

    Also, my PT used some of that black massage tape on my lower back and neck when my spasms were worse than normal, and he wanted me to keep the tape on for about 4-5 days. That's some really cool stuff and you can even shower with it on and it won't come off. It's intended to massage your muscles as you move. If you do have some put on and you take a shower, just know that it takes forever to dry - it's actually made out of cloth so you'll need to allow extra time for it to dry before you put your clothes on.


  • I totally agree with Lala's comment about asking how much experience they have with spinal surgery, and if they have a spinal specialist.

    The first physio I saw seemed to be overwhelmed with how many different pains I was getting in different places after surgery. I don't think that is unusual, but she commented on how complicated my case was, and that with a case like a bad knee it was far simpler. That didn't give me confidence that she had experience in spinal surgery rehab.

    I then found a physiotherapist who specialises in spinal surgery, and switched to him. He is great and is working to get me ready for my return to work, specifically strengthening me ready to do the movements my job entails. He explains everything to me, which I really appreciate as I want to know what we are working on, and why.
    He is actually cheaper too! :D

    How did you get on yesterday, with your first session?
  • so yesterday was good. I am seeing the main therapist, mot a aid, which i like. i mainly did a evaluation, a seated elliptical machine and stretches. he wanted to take it easy for the first day. he also used a muscle stimulator, kinda like a tense unit, to help the muscles stop spasming. I felt pretty good after. not to sore today either. so, so far so good. he also recommended i walk in a pool when i can.
  • so yesterday was good. I am seeing the main therapist, mot a aid, which i like. i mainly did a evaluation, a seated elliptical machine and stretches. he wanted to take it easy for the first day. he also used a muscle stimulator, kinda like a tense unit, to help the muscles stop spasming. I felt pretty good after. not to sore today either. so, so far so good. he also recommended i walk in a pool when i can.
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