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Physical Therapy / Range of Motion

Hello everyone,

I'm still in a Miami j hard collar while healing from my C4-C7 fusion. I'm 41 years old and would like to remain as active as possible, like I'm sure everyone would hope to as well after a fusion. The stiffness is getting a bit worse after four weeks and now that I feel the inflammation from the surgery coming down, I'm noticing the tightness around the incision. My whole front of my neck feels like it moves when I drink.

I'm curious to know what it feels like to begin physical therapy? How does one know if they are stretching out the stiffness or if because of the fusion you can't turn your neck any farther? I'm sure the PT will help with this but I'm feeling anxious about it. I'm nervous about putting undue pressure on the adjacent levels during PT and further herniating them, but I'm also worried about how much range of motion will be lost. All of the doctors say it is up to the patient and how dedicated you are to your PT, but how do you know when you've reached your maximum range of motion?

I realize everyone heals differently but, any perspectives would be appreciated :)



  • Hey Faith,
    I started PT after 7 weeks of recovery on c6/7 fusion. My physio is wonderful. She is staying away from the neck for the time being and is allowing its stiffness to just be what it needs to be for a bit. Her focus has been on rebuilding my strength in my tricep and doing some light theraband work which is aimed at doing the shoulders and arms with a small bit of engagement of the neck muscles. Even had acupuncture the other day to help get the nerves singing properly again.

    Its fully okay to feel a little nervous - I know I was as nobody except me had been anywhere near my neck for 7 weeks and I was unsure whether she was going to hurt me basically. I have nothing to worry about - she knows exactly what she is doing and is confident that once all my shoulder, arm and mid back muscles are working fine the rest of the body will respond accordingly and in the right sequence.

    So go with it would be my suggestion - my incision still itches every so often and is giving me a feeling of a lump in my throat there at the moment...annoying but in comparison to my pre-surgery arm pain...I'll put up with it!!

    Kindest Regards
    C6/7 ACDF 18th April 2015 after 8 years of mucking around pretending it was something else...
  • dilaurodilauro ConnecticutPosts: 9,859
    the physical therapy for your neck may be tough, even a bit painful. You are starting to use an area that was just surgically repaired so there is bound to be some troubles.

    The therapist will be working based on the prescription written by your doctor. In my post ACDF Physical Therapy, they worked on two things... 1) Getting back some strength to the neck and surrounding muscles and 2) Range of Motion.

    Range of motion is key. I think over time, the strength will start to come back just in your day to day activities. Not so with range of motion. There are specific exercises that they will teach you to help improve with that. Even now, 15 years since my last ACDF, I still do some of those stretches while I am in the shower.

    Unfortunately, I have some permanent loss in my range of motion. Not sure how I can contribute that towards. But it is here.
    I have troubles moving left to right and right to left. That impacts me when I am driving. To compensate, I have a over large rear view mirror.

    But beyond that, range of motion has never been a concern for me.

    The Physical therapist takes measurements at your initial evaluation. That will identify your range of motion from the start. Then after a couple of sessions, they will measure again. And then finally before your release, they will measure it again and they can identify the gain you had from the start.
    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
  • Thank you both for sharing your experiences! It really helps to hear other peoples views. I will keep it in mind when I finally get to PT!

    That is interesting that she is focusing more on your upper body right now than your neck. It makes sense though, since they want patients to avoid turning left and right while still fusing.

    My surgeon requested that I get a four week cervical x-ray today to check on healing. Prior to surgery I had lost my correct cervical curve (Kyphosis), it was ever so slightly starting to curve forward as my spasms were making my neck tighter in the front and pulling my head down. I was hoping the surgery would relieve the pain, (which originally it did, but now I'm achy from stiffness) then my spine would be allowed to curve correctly again. I see the the discs above the fusion still curved slightly forward (C3/4, C2/3, etc.) despite everyone telling me how much my posture has improved since the surgery. I'm hoping when I get to PT I could correct this as I'm concerned since I have a small herniation at the C3/4 and I want to protect it as much as possible from another fusion.
    I would be curious to hear anyone's insight on that, if they have had a similar experience.
  • I am in the 4th week of PT after a 2 level ACDF (12 weeks post op) . my therapist focus to work on my weakness in my bicep and deltoid, and also the entire upper body strength, seating.. arms push up, pull down, push and pull from 10 pounds to 30 pounds, She really want to me to FEEL the burn in between my shoulder blade, basically building the muscle to support my posture and my spine. we didn't do any range of motion, neck exercise or any stretching at all. Posture was the most important thing to her. They will measure my ROM in August a week before my 4 month post op with my surgeon.

    I lost quite a bit ROM, can't see the rear window of my car, my chin can't touch my chest, hard to hold a phone between my ear and my shoulder.. but it's getting a bit better but I don't want to stress it... you will find a way to get around these little inconvenience.

    Yes you will feel a little sore after PT... but it's muscle sore, no worries.

    Hope this answer some of the questions,
  • Thank you for sharing your experience, Kenny. It is interesting that even in the fourth week of PT you don't work on range of motion. Seems to be the norm though.
    I recently saw my surgeon for a follow up and was told I can start to ween off the hard collar and use the soft or nothing at all! I was surprised since my care forms from the doc said hard collar for me for 12 weeks post op and I'm in the 6th/7th week! PT won't start for me until after me 12 week check up. They told me it was ok to turn left to right, but avoid up and down. When I try to turn left to right I suddenly stop and I can't tell if it's stiffness or I've reached the limit of my 3 level fusion plate. I wonder how anyone can tell?

    I have begun to get terrible headaches and pounding in my head since coming off the collar. I'm curious to know if anyone else has felt not only headaches but pounding in the head? It feels like the pressure is going up and down. I'm not sleeping very well either. I can't get comfortable, so that may be contributing to it. I worry because the disk above and below the fusion have a small herniation and I have some numbness in my thoracic spine which they think is a separate issue but don't advise an MRI right now.

    Keep up the good work on your PT :) Sounds like your doing well!
  • Hi,
    Yes, you neck will be pretty stiff when you are off collar the first few weeks, it will get a bit better later, you have 3 level so you will lose some ROM there.

    I've gone back to work and do normal things for a month now, my range of motion is getting better, neck turning left and right is easier but I still can't see the back windows of my car (better now then before). I can barely hold a phone between my ear and my shoulder now, (regular phone, not a smart phone) but I felt the stress when I tilt my neck.

    I did PT for 6 weeks now, never work on range of motion, still focus on my bicep and shoulder, and my core strength to protect my spine (my entire back, abs) . I will have an Eval later this month and I think they will measure my ROM and strength then. PT helps a lot, they can really pin point the group or groups of muscle you need to work on. a little change in posture make a big different.

    Take care
  • dilaurodilauro ConnecticutPosts: 9,859
    and my range of motion for the most part is permanent. It can get worse if I have a flare up in my neck, but with approved exercises, I can get back to my norm.

    LamMan comments reminded me of something. Besides not really being able to turn my head, the other regular problem is touching my chin to my chest. When does that become a problem? If I try to fold my pants, starting with the cuffs by my chin to straighten the pants. Nope, the pants just slide down!

    But seriously, I still have better overall long term situation with my cervical surgeries then I did with my lumbar. I still have a lot of lower lumbar pain and the mid down to lower stenosis is getting worse.

    I think as long as you do the right things, you will have good success with your neck short term and long term
    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
  • Kenny - It's good to hear how well you have done on your 6 weeks of PT! Makes me wish I was cleared to start mine. I think it would help with the pain possibly.

    dilauro - Thank you for the encouragement! Sorry to hear you did not heal as you hoped. I know I will never be able to reach my chin to chest again among other things. I try to think what I'm grateful for when I get down about things like that as I'm sure we all do. So glad my spinal cord is no longer compressed there! Like you have said it is a roller coaster. I'm grateful to have the chance to still live it.

    Hope everyone has some fun this weekend. :)
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