Guide to Physical Therapy After Spinal Fusion

supine stretch
Fig 1: Nerve and supine
hamstring stretch
(larger view)

seated hamstring stretch
Fig 2: Seated hamstring stretch
(larger view)

prone knee flexion
Fig 3: Prone Knee Flexion
(larger view)

pelvic tilt
Fig 4: Pelvic tilt
(larger view)

hook lying march
Fig 5: Hook lying march
(larger view)

Fig 6: Bridging
(larger view)

upper body extension
Fig 7: Upper body extension
(larger view)

prone hip extension
Fig 8: Prone hip extension
(larger view)

bilateral scapular retraction
Fig 9: Bilateral scapular retraction
(larger view)

Meeting with a physical therapist before and/or a few days after surgery is important so specific direction can be given on when to begin various types of exercise. Surgeons use many surgical techniques and approaches for fusion—for example:

  • Access to the spine can be achieved through incisions in the front, the back, the sides, or some combination of approaches
  • Minimally invasive techniques or traditional open surgical techniques may be used

Because of these variations, some exercises may not be appropriate for all patients. The surgeon's technique and the patient's individual diagnosis will influence what rehabilitation should be done.

See One to Four Weeks After Spine Fusion Surgery

While the program will be different for each patient, here is a general guideline for post-operative spine fusion rehabilitation that should be customized for each patient.

Week 1: Start Rehabilitation and Exercise

Day 1: Limit Exercise to Short Walks

The patient must move frequently beginning the first day after surgery. The patient should walk as often as the surgeon allows, to the point of minor aching, but stop if there is any sharp pain.

Most surgeons will encourage patients to get out of bed and walk the first day after surgery, and recommend walking frequently throughout the initial recovery period, increasing the amount and length of the walks as tolerated.

See Techniques for Effective Exercise Walking

Days 1-7: Start Stretching

Stretching the hamstrings and quads

Stretching the hamstrings and quadriceps is particularly important, as well as the middle back where the nerve root is located to prevent formation of adhesions or scarring of the nerve. Stretching of muscles should be done slowly with 30 second holds, three repetitions, two sets per day. Example stretches:

Nerve stretches

Nerve stretches (mobilization) should be done in a “pumping” fashion without long hold times, and can be done every two hours.

  • A nerve stretch is achieved by lying on the back with legs on the ground, and slowly lifting one leg until a stretch is felt in the back of the thigh and through the hip. While supporting the raised leg with hands behind the knee, pump the ankle while holding the knee still. See Figure 1.
  • Variation: An active hamstring stretch can be done from the same position. While lying on back, bend both knees. Slowly straighten one leg and pushing the heel toward the ceiling until a stretch is felt. Alternate stretching each leg. See Figure 1.
  • Watch: Supine Hamstring Stretch (Towel Hamstring Stretch) for Sciatica Relief Video

    For all stretches, patients should feel the stretch, but never to the point of pain, If a patient feels pain the stretch should be stopped.

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Weeks 1-9: Include Static Stabilization Exercises

These movements are described as "static" because they are done without moving the trunk. They should be completed by moving arms and legs while avoiding any rocking or arching of the lower trunk.

See Lower Back Stabilization Exercises for Back Pain

Examples of Stabilization Exercise Movements

  • A pelvic tilt involves lying on your back on the floor with knees bent and pulling the belly in towards the spine. This position is the basis for keeping the lumbar spine stable. See Figure 4.
  • March in place by lifting alternating legs 3-4 inches above the floor without letting the pelvis rock side to side. See Figure 5.
  • Form a bridge with trunk raised by raising hips from floor and keeping a straight line from shoulders to hips. See Figure 6.
  • Extend the upper body by lying on the stomach and squeezing shoulder blades together while slowly raising head and shoulders only one inch off floor. Keep looking down at the floor throughout the exercise. See Figure 7.
  • Also while lying on the stomach, extend hip muscles by raising one leg at a time holding the knee straight. Avoid any rocking of the pelvis. See Figure 8.
  • Exercise the upper back muscles by using an elastic band positioned around a stable object and performing a "rowing" motion with arms pulled back and shoulder blades together with the chest supported. See Figure 9.