[PDF] Lumbar Laminectomy Protocol - Molina Spine

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34699_7Lumbar_Laminectomy_Protocol_PT_Protocols_6_20.pdf

Rehabilitation Department

Lumbar Laminectomy Protocol

937-398-1066

| springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502

The following protocol for physical therapy rehabilitation is based on the "typical" patients seen at Springfield Orthopaedic and

Sports Medicine Institute for the procedure of lumbar laminectomy and discectomy. Each physician has his/her own specific

guidelines for the rehabilitation process. Therefore, this protocol was designed to encompass the physician's and therapist's

philosophies. Deviations from the protocol are dependent on prior level of function, general health of the patient, equipment

available, goals of the patient, specific orders wri?en on the prescription, and others. It is the treating therapist's responsibility along

with the referring physician's guidance to determine the actual progression of the patient within the protocol guidelines.

Two important concepts throughout the laminectomy / discectomy physical therapy protocol are neutral spine and stabilization.

Stabilization can be defined as a balance between strength, flexibility, muscular endurance, coordination, and aerobic capacity which

makes it possible to maintain neutral spine during static and dynamic loading. Neutral spine can be thought of as a position between

spinal flexion and extension that is most comfortable for the patient and produces the least amount of pressure on the disc.

Once the patient can demonstrate proper stabilization without cueing, a progression of exercises to further develop and improve

stabilization (coordination) should be considered. It is important that proper stabilization be achieved with each a?empted exercise

prior to progressing to moderate/advanced stabilization exercises. Many exercises are described in the protocol, however, the list

is not exhaustive and other options may be incorporated as needed. The treating therapist will use his/her professional judgment,

guided by the patient's response and mechanical basis for achieving proper stabilization to determine when proper progression of

exercises can occur. The following clinical observations require a consultation with the referring/consulting physician: 1. Failure of incision to close, significant redness, swelling or pain in the area of incision. 2. Unexpectedly high self-reports of pain in comparison to presurgical state. 3. Loss of Bowel or Bladder function.

4. Failure to meet progress milestones according to protocol "guidelines" as may be modified by clinical judgment with

consideration given to previous presurgical state and typical progression of patients during rehabilitation.

5. Evidence of acute re-herniation: significant increase of pain, sudden increase of radicular symptoms, sudden loss of

strength/ sensation/ reflexes. 6. Development of new unexpected symptoms during the course of rehabilitation.

Further information can be obtained by contacting Dr. Domingo Molina IV, at Springfield Orthoapedic and Sports Medicine Institute.

This is for information only and not intended to substitute for sound clinical and professional knowledge.

Lumbar Laminectomy / Discectomy Protocol

General Considerations:

Precautions: • Surgical Incision Healing • Excessive Initial Mobility / Stress on Tissues • Lumbar Stabilization /Aerobic Progression • Start with patient's comfortable position (flexion/extension/neutral) and • Body Mechanics / Posture progress toward other motions. • Symptom Modification/ Modulation / Max Function • Wean out of support if needed

PHASECONSIDERATIONSTREATMENTSGOALS

I. Pre- P.T.

Wound Healing and Protection

0 - 2 weeks• Decrease Inflammation

• Increase Activity Tolerance • Encourage Wound Healing • Increase Aerobic Tolerance • Monitor for signs of Possible

Infection• Reinforce basic post-op home

exercise program • Per hospital discharge • Increase tolerance to walking • Reinforce si?ing, standing, and ADL modifications• Independent with home exercise program (20 min tolerance to exercise) • Walking ½ mile daily (15 - 30 min. cardiovascular activity) • Functional ADL and hygiene • Good healing of surgical incision

II. Initiation of P.T.

Basic Stabilization, Flexibility, Body

Mechanics, and Activity Tolerance

2 - 5 weeks

2 - 3 sessions/week• Posture

• Body Mechanics • Basic Stabilization Concepts • Basic Stretches • Mobility Advancement • Return to Work Investigation • Prevention of So? Tissue

Restrictions

• Cardiovascular Training • Avoid Lumbar Loading• Body Mechanics Training /

Postural Exercises

• Scar Mobilization • Nerve Mobilization • U/E & L/E Resistance Training with lumbar stabilization and pelvic control • Pelvic stabilization exercises with emphasis on transversus abdominus • L/E mobility (hamstring, piriformis, gluteal, quads, hip flexors, gastroc, soleus, etc) • Cardiovascular training, treadmill,

UBE, Stationary bike (patient must

have good pelvic control) • Trunk Mobility Training (Flexion,

Extension, Rotation)

• Dynamic Lumbar Stabilization /

Prone Extension Progression

• Initiate Aquatics (if available & indicated) • Address other mechanical restrictions as needed • Modalities for symptom modulation if needed• Prone extensions with proper firing sequences • Lower abdominal/transversus abdominus x 1 min. [or] • Dying bug/ladder climb x 1 min. with good pelvic control • Independent with H.E.P. • Working knowledge of body and li?ing mechanics • Level one stabs • Balance single leg x 20 sec • Cardiovascular tolerance to

30 min./day

• Treadmill or bike x 30 min. (continuous) plus other activities • Mild resistance training tolerance of 30 min. • Dynamic Standing and/or si?ing activity tolerance of 15 to 60 min. • Isometric trunk extension x 1 min.

III. Advanced P.T.

Recreational Activities, Return to

Work, Advanced Stabilization,

Independent Program

5 - 8 weeks

2 - 3 sessions/week• Increase Strength and Flexibility

• Advanced Li?ing and Posture

Training

• Address RTW concerns • Advanced Stabilization and Trunk

Control• Activity specific training

• Advanced stabilization and proprioceptive training • Body mechanics drills • Multi-plane stabilization / mobility • Advanced cardiovascular training • FCE if appropriate / Return to work program if necessary• MMT WFL • Independent with gym program • Trunk ROM within functional limits • Level 2 stabs

937-398-1066

| springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502

Activity Restrictions

Range of MotionNo FORWARD bending or twisting until authorized by your surgeon, use your legs not your back to

bend down. Limit backward bending for 3 weeks.

Bed Positioning

Avoid lying on stomach. Utilize side lying with pillow between the knees or on back with pillow behind knees.

Bed MobilityUtilize the log rolling method to go from lying to si?ing or si?ing to lying. (See A?ached)

Driving

No driving for 2 weeks then consult your Surgeon. A?er 2 wks drive only short interval of 20 minutes

or less. Do not drive stick shi?s without consulting your Doctor.

Li?ing

Do not li? anything heavier than 10 lbs. Keep objects close to body. No not do any heavy li?ing or straining until authorized by your surgeon.

Si?ing

No si?ing for more than 20 minutes intervals for 2 weeks then slowly progress to 30-40 minutes as tolerated a?er 4 weeks. No unsupported si?ing.

Sexual Activity

None for 2 weeks. Assume the least exerting and most comfortable positions. Avoid flexing/ extending/rotating lumbar region.

Tub Baths:

None for 1 month because of posture and submersing the incision, then only for short durations secondary to posture. Do not use extremely hot water (skin should not turn red). Household ChoresAvoid for 2-3 weeks, then begin light activity slowly progressing workload.

Yard WorkWait at least 4-6 weeks, then begin slowly and take frequent breaks. Use legs to bend down for low work.

Braces Wearing

If prescribed by your Doctor, Corset brace should be worn when in si?ing, standing, walking

positions for added support, but will not prevent spinal motion. Continue use until your Doctor tells

you to wean off brace. There is no need to wear brace when lying down. Take it easy the first 24 hours at home!!! Rest as much as possible

Walking Program

- Walk as much as your pain will allow at a comfortable casual pace • Choose a safe, paved area that is flat and firm

• Gradually increase total walking time to 45 minutes or greater per day by 1 - 2 months post surgery.

Be a?entive to your body's painful "warning signals" which may indicate over activity or undue stress.

Discontinue any activity if:

They cause persistent pain in the trunk, arms, back, bu?ocks, or legs during or following the activity, or

they cause an abnormal increase in morning pain or stiffness (muscle soreness is okay, pain similar to prior to surgery is not okay).

Begin the exercises on the following page

on your first full day home and progress gradually as tolerated. Perform exercises in

bed per instructions on the following page. These home exercises were designed to reduce chances of a blood clot following surgery

and aid with mobilizing fluids in the tissues to manage inflammation and aid in the healing process. The exercises are also designed

to reduce onset of muscle atrophy by maintaining strength, endurance, and mobility to prepare you for outpatient therapy. Your

outpatient physical therapist will progress you through more advanced exercises when appropriate, and guide you safely back to a

more normal activity level. The outpatient therapy is an essential part of your rehabilitation.

Laminectomy / Diskectomy

Activity Restrictions & Home Exercise instructions

937-398-1066

| springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502

Lumbar Laminectomy / Diskectomy Acute Phase

Home Exercise Program

Perform these exercises every hour (For reducing blood clots):

HAMSTRING SETS:

Slightly bend your knee, press your heel down into the bed and tighten the muscle on the back of your thigh. Hold for 5 seconds. Relax, and then repeat 5 times. As tolerated, bend knee further, keeping foot on bed.

QUAD SETS:

With a straight leg press your knee down into the bed and tighten the muscle on the front of your thigh. Hold for 5 seconds. Relax, then repeat 5 times.

GLUT SETS:

Squeeze your bu?ocks together gently. Hold for 5 seconds. Relax. Then repeat 5 times. Avoid arching your back

ANKLE PUMPS:

Pump foot up and down keeping leg

straight. Do not hold position. Repeat 15 times.

937-398-1066

| springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502

937-398-1066 | springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502

Perform these exercises 2 - 3 times a day:

ISOMETRIC EXTENSION:

Lie on your back with arms

extended at your side. Press your arms into the bed. Squeeze shoulder blades together while pressing. Do not arch your back. Hold 5 seconds. Repeat 5 reps.

SCIATIC NERVE MOBILIZATION:

Lie on your back with knees comfortably bent. Bring one thigh up toward waist line with knee bent (use a towel or sheet assist if hands are unable to reach back of thigh). Slowly pump leg up and down with gentle pull at top and no hold. Perform 15 reps each leg.

TA (Transverse Abdominus) STABILIZATION:

Draw or suck in navel towards the ma?ress without moving hips or spine. Your navel should drop not rise. It feels like zipping a tight pair of pants. Hold contraction 5 - 10 seconds then relax, perform

5 - 10 reps

Marching w/ TA STABILIZATION:

Lie on back wih knees bent. Maintain TA contraction (navel to spine) throughout exercise. Bring one knee up, then return. Be sure pelvis does not rock backward or forward keeping the back relaxed. Perform 5 - 10 reps each leg.

Modified Glut / Pretzel Stretch:

Lie on back with one

ankle crossed over the opposite knee. Gently push out knee with arm on same side. Hold for 10 - 30 seconds based on tolerance. Perform 1 rep each leg.

Log Rolling Method:

Bend both knees until you are in this position

Roll your body as a unit Keeping hips and shoulders in alignment, do not twist at trunk

Push yourself up with arms keeping hips and

shoulders in alignment, do not twist at trunk

Sit Pivot Method:

Sit on car seat facing out the side of the car. Pivot body to inside of car keeping hips and shoulder in alignment, do not twist trunk

937-398-1066

| springfield-ortho.com 140 W. Main St. | Suite 100 | Springfield, OH 45502 Spine_Lumbar Laminectomy Protocol_PT Protocol (6-30-20)

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