- Reference Number: HEY1086/2020
- Departments: Neurosurgery, Physiotherapy
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This leaflet has been produced to give you information about how to care for your back following surgery. Most of your questions should be answered by this leaflet. It is not meant to replace discussion between you and your physiotherapist or spinal surgeon, but may act as a starting point for discussion.
Your consultant spinal surgeon should have explained the operation procedure and the risks and benefits. This leaflet will concentrate on providing you with information on the physiotherapy input you can expect after surgery.
If after reading this leaflet, you require further explanation please discuss this with a member of the physiotherapy team who has been treating you.
Physiotherapy after surgery
In most circumstances you will be reviewed by the physiotherapist on the first day after your surgery.
The physiotherapist will assess your limb movement and sensation and will teach you a series of exercises (which are described later in this leaflet) to help you to get your back moving.
The physiotherapist will also teach you how to get out of bed and encourage you to begin walking. You may have some attachments such as drips, catheter and drains. These do not prevent you from walking, although you may require some assistance initially.
You will also be expected to sit out into a chair for short periods from the first day after surgery.
In some cases you may be assessed shortly after surgery with a view to helping you to prepare for discharge home on the same day. Your consultant will have discussed with you before your surgery if you are likely to be a day case patient.
The best thing you can do for your back is to try to relax it and move it as freely and normally as possible. However, for the first few days or weeks, after your operation it is normal for your back to initially be stiff and sore. During this time you may find yourself bracing and protecting/guarding your spine as you move about. It is a common belief that bracing and tensing your spine will protect it but in fact this often does the opposite and creates more pressure and can lead to ongoing discomfort.
It is important to remember that as things begin to heal and the pain settles down you should try to move freely and confidently again. Following your operation you should aim to get back to normal levels of activity in a graded manner. This can start straight away by sitting up in bed, sitting out in the chair and taking short walks. You should try to avoid long periods where your back is inactive.
It is important to strike a balance between periods of activity and rest. Inactivity can be just as harmful to your back as over activity.
The most important thing when you are lying down is that you are comfortable. Some people prefer harder mattresses and others softer mattresses; you should be guided by comfort and pick what suits you.
You are free to move around in bed, and practising rolling from side to side will make transferring in and out of bed much easier.
It is important to minimise the strain on your back when getting in and out of bed. To get out of bed, roll onto your side and swing your legs over the edge of the bed whilst pushing up with your arms. Sit on the edge of the bed for a moment before standing up.
There is no such thing as the perfect sitting posture; this varies depending on the individual. Some people prefer to sit up straighter while others prefer sitting more slouched. You should sit in the posture that feels most comfortable. Although we have traditionally sat up straight there is no scientific evidence to support this, sitting with a more relaxed lower back is not in any way harmful.
When you first start walking your lower back may be sore, this will improve over the first few days and weeks and is to be expected. It is important to try to walk little and often and gradually build things back up to normal. Do not worry too much about holding an upright posture; you are best to try to walk as normally as possible.
To begin with you should try to keep your wound dry, this is made easier by showering rather than having a bath. If you have any concerns about washing then please discuss this with the ward occupational therapist before you are discharged home.
You should keep the wound dry until your clips/ stitches are removed. The nursing staff will update your discharge letter with the date your clips/stitches are due out and this will be sent to your doctor. Call your doctor to arrange an appointment for these to be removed on the date given on the discharge letter. These are usually removed by your doctor’s practice nurse.
Prior to being discharged from hospital you will need to be able to complete your exercises, walk short distances comfortably and be able to walk up and down a flight of stairs (if you have them at home).
It is your responsibility to continue with your exercises and back care independently and liaise with your doctor if necessary.
If you continue to have any pain, stiffness or weakness you may be referred for ongoing physiotherapy at your local physiotherapy unit.
Please monitor your wound for any signs of infection. These include leaking, redness and swelling. If you develop any of these symptoms you should call the ward or your local doctor for advice.
You must wear your Thrombo-Embolic Deterrent (TED) stockings for 2 weeks from your discharge from hospital. These will reduce your risk of developing blood clots post after your operation; they should be removed for bathing/showering then put back on once your legs are dry. After this time you can remove your TEDs. The nursing staff will provide you with more information regarding TED stockings on your discharge from hospital.
Following your surgery it is normal for you to experience some pain and discomfort as you recover. Try not to panic about this as it is to be expected. If you are struggling with this you may need to consult with your doctor for advice. It would be better for you to take medication that allows you to gradually get back to your daily routine than to struggle and become more inactive.
Your driving/sitting posture should be based on comfort (please see the previous guidance on sitting). You should gradually build your sitting tolerance back up over time and take regular breaks when driving long distances where you get up and move about.
It is your responsibility to ensure your vehicle insurance covers you to drive prior to commencing driving after your surgery.
Avoid lifting heavy objects and also holding items at arms length away from your body. Always use a correct lifting technique, bending at the knees and not at your back (see following diagram). Avoid bending, twisting or leaning movements.
Return to work will depend very much upon your recovery and the type of work you do. It is important that you discuss with your doctor when it is safe to return to work.
Exercising your back will often help provide pain relief and assist the healing process. It is best to keep things moving little and often and start by moving things gently to begin with. Care should be taken to avoid tensing and bracing your spine as this often makes things stiffer. Instead you should try to concentrate on relaxed movement. It may be painful to begin with but this is to be expected after an operation. If this is the case you should keep moving but focus on smaller movements and make sure you keep things gentle and relaxed.
- Breathing control in the lying position (abdominal breathing). Put one hand on your upper chest and one hand on your abdomen just below your rib cage. Relax the shoulders and hands. As you breathe in, allow the abdomen to rise, and as you breathe out, allow the abdomen to flatten. There should be little or no movement in the chest. Try to slow your breathing down. Using this exercise often helps decrease muscle tension and relieves pain.
- Sat over the edge of the bed or in a chair gently practice moving from sitting up straight down into slouching. Repeat this process smoothly little and often. This creates some gentle straightening and bending in your lower back and will help get you moving more freely again.
- Walking little and often after your operation will be very useful. Try to relax your lower back and let it move freely as you walk. Build your walking up slowly depending on how your are feeling.
Telephone follow-up service
Your consultant may place you onto the telephone follow-up service. This is when you are expected to recover well with time and you do not routinely need to see the consultant for follow-up review.
The physiotherapists will arrange this follow up procedure with you on your discharge from hospital, and make provision to track your progress by telephone.
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