Care Of Your Back Following Lumbar Spine Surgery

  • Reference Number: HEY-311/2016
  • Departments: Neurosurgery, Physiotherapy

Introduction

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 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.

General Advice

Following surgery you will need to care for your back to ensure that the operation is a success and that potential post-operative complications can be minimised.

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.

Lying

Lumbar Support - Lying

A good firm support is usually desirable; a mattress that is too soft will provide you with little support.

You are free to move around in bed and practicing 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 (see diagram).  Sit on the edge of the bed for a moment before standing up.

Sitting

Whilst sitting out in a chair you should ensure a good upright posture.  You should avoid standing still or sitting for prolonged periods as this will cause your back to stiffen and your posture to deteriorate.

Also try to avoid sitting in soft low chairs as this will cause your posture to become slumped increasing the strain on your lower back.  You may find it useful to place a rolled up towel into the curve in your lower back to provide support and help maintain a good posture.

Walking

Initially after your operation your back may be sore as you move; this may increase over the first couple of days but will then improve.  You should aim to walk short distances little and often to ensure your muscles do not stiffen up.  Once you are home, try to increase the distance you walk daily, always trying to maintain a good upright posture.

Personal Hygiene

Showers are initially better for you as sitting in a bath increases the pressure through your lower back.    If you have concerns please discuss this with the Occupational Therapist on the ward prior to discharge.

Initially when washing you will need to keep your wound dry; the nurse looking after you will be able to advise you on how to do this.

Pain Management

Following your spinal surgery it is likely that you will feel some pain and discomfort as you recover from the procedure.  Therefore, it is important to discuss with your GP appropriate pain medication during you recovery period, so that you can manage daily activities.

Driving

Always ensure that your driving position allows you to maintain a good posture.  Long distances should be avoided unless interspersed with regular stops.  At these stops get out of the car, walk about and stretch.

It is your responsibility to ensure insurance cover prior to commencing driving after your surgery.

Lifting

Lumbar Support - Lifting

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 diagram).  Avoid bending, twisting or leaning movements.

Work

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 GP when it is safe to return to work.

Exercises

These exercises are designed to improve the movement and strength in your back, prevent muscle spasm and help the healing process.

They should be carried out approximately 3 times a day.  Begin by doing 2 or 3 of each exercise and gradually increase from there, aiming to build up to 10 repetitions.  Remember these are gentle exercises.

If you experience any increase in pain cease from doing that exercise until the pain resolves at which point you can recommence the exercise.

Lying on your back with your knees bent, tighten your stomach muscles and flatten the curve of your back into the bed by tucking your bottom upwards.

Lumbar Support - Exercises

In the same position slowly try to arch your back, by rolling your pelvis forwards.  Use minimal effort and do not strain the arched position.

Lying on your back with knees together, slowly roll your knees from side to side keeping your upper trunk still.

Lying on your back with knees bent and feet flat, rest your arms by your side. Tighten your stomach muscles and raise your hips (by squeezing your bottom cheeks) until your bottom and lower back is off the bed.

Lumbar Support - Exercises

Hold for 3 seconds then slowly lower down.

Lying on your side with the hips and knee bent.

Lumbar Support - Exercises

Leaving the heels together, slowly lift the top knee upwards, being careful not to roll backwards.

Hold this position for 3 seconds, and then slowly lower.  Repeat on both sides.

Core Stability Exercise

Core stability exercises improve the strength of the ‘muscular corset’ around the back.  These muscles often become weak in the presence of back pain and it is through exercise they can be strengthened to improve the support and posture of your back.

Core stability muscles are small but have a very significant role – Evidence shows that it is only necessary to gently tense these stability muscles, so trying or straining too hard will not necessarily gain better results.

Lumbar Support - Exercises

Once you are able to tense your muscles in the position above, try to tense them in standing, walking or when you are doing general activities (e.g. washing up, picking up a child) or you are performing a strenuous movement (e.g. lifting a heavy object, during sports).

It is also beneficial to increase your walking tolerance to aid general fitness.  This should be done within the limits of pain.

You may also be provided with additional exercises to strengthen your back and legs if your physiotherapist deems this necessary.

Discharge Home

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 GP if necessary.

If you continue to have any pain, stiffness or weakness you may be referred for ongoing physiotherapy at your local physiotherapy unit.

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.

Please remember that you do not have to attend the hospital for this appointment, this is a telephone call only.

Contact Numbers:

Should you require further advice on the issues contained in this leaflet, or you need to contact us, please telephone the hospital where your surgery took place.

Castle Hill Hospital

Physiotherapy Department            (01482) 626712

(Ask for Orthopaedic Physiotherapists)

Ward 8                                                (01482) 623008

Ward 9                                                (01482) 623009

Hull Royal Infirmary

Physiotherapy Department           (01482) 674539

(Ask for Neurosurgical Physiotherapists)

Ward 4                                               (01482) 675004

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.