Lumbar Laminectomy Pt Rehab Protocol

Transcript

POST-OPERATIVE SPINE REHABILITATION FOLLOWING LUMBAR LAMINECTOMY By George Aaron, MHS, PT, OCS, MTC PHASE II OF SPINE REHABILITATION Goals: Return to activities of daily living Functional dynamic lumbar stability Normalization of flexibility deficits in extremities Normalization of any gait deviations Patient education Improve positional tolerances for return to work 7 to 12 Days Post-Operative: Start outpatient physical therapy Back Education Program • Reinforce neutral spine positioning • Anatomy, Pathology, & Biomechanics • Performance of functional activities with neutral spine and protective positions Exercises: All performed in neutral and protective positions • Stabilization Program - Neuromuscular control of lumbar spine •• Supine progression with abdominal brace ••• single leg slides ••• bent and straight leg raises ••• toe tapping ••• supported dying bug ••• curl-ups with lumbar spine in protected position ••• diagonal curl-ups with lumbar spine in protected position •• Bridging progression ••• normal bridge with abdominal brace ••• with tiny steps ••• with leg extension Post-Operative Spine Rehab-Lumbar Laminectomy Page Two •• Prone progression with abdominal brace ••• single arm or leg lifts ••• contralateral arm and leg lifts ••• bilateral arm and leg lifts ••• modified push-ups with neutral spine •• Quadruped progression ••• single arm or leg lifts ••• contralateral arm and leg lifts PHASE III OF SPINE REHABILITATION 5 Weeks to Discharge Goals: Restore lumbar motion Normalize upper & lower extremity strength Improve cardiovascular function Decrease soft tissue dysfunction Improve positional work tolerances for return to work Functional Baseline Evaluation Exercises Muscle Strengthening Program: to restore any upper and lower extremity strength deficit Dynamic Lumbar Stabilization: continue to progress with stabilization exercise as indicated Flexibility: continue with flexibility exercises as indicated • Flexibility Exercises - in neutral and protective positions •• hamstrings •• quadriceps •• iliopsoas •• gastroc-soleus complex •• hip internal and external rotators •• gluteals and hip adductors •• iliotibial band •• quad lumborum and paraspinals •• upper extremity musculature, as needed Post-Operative Spine Rehab-Lumbar Laminectomy Page Three Aerobic Conditioning • progressive walking, stairmaster • swimming • stationary bicycling, upper body ergometer Aquatic Exercise Program - to normalize any gait deviations, and perform strengthening activities with decreased axial compression on the spine • functional stabilization exercises • pool walking - 4 directions Standing Progression • functional squats • leg lunges Work Tolerance Positioning and Simulation - To begin focus on return to work/daily activities and function. Functional Baseline Evaluation performed. Soft Tissue Mobilization - For scar tissue management and areas of dysfunction Modalities - utilized only as required to meet established goals PHASE IV OF SPINE REHABILITATION - WORK HARDENING Goals: Restore lumbar motion Improve/normalize gait cycle Improve cardiovascular function Normalize upper and lower extremity strength Increase positional tolerance to 3-5 continuous full days (7-8 hours of job simulation required of his/her occupation and demonstrates physical demands of the job utilizing proper body mechanics) Job specific training Work Hardening - Progression into work hardening as appropriate (12 weeks post-op) Exercise: continue with flexibility, strengthening and cardiovascular exercises through a daily program Work Tolerance: Increase patient's ability to perform a full day of activities Work Simulation: Performance of work simulated tasks while reinforcing proper body mechanics Post-Operative Spine Rehab-Lumbar Laminectomy Page Four Flexibility Exercises: Continue with flexibility exercises as indicated. Aquatic Exercise Program: To continue to assist with normalizing gait cycle and perform strengthening activities. Walking Program - progressive walking program Use of modalities and/or hands-on treatment is discouraged during our Work Hardening Phase (Phase IV). /spnrhab.lam