A lumbar laminectomy and discectomy is a surgical procedure that your orthopedic or neurologic surgeon may perform to help decrease pain and improve mobility. The procedure involves cutting away disc and bone material that may be pressing against the nerves coming from your spine.
You may benefit from physical therapy after a lumbar laminectomy and discectomy to help you fully recover.1 The goals of low-back rehab after surgery are to help you regain full range of motion and strength in your spine and to help you return to your previous lifestyle.
Your physical therapist (PT) will also work with you to develop an exercise program that you can do to help prevent future problems with your spine. If you have had low back surgery, here is a step-by-step guide to what you may expect to do in physical therapy.
Note that before embarking on any exercise program, you'll need to get prior clearance from your physician to ensure that these moves are safe for you to do. Some surgeons may have restrictions on how much you can bend, lift, and twist for anywhere from two to six weeks after your surgery.
After back surgery, you must work to maintain proper posture when you are sitting and standing.1 Postural control is essential as it keeps your low back in the optimal position to protect your healing lumbar discs and muscles.
Your physical therapist can teach you how to sit with proper posture by using a lumbar roll to maintain your spine in the best position. The slouch-overcorrect procedure can also help you maintain proper posture for your low back.
Attaining and maintaining proper posture for your low back is one of the most important things you can do to help protect your back and prevent future episodes of low-back pain.
Walking Exercise Program
Walking is one of the best exercises you can do after a lumbar laminectomy or discectomy surgery.1 Why? Because walking helps to improve blood flow throughout your body. This helps to bring in oxygen and nutrients to your spinal muscles and tissues as they heal.
Walking also helps to improve your cardiovascular health, keeping your heart and lungs functioning properly after lumbar surgery. The best thing about walking after back surgery is that it is an upright exercise—your spine will naturally be in a good position while you walk. This helps to protect your discs against future problems.
Starting a walking program after back surgery sounds easy; you just go out and walk, right? There may be more to it, so check in with your PT to help you set up a program tailored to your specific condition.
Prone Press Ups
One of the simplest, yet most effective, exercises to protect your back and lumbar discs after laminectomy is the prone press-up.1 This exercise compresses the back of your healing discs and helps to keep them situated in the proper place in your low back. It also helps to improve your ability to bend back into lumbar extension.
To perform the exercise:
Lie face down on a yoga mat on the floor and place both hands flat on the floor under your shoulders.
Keep your back and your hips relaxed, and use your arms to press the upper part of your body up while allowing your lower back to remain against the floor. You should feel a slight pressure in your low back while pressing up.
Hold the press-up position for 2 seconds, and then slowly lower back down to the starting position.
Repeat the exercise for 10 to 15 repetitions.
Be sure to check in with your doctor before starting this exercise to ensure it is safe for you to do after your lumbar laminectomy and discectomy surgery.
Prone Straight Leg Raise
One of your physical therapy goals after lumbar laminectomy and discectomy may be to improve the strength and stability of your low-back muscles. This can improve the support that the muscular system gives to your spine.
One great exercise to help improve your low-back strength is the prone straight leg raise (SLR) exercise.
To perform the exercise:
Lie on your stomach (prone), tighten your abdominal muscles, and slowly lift one leg up in the air.
Hold the straight leg up for 2 seconds, and then slowly lower it down.
Repeat for 10 to 15 repetitions.
The prone SLR can be performed once or twice a day, but be sure to check in with your physical therapist before starting the exercise to ensure that it is safe for you to do.
Prone Straight Leg Raise
Sciatic Nerve Gliding
If you had leg pain coming from your back prior to surgery, you may have been diagnosed with sciatica, or an irritation of your sciatic nerve. After surgery, you may notice that your leg feels tight whenever you straighten it out all the way. This may be a sign of an adhered sciatic nerve root, a common problem in people with sciatica.
After your lumbar laminectomy and discectomy surgery, your physical therapist may prescribe specific exercises, called sciatic nerve glides, to help stretch and improve the way your sciatic nerve moves in your back.2 This can help free the adhered nerve root and allow for normal motion to occur.
To perform sciatic nerve gliding:
Lie on your back and bend one knee up.
Grab underneath your knee with your hands, and then straighten your knee while supporting it with your hands.
Once your knee is fully straightened, flex and extend your ankle about 5 times, and then return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve the way your sciatic nerve moves and glides in your low back and leg.
Supine Lumbar Flexion
After your low-back surgery, your physical therapist may prescribe gentle back flexion exercises. This can help safely stretch your low-back muscles. It can also be used to gently stretch the scar tissue in your low-back from the surgical incision.
Supine lumbar flexion is one of the simplest things to do to improve your lumbar flexion ROM after low back surgery. To perform the exercise:
Lie on your back with your knees bent.
Slowly lift your bent knees up towards your chest, and grasp your knees with both hands.
Gently pull your knees toward your chest, and hold the position for 1 or 2 seconds.
Slowly lower your knees back down to the starting position.
You can perform the supine lumbar flexion exercise for 10 repetitions.
Be sure to stop the exercise if you are experiencing an increase in pain in your low back, buttocks, or legs.
Supine Lumbar Flexion Exercise
Posterior Pelvic Tilt
After a lumbar laminectomy and discectomy, your physical therapist may prescribe exercises to help improve your abdominal strength. One exercise to start improving the way your abdominal and core muscles contract is the posterior pelvic tilt.
To perform the posterior pelvic tilt:
Lie on your back with both knees bent.
Slowly rock your pelvis backward as if you are trying to flatten your low back into the floor.
Tighten your abdominal muscles as you tilt your pelvis posteriorly, and hold the position for 2 seconds.
Slowly release the pelvic tilt to return to the starting position.
You can perform the posterior pelvic tilt for 10 to 15 repetitions.
This exercise can be difficult to properly perform, so be sure to check in with your PT before you start to avoid common errors that may make the exercise ineffective.
Hip and Core Strengthening
Once you have mastered the posterior pelvic tilt, you can progress your abdominal and core strengthening program. This involves performing specific motions for your hips and legs while maintaining the pelvic neutral position.
Advanced hip strengthening exercises may be started to help you gain strength and stability in the muscles that surround your pelvic area and low back. Your physical therapist can help you decide which exercises are best for your specific condition.
Advanced Hip Strengthening Exercises
Once you have gained improved lumbar range of motion, hip, and core strength, it may be time to start to work on specific activities to help you return to your previous level of work and recreation.
Depending on your work, you may need to work on proper lifting techniques, or you may require an ergonomic evaluation if you spend time sitting at a desk or a computer terminal.
Be sure to work closely with your doctor and physical therapist before returning to work to ensure that it is safe for you to do and to be certain you are ready for normal work and recreational activities.
Low-back surgery, such as a lumbar laminectomy and discectomy, can be difficult to properly rehab. By working with your doctor and physical therapist, you can be sure to improve your range of motion, strength, and functional mobility in order to return to your previous level of function quickly and safely.