Treatment of degenerative lumbar spine disease, particularly lumbar spinal stenosis, often involves decompression, fixation, and fusion of the spine. With advances in surgical techniques, most patients with spinal fusion can achieve immediate spinal stability. This makes early rehabilitation possible.
Early postoperative retraction of the vastus lateralis and quadriceps, as well as the low back muscles, is important to help prevent nerve root adhesions and scarring. Each pulling motion can be performed for 30 seconds and repeated 3 times, on the right and left side. This can be repeated every 2 hours if the patient tolerates it well.
Nerve pulling can be performed in the supine position by straightening the lower extremity and slowly lifting it off the bed until tension is felt in the posterior thigh. The leg can be lifted with the aid of the hand under the knee, while keeping the knee straight and the ankle dorsiflexed. Quadriceps pulling should be performed in supine position so that the heel is as close to the hip as possible.
I. 1-9 weeks after surgery: postoperative static stabilization training
The reason why it is called static stability training is that the training in this period only includes the limbs, and rotation or flexion of the lower part of the trunk should be avoided as much as possible. The specific contents are as follows.
1, pelvic tilt training, prone position, knee flexion, so that the abdomen tilted toward the spine.
2, the same position, the lower limbs alternately raised about 3-4 inches to maintain the pelvis level.
3.Lift the hips, so that the trunk rises, from the shoulder to the hip joint to maintain a straight line, also known as bridge training.
4.In prone position, with hands behind your back, gently lift your head and shoulders 1 inch off the bed, taking care to always keep your eyes down.
5, Prone position, knees straight, both hips alternately posteriorly extended, pay attention to maintain the pelvis level.
6.Pull the elastic band and make a rowing motion, keeping the shoulder joint and thorax fixed, and train the strength of the upper trunk.
The purpose of training in the first 6 weeks after surgery is mainly to improve the patient’s tolerance ability. 6 weeks later, the training volume and training program can be increased appropriately according to the actual situation of the patient. The exact timing of the start of dynamic training is determined by the stability of the patient’s spine and the clinical experience of the surgeon.
Second, 6-12 weeks after surgery: increase dynamic stability training
This phase of training requires movement of the trunk, and therefore requires training balls to assist in training. The specific contents are outlined as follows.
1.Supine position, knee flexion, lift the head and one shoulder to the other side of the hip, through this action to train the abdominal muscle strength.
2, four-point kneeling position, the upper limb of one side and the opposite side of the lower limb alternately lift, after extending the back.
3, the upper limbs remain fixed, the trunk back to pull the resistance band.
4, feet apart and shoulder width, one end of the resistance band fixed to the ground, hands grab the other end of the resistance band from the lower left to the upper right to pull, the same method of training the other side.
The main purpose of using the training ball is to control joint mobility, not to maximize joint mobility, which is especially important for those patients who are not familiar with the training ball. The intensity of each training session is based on fatigue or difficulty maintaining balance. The details are as follows.
1.Sit on the training ball and alternately lift one upper extremity and the opposite lower extremity.
2.Sit on the training ball and move the ball with the waist as the fulcrum, paying attention to keep the shoulder joint level.
3.Lie on the abdomen on the training ball, support both upper limbs and move the trunk forward until the training ball moves to the bottom of the thighs, alternately lift the thighs.
4.Kneeling abdominal lying on the training ball, using the upper limbs to move the trunk forward, pay attention to keep the trunk straight.
5, supine position, the training ball placed under the lower legs, lifting the hips, hips and lower trunk, so that the abdominal muscles remain tense.
Third, 9-12 weeks: under a light load to start intensive training
Regular aerobic training plays an important role in promoting integration during this phase. Regular aerobic training increases blood and oxygen supply, maintains body weight and reduces the load on the spine. The duration of training can be increased from a few minutes per day to 30 minutes per day, whichever is less painful. Recommended aerobic training programs include walking, swimming, and cycling. However, running, dancing and sports are not recommended.
It is completely wrong to abandon training for fear of fusion failure. Although physicians have different opinions on the method and intensity of training, studies have shown that good postoperative rehabilitation is very beneficial in improving fusion rates and surgical outcomes. The specific training program should be selected according to the different stages of the patient’s postoperative period and the fusion of the implant.