Physical Therapy after L5S1 Laminectomy
This post was started because I could not find a good guide of how to recover from an L5 S1 laminectomy. Physical Therapy guidance for the hospital was minimal. And, I needed something more than Walk, Walk, Walk and do not Bend, Lift or Twist. The following is that log
L5S1 LAMINECTOMY RECUPERATION
On Tuesday August 7, 2012 at 11:30 AM an L5S1 laminectomy was performed on my back. The procedure was after ~ 20 years of physical therapy to keep the pain in check. However, in the end, PT had researched its limits as there was a strong fear the work I do would have resulted in an unplanned surgery to fix a work related injury.
The procedure revealed a disk that was almost fully collapsed which resulted in a 7 mm D cage (spacer with bone chips) being inserted. In addition, to bone removal for entry, a piece of bone from the hip chosen for the bone graft material and the spacing for nerves through the spine was opened up.
Surgery took about 3.5 hours and I was discharged from the hospital on Friday (4 days later).
While the surgery went as planned, how to do PT to minimize downtime was unclear. The recommendation was to walk and not to Bend, Lift and Twist. However, I have secondary osteo-arthritis much of which, I believe, was caused by the reduced mobility of the back. Therefore, I am keeping my own log and providing my own PT. This log was started 5 days after surgery.
Day 1 (August 7 – 8). Just out of surgery, I was told everything went well. However, there was a numbness and weakness in the toes and ankle of the left foot that was not there before the operation. The best guess here was this was attributed to swelling and should go away after a period of time (2 – 4 weeks to 2 – 3 months). The biggest problem after regaining consciousness was vomiting. Simply by moving from my side to my back, the urge to vomit was instantaneous. So, the liquid dinner did not stay there long especially after scheduling the first PT session just after dinner. By 1:30 AM, I was able to keep clear liquids down. I finally got to sleep late and some Z’s early the next morning.
Day 2 (August 8 – 9). Had a clear liquid breakfast. Again, physical therapy came too soon after, but I made it back to the bed before discharging. I ask that they better coordinate PT with my meal plan. Lunch was my last “clear” meal. And though nauseous for the next several days, no more thro ups. Therapy consisted of getting into a walker by properly rolling out of bed, walking increasing distances (50’ to start) and doing some basic leg muscle loosening exercizes – ie high stepping, side to side stepping, standing heel lifts, leg lifts, but squeezes and sitting leg lifts. Random cold sweating at nite was addressed by drugs. This event was “not uncommon for people with back operations”.
Day 3. The tubes started coming out. The oxygen was first. Pulling out the catheter was painful and going the bathroom the normal way was painful for several more days. They checked for infection, but there was none. The vacuum seepage drain was also removed. The incisions were heeling well, and the bandage changed. Therapy progressed to climbing up and down steps. Discovered “Filet Mignon” was one of the items on the menu and I ordered it.
Day 4. Discharge from the hospital. One more round of therapy, questions to/from the doctor. Got “walker” and continued therapy. Discharge was delayed to confirm there was no bladder infection. The main therapy was to walk, walk and walk. At home, I re-familiarized myself with my surroundings. And then had a progressive walk with weakness/numbness of the left foot the main complication.
Day 5. The good news, I had my first Number 2 at 1.5”D x 2’. Began the day with my back joints creaking. Conclusion, WWW solution was not right for me. Did I do damage from a) the difficulty in getting up from the toilet the day before or b) from carefully doing dishes (to/from the dish washer) or did the long walk get complicated from my earlier condition. Therefore, changed the program to increase walking by increasing the frequency of my walks and walking more properly for short distances. Also, changed dish washing protocols to washing in the sink and drying on the counter versus using the dishwasher (minor BLT).
I began motion exercises for the numbness. I also aggressively increased my walked time to the point of limping when not on the walker. Also, I developed the plan to put an ice pack on my pack after each walk.
Day 6. The numbness and weakness in my left foot is slowly but progressively getting better. So, continuing with the motion exercises. My original plan was to use swimming instead of walking as my primary therapy. Looks like I will go there. However, the stitches will not fully heal for another 1 – 1.5 weeks. Therefore, I checked out doing squats on my Total Gym. I definitely expect benefits from the results of the toe lift exercise. And, the squats appear to address the momentary nerve pain I am feeling in my left buttocks while not stressing the back. It was a rain day, so in the end did 3 sets with the Total Gym (1set = alternating at 20 reps the 3 angles of toe lifts and 2 angles of squats). Also, completed 1 walk, block down and back, without clicking.
1 Week (Aug 14). Expected weather at 2 days wo rain, then rain. Therefore, will plan for several short walks as permitted by creaking. Need to work out how to walk. Also, set up next Dr appointment. This was a productive therapy day completing 4 sets = 25 reps of 3 different angles of toe lifts and 2 angles of squats. Also, 3 walks of around the block without clicking. By bedtime, my muscles were slightly sore but in a good way. And, rotating in bed via side back side was less difficult.
Week 1, Day 1. It was raining when I woke up. So, therapy is weather dependent. Today, I will work on phasing out the pain medicine. In short, I have been using oxycontin for basic pain relief (@ 2 pills per day) and hydrocodone / acetaminophien (HA) as needed but not more than 1 pill per every 4 – 6 hours. The plan is to stop using the HA starting today and measure the impact of pain; then stop using the oxycontin but use the HA instead during the day as needed.
Therapy included 3 sets of 30 reps of 3 different angles of toe lifts and 2 angles of squats. A short walk (1.5 blocks) and 1 long walk ( 2 block perimeter) was completed. The latter was probably a maximum limit for good therapy.
Week 1, Day 3. The day again threatens rains which will dictate the type of therapy. The HA was not used during the day. Therefore, phase 2 of phasing out the pain medicine will be tested. Specifically, no oxycontin but instead use HA for any flare ups in pain. The result of this was to determine that pain medicine was required for 1) proper therapy – ie going into the pain threshold without thinking about it and 2) better sleeping at night. 3 sets of 35 reps of 3 different angles of toe lifts and 3 medium walks (~1 block perimeter) were completed.
Finally, the lack of progress of being able to lift the toes on my left foot has become my biggest concern.
Week 1, Day 4. Good weather predicted, so will plan therapy accordingly. One HA tablet taken to start the day. The end result was a good therapy day. Completed 3 sets of 40 reps of 3 different angles of toes lifts and 2 medium walks plus one walk to the beach, then back. Also, added a core strengthening back exercise to the therapy. 3 HA pills were taken morning, early evening and nite for sleeping. Apparently, the expected complication has begun to surface. Specifically, a hip ache which I associated with secondary osteoarthritis surfaced and made sleeping more difficult.
Week 1, Day 5. Good weather predicted, so will plan therapy accordingly. 2 HA pills were taken, one in the morning and one in the evening. In the morning, it takes about 25 minutes for the pill to fully click in and a definite benefits is seen. In the evening, this is taken to improve sleeping. Sleeping consists of rotating between left side, back to right side. Progressive therapy continued. Completed 3 sets of 45 reps each of 3 different angles of toe lifts, 2 angle squats, 2 medium walks and one back and forth from the beach plus the back arches. Drove for the first time and went to the local, butcher shop without walker. Walking speed seen to increase and toe movement (left foot) had slight improvement. Beginning to debate going off of the walker.
Week 1, Day 6. Good weather predicted, so will plan therapy accordingly. 3 HC pills were taken, one in the morning and two in the evening. Progressive therapy continued. Completed 2 sets of 50 reps each of 3 different angles of toe lifts, 2 angle squats. Went off the walker and completed 2 medium walks and one back and forth from the beach (+1.0 miles). First post-operation doctors visit planned for the morning. Questions include, 1) when can I sleep on my stomach, 2) recommended progressive activity guidelines and 3) when can I go back to work and under what guidelines.
Doctors appointment went well. I have been cleared to go back to work after Labor Day conditional upon not lifting more than 10 – 20 #s. Added therapy to include flexible bands for side-by-side exercises for the left ankle.
Week 2. Log being terminated after today. In short, therapy will continue with the total gym adding 5 more reps per day and in the positions mentioned. Walks will include, when practical, a 1 mile walk with the focus on improving speed and the gate. Currently, I take about 30 minutes to walk 1 mile. In addition, I will probably walk on the beach to improve my ankle strength. Finally, I will be shifting to swimming (versus walking) as the primary back cardio exercise in the next 2 weeks.