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Laminectomy and Physical Therapy/Exercise

From: PolvaderaNM - on 04/29/2010 3:27am

I'm 4 weeks out from spine surgery due to spondylothisthesis at L5-S1. I had decompression surgery with instrumentation. I also have Ehlers-Danlos Syndrome - a connective tissue disorder that weakens tendons and ligaments, and makes me dangerously hyperflexible (dislocated joints, joint deformities, etc.). EDS also causes terrible chronic pain and gives me poor balance.

My first follow-up visit with my neurosurgeon isn't until 5/7/10 - so over 5 weeks after surgery. I had a physical therapist come in once a week for 3 weeks, and his overall advice was to just take it easy and not push it. He also gave me a thera-band to work on my upper body strength.

Today I had another physical therapist come in and he is much more of a drill sergeant. He wants me to start doing a group of exercises for both flexion and extension that are pretty intense. He also wants me to take much longer walks than I have been, and to stop using my walker and/or wheelchair completely. After doing the exercises today, my pain and leg weakness was much worse.

My surgeon didn't give me any instructions about when I should start exercising and at what intensity. I was only told to take 2 or 3 short walks a day, and mix rest with activity.

My question is this: How soon after spine surgery is it safe to exercise? My hyperflexibility makes it look like I can do all sorts of things that most folks probably can't do right after surgery, and I'm afraid that even though I can do these things, maybe I shouldn't be, maybe I'm hindering the healing process.

I'd appreciate any advice anyone has! Thanks very much.

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on 05/07/2010 10:36am

Hi,
rehabilitation is a complex task the and certainly one size does not fit all - same as back pain. No 2 sets of symptoms are the same... everyone is unique. It is a tough comprimise between restoring motion and mobility and allowing your body to heal.
One of the challenges with increased mobility is getting the motion where you need it rather than where the body can move easily. Its also important to restore stability - and muscle strength around the lumbo-pelvic region. You should have some specific exercises for this by now from your therapist also.
Walking is great. I usually advise short bursts frequently. Keeping it short of your pain threshold - but doing it often through the day. Restoring normal patterns of motion are important. Weaning off the assistive aids is critical - but at a steady pace. How you feel the following morning is often a good indicator of whether you have done too little or maybe could have done a little more.

I suggest you start asking your therapist questions like you have here. Query what and why and your fears. Ask them to explain the benefit of any exercise that you have been asked to do. Get to the "what about..." questions so you are sure that they are aware of your hypermobility issues. Ask them about the safety of the exercises for the point you are at in your healing post surgery also. They should be able to answer this for you.

You are not just a 'patient' to do what you are told... this is your opportunity to get onto a new phase in your life - make sure that your medical and allied health team are willing to help you understand so you can work with them without fear. If they dont take the time or courtesy to assist you in this manner - I would suggest you try and find a therapist that will. There are plenty of us out there.

You may however find on questioning that the process the therapist is trying to direct you towards is exactly what you need - but maybe with a little bit of modification. Relaying your symptoms after an exercise session or a program provided is important. Finding that middle ground is difficult especially if they are only seeing you once a week. What you tell them will feed back into the exercise program set at your next session. It may just be a communication issue that you both need to work on - both during and a day or two after the program has been provided. The therapist will have no idea how you are the day after unless you inform them so stay in contact so they can continue to assist you as you need it.

I hope that helps. I wish you all the best. Donna McCook

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on 05/31/2010 11:45am

I've had 2 surgeries for spinal stenosis, they did a laminectomy, fusion, and 8 rods. My right leg does not hold very much weight (gives way as soon as I put half my weight, I'm obese) and I fall. I need some excercise to strengthen my lower body and legs, but have no idea what that would be. Forgot to mention, I'm 69 years old. I have always been very active, but since 1996 I became disabled with fybromylia which seems to be in remission for the last 8 years, which is when my spinal stenosis cropped up. Since 1996 I have done nothing but gain weight even though I have cut back on food, with not much movement from one thing or another, I have not been able to stop the weight gain until this last year. Now I need to find out how to get moving again. What exercise can I start with and then progresss to. I have been in the hospital way too much. Can't stand them now. I'm in a hospital bed and wheelchair now at home. They say I've used up my PT time, but some of the exercise left me incapicipated for weeks at a time. I don't want exercise that is going to cause me more pain. Can you help me? I need demos of the exercise I need to do so that I will make sure I to them correctly.

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on 09/19/2010 2:25am

When you are at a point where you are spending periods immobilised due to pain and physical limitations as a consequence to injury - it is very difficult to move forwards, but not impossible. Unfortunately based on little information is it difficult to provide an exercise program to help - you need someone onsite and local that can assess you and help.

However - and this advice is provided only as information and not as treatment recommendations -

Initial option would ba aquatic based / hydrotherapy where you are weightless and able to move far better than you can manage on land. Check out local options for community based hydrotherapy pool centres where you may be able to access and utilise. Simple things like water walking - submerged up to the middle of your chest can be very beneficial. Gentle leg motions in the water for mobility and strength can also help. Ideally, the pool comes with a therapist that can help you - most commnities have a facility of some sort that will be able to provide this type of service. There is often hoists / lift devices to assist you getting in and out of the pool if this is a challenge for you.

At home - it is a matter of breaking down the things you can manage and trying to do them a little more. You will have exercises that your therapist had given you that should be safe for you to do. Start with these and try to do what you can. If they need to be when you have someone else on site for balance and stability - then you make the most of people visiting with you so they can help.
This might involve simple things like upper body exercises while sitting to strengthen your arms and upper back such as arm curls, slowly raising your arms out to the side, raising your arms in front. Initially with no weight - just motion and the weight of your arms, but in due course as long as is pain free, potentially with something small like a can of beans in your hands.
For your legs, again, working on what you can. This might be just straightening your legs and lowering in sitting. Do a few extra sit to stand manoevers when getting back into a chair after walking around on days when you can manage this. There are likely to be 'chair aerobic' type videos / DVDs available at your local library. You will need to look closely at the things you can manage and skip the things that you cant.

Change is going to come from a little every day -
you should also keep linked into a dietician to assist you with your nutrition needs to ensure you are getting what you need . Nutrition is a key part of weight gain when you are immobile. Addressing only exercise challenges and not nutritional will not bring you results that help you to reduce your weight concerns. Its great that you have started to lose some weight through eating changes - dont stop, keep on this pattern. It is not going to be a diet. It is a change in the way that you eat for life.
Talk with your Doctor and get the assistance that you need. There has got to be some assistance somewhere locally for you. This may even be via a hopsital based exercise class for an alternative condition such as cardiac rehabilitation, diabetes exercise, arthritis exercise groups (often pool based for rheumatoid arthritis) or even through a weight reduction / barriatric program. A lot of exercise physiologists (eg - clinical exercise specialists - certified through ACSM) will target exercise for people with these types of conditions - and often have groups where people are starting at quite a low level of fitness which may suit you well.
I wish you all the best.

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on 11/24/2010 11:47pm

I had @ the same surgery in el paso texas aug 5. I teach in sunland park as a hs math teacher. He is amazing and I was @ 40 percent fused, minimal pain. Do not start pt for @ least 6 months til it really heals. U can do 2 inch torso lifts. Its a baby crunch but works the lower abs for stability. If u reach 45 degrees its way too much and u r using ur quads u can do supermans, a reverse crunch but u use ur periformis/low back muscles u can do pilates
Do not twist ur torso too much use therabands. Put it around doorknob and close the door so it won't come loose. Stand perpendicular to door and hold band taut and turn your toso, feet planted and knees bent and turn just @ 5 inches, no more
Let me know

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