How Physical Therapy Treats Failed Back Surgery Syndrome

Physical therapy (PT) or physiotherapy is often part of a multidisciplinary program to treat most spinal disorders including those that cause failed back surgery syndrome (FBSS). Your doctor may recommend PT to help manage pain, reduce inflammation, improve or restore flexibility and function (eg, mobility, movement), build strength and endurance, and correct posture.
Man in a physical therapy session.Your physical therapist is a healthcare expert who formulates an individualized treatment program of passive and active therapies specific to your needs and goals. Photo Source: 123RF.com.Your physical therapist (physiotherapist) is a healthcare expert who formulates an individualized treatment program of passive and active therapies specific to your needs and goals. Your PT care may begin at any time—immediately after a diagnosis is confirmed, soon after acute back or neck pain has subsided or is controlled, before spine surgery (if recommended), and during post-operative recovery and rehabilitation.

Therapies are classified as being passive or active depending on whether the treatment is administered to the patient (passive) or the patient is actively involved in the therapy (active). Examples of passive PT include therapist-guided range of motion movements, heat and cold packs, and ultrasound. Types of active therapies include stretching and strengthening exercises.

Physical Therapy’s Passive and Active Components

Therapies are classified as being passive or active depending on whether the treatment is administered to the patient (passive) or the patient is actively involved in the therapy (active). Examples of passive PT include therapist-guided range of motion movements, heat and cold packs, and ultrasound. Types of active therapies include stretching and strengthening exercises. Therapies are classified as passive or active based on who is performing the therapy and/or how much effort the patient exerts during the therapy.

Passive physical therapies—such as therapist-guided range of motion movements, heat and cold, transcutaneous electrical nerve stimulation (TENS), and ultrasound—can help increase flexibility, soothe soft tissues and relax tense muscles. Passive therapies also prepare your body for more active strengthening treatments—like exercise. Passive modalities are designed to make you feel better while you are getting them but they aren’t really helpful once you leave. Therefore, other than in the acute setting, passive modalities should be a limited part of physical therapy and the key part of therapy should be the exercise portion.

If your doctor refers you to a physical therapist to treat FBSS, your course of therapy may start with and/or include passive therapies. These therapies may be selected to help alleviate inflammation and/or muscular pain (eg, muscle spasms). One or more passive treatments may be administered before and after active therapy. Certain passive therapies can help warm your body and prepare it for active physical therapy. Depending on your treatment plan, the physical therapist may teach you how to safely use a passive treatment at home (eg, heat pack).

Common passive therapies used after failed back surgery include:

  • Ice and heat is often used alternatively, as they deliver different benefits. Ice reduces swelling and pain, while heat stimulates healing through blood flow. Your physical therapist will show you how to safely use hot and cold therapy.
  • TENS is a safe and painless passive treatment that works by sending a gentle electrical current to spinal nerves. Your physical therapist will apply special patches to your skin through which the currents pass. The heat caused by the current eases stiffness and pain and improves function.
  • Ultrasound uses sound waves to create soothing heat within your spinal tissues. Your physical therapist administers the treatment by applying gel to the treatment area, then gliding a probe over the gel to transmit the sound waves.

Active therapies are exercise-based, so your physical therapist will teach you a set of exercises or simple movements intended to improve flexibility, strength, and range of motion. The active therapies your therapist shows you are custom designed with you and your specific spinal condition in mind.

Once you have reached a level of comfort and conditioning, your physical therapist may then move on to teaching you a more structured exercise regimen that you can do independently at home to maintain the health of your spine. The home exercise portion of physical therapy is extremely important for sustained effort.

Exercise for FBS Has Strong Research Support

Exercise has an important role in every phase of spine care: It helps prevent spine disorders by strengthening the structures in your back to resist injury, it gently reconditions your spine after surgery, and it may effectively treat spinal conditions. In fact, several studies have shown that exercise is a safe and effective treatment for failed back surgery syndrome.1

If the thought of exercising makes your nervous, don’t worry: Exercising for spine health isn’t about pushing yourself to the limit; it’s about conditioning your spine to be stronger, more flexible, and less prone to injury.

The key to making exercise a successful part of your failed back surgery treatment plan—and lifestyle—is to make it something you enjoy doing most days. If it’s not sustainable, you won’t see or feel the benefits. Results from exercise may take months to realize. For various reasons, physical therapy visits may be limited and therefore incorporating exercise in a daily routine is key to realize results. One of the most important elements of exercise is walking. Patients with FBS may not walk as much as much as the general population on a daily basis because of pain, which results in deconditioning and further worsening of their condition. Therefore, they need to actively pursue a daily walking program.

Your doctor may refer you to a physical therapist to teach you exercises specially designed to address your pain and other FBS symptoms. You may learn flexibility exercises, core work to promote more supportive abdominals, strength-training exercises, or follow a specific exercise regimen.

Hydrotherapy

Depending on your specific situation, the gentlest approach may be the best way to stay active after FBS. Hydrotherapy is a great way to incorporate exercise while keeping the pressure off your spine. Hydrotherapy may be appropriate for older patients or patients who are generally non-ambulatory.

Hydrotherapy, or water or aquatic therapy, allows you to move your body with minimal effort. However, you’ll still enjoy many benefits of exercise, including improved muscle tone and flexibility. Water provides gentle resistance, so you’ll condition your muscles and boost cardiovascular health without the strain that often comes with land-based exercise. You may also be able to perform certain activities in water that are challenging on land (eg, balancing on one leg) and exercising with a greater range of motion.

Behavioral Rehabilitation

Failed back surgery syndrome is a complex spinal condition, and your doctor may rely on several different treatments from several medical specialties to address your pain and symptoms. This is called using a multidisciplinary treatment approach.

In addition to referring you to a physical therapist, your doctor may also recommend a psychologist. Your doctor may include a psychologist if he or she believes behavioral treatments, such as mindfulness-based stress reduction or cognitive behavioral therapy, may help improve your quality of life in light of FBS. For patients with the same condition—some patients are able to manage their pain conditions and live relatively normal lives while others feel severely disabled. Dealing with pain and stress varies greatly among patients.

Learning your spine surgery did not achieve the results you and your doctor expected can cause much stress and anxiety. These forces work against your optimal function and health. By addressing mental, emotional, and behavioral aspects of that influence your pain, you will more fully address your FBS pain and symptoms.

Alternative Therapies May Include Acupuncture

Though alternative treatments, including acupuncture, cupping, dry needling, and biofeedback, often lack the high-quality scientific research to support their efficacy, most are generally regarded as safe. Alternative treatments do not ‘fix’ a problem but rather help patients manage pain issues. As such, your doctor may allow or even recommend that you try them as part of your FBS treatment plan. Patient results vary greatly. It’s important, however, to ensure that your doctor approves the use of any alternative treatments before you try them.

More Research Is Needed to Know These Therapies’ Effect on FBS Symptoms

While the medical community largely believes passive and active therapies are strong components of any failed back surgery (FBS) treatment plan, more research is needed to truly understand how effective they are treating back and neck pain after spine surgery. In the meantime, the best way to assure success with these treatments is to follow your doctor’s and/or physical therapist’s instruction for how to safely engage in these activities to achieve the greatest benefit.

Updated on: 02/06/19
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Physical Therapy Center

The SpineUniverse Physical Therapy Center provides helpful information about physical therapies used to treat neck and back pain caused by a spinal disorder. Passive therapies include ultrasound and massage, and active PT involves exercise.
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