Physical Therapy Post-Lumbar Microdiscectomy
What is a Lumbar Microdiscectomy surgery?
A lumbar microdiscectomy is a minimally invasive surgical procedure used to remove a portion of a herniated or damaged disc in the lower spine (lumbar region), explained in this article. This procedure aims to relieve pressure on the spinal nerves, often caused by a disc pressing on them, which can result in pain, numbness, or weakness in the lower back, legs, or feet. The surgeon uses small incisions and specialized instruments, sometimes aided by a microscope, to remove the damaged disc material. It's typically done when conservative treatments like physical therapy or medications fail to provide relief.
How long does it take to recover after lumbar microdiscectomy surgery?
Recovery time after lumbar microdiscectomy varies depending on individual health factors and the specific details of the surgery. However, many people can return to light activities within a few weeks. Full recovery can take anywhere from 6 weeks to 3 months. During the first few weeks, patients may experience some discomfort, but most can resume their normal routines relatively quickly compared to traditional open back surgery. It's essential to follow the doctor's advice for a safe recovery and avoid certain activities to minimize the risk of complications.
What precautions are there after lumbar microdiscectomy?
After a lumbar microdiscectomy, there are several precautions to ensure proper healing, as explained in this article:
Avoid heavy lifting: For at least 4-6 weeks, avoid lifting objects heavier than 10-15 pounds to prevent strain on the back.
Limit bending and twisting: These movements can stress the spine and should be minimized during the early recovery phase.
Rest but stay active: While rest is essential, it’s also important to engage in light walking and gentle movements to encourage circulation and prevent stiffness.
Follow post-operative care instructions: Adhere to your doctor’s specific advice regarding pain management, wound care, and other protocols.
Physical therapy: It may be prescribed to help you regain strength and flexibility.
Physical Therapy protocol for post-lumbar microdiscectomy
After a lumbar microdiscectomy, physical therapy is crucial for recovery, helping to restore mobility, strengthen the muscles supporting the spine, and reduce pain. The exact protocol will vary depending on the surgeon's recommendations and individual patient progress, but here’s a general outline of the stages of physical therapy after the procedure:
Phase 1: Early Recovery (0-2 weeks)
The primary focus in this phase is to control pain and inflammation while promoting gentle healing.
Goal: Protect the surgical site and prevent re-injury.
Treatment:
Rest and Activity Modification: Gradual return to light daily activities. Avoid bending, twisting, or lifting.
Gentle Range of Motion (ROM) Exercises: Low-impact movements (e.g., pelvic tilts, gentle back stretches) to maintain spinal flexibility.
Core Activation: Gentle core strengthening to engage the abdominal and pelvic muscles.
Pain Management: Modalities like ice/heat therapy and electrical stimulation (if indicated).
Walking: Short, frequent walks to improve circulation and prevent stiffness.
Phase 2: Intermediate Recovery (2-6 weeks)
The goal now is to regain mobility, stability, and begin strengthening the muscles that support the spine. Patients typically begin physical therapy during this stage of the rehab process.
Goal: Start restoring strength and functional movement while avoiding overload.
Treatment:
Core Strengthening: Begin more focused exercises, such as bridges, planks, and controlled leg lifts, to improve abdominal and lower back strength.
Low-Impact Cardiovascular Exercises: Stationary biking or swimming can help improve overall fitness without stressing the lower back.
Posture and Body Mechanics Training: Reinforce correct posture during standing, sitting, and walking to avoid strain on the healing spine.
Strengthening Exercises: Light strengthening for lower back, hips, and legs with resistance bands or light weights (as tolerated).
Functional Movements: Practice bending and lifting with proper technique to improve movement patterns.
Phase 3: Advanced Recovery (6-12 weeks)
At this stage, you should focus on improving strength, stability, and returning to pre-injury activities.
Goal: Strengthen muscles around the spine and improve endurance.
Treatment:
Progressive Strengthening: Gradually increase the intensity of exercises, including squats, lunges, and more advanced core exercises (e.g., dead bugs, bird dogs).
Balance and Stability Exercises: Focus on balance activities like standing on one leg, stability ball exercises, and proprioceptive training.
Aerobic Exercise: Gradual return to more intense cardiovascular activities like walking, biking, or swimming.
Return to Functional Activities: Introduce more functional movements such as bending, lifting, and twisting, but ensure these are done with proper technique.
Phase 4: Maintenance (3-6 months)
This phase aims at ensuring that the spine remains stable and strong, preventing future issues.
Goal: Continue to build strength and endurance while maintaining flexibility.
Treatment:
Strength Training: Continued focus on core and back strengthening exercises, as well as full-body strength training to prevent muscle imbalances.
Flexibility: Regular stretching to improve flexibility, particularly in the hamstrings, hip flexors, and lower back muscles.
Functional Training: Prepare for return to sports, heavy lifting, or more strenuous activities if needed.
Ergonomics and Activity Modification: Reinforce strategies for preventing back strain in daily activities.
Key Considerations:
Listen to your body: Pain should not increase during exercises. Mild discomfort may be normal as long as it does not become sharp or persistent.
Gradual Progression: Physical therapy should progress slowly to avoid overloading the healing tissue. Progression is based on pain levels, range of motion, and functional abilities.
Posture & Body Mechanics: Throughout recovery, it’s important to focus on maintaining good posture and proper body mechanics to avoid strain on the lower back.
Always work closely with your physical therapist and follow your surgeon’s guidance, as individual cases may differ.
What are the best exercises after lumbar microdiscectomy surgery?
The best exercises after lumbar microdiscectomy will depend on the individual and their stage of rehab. With that being said, here are some of our favorite exercises to promote recovery after lumbar microdiscectomy:
Walking: A low-impact exercise that encourages movement without stressing the spine. You can start with 10 minutes, 1-2x/day, and gradually progress to 20-30 minutes. Initially, you should focus on frequency over duration.
Pelvic tilts: These will help to strengthen the lower back and abdomen without putting pressure on the spine and also to restore pain-free lumbar flexion (forward bending). You can start with supine pelvic tilts and progress to quadruped pelvic tilts.
Sciatic Nerve Glides: These will help to decrease inflammation of the sciatic nerve, restore nerve mobility, and decrease radiating pain/symptoms that go down the leg. Some individuals may need to start with ankle pumps with leg elevation and progress to sciatic nerve glides, sciatic nerve tensioners and downward dog with foot pedaling.
Bridges: Works the glutes, core, and lower back muscles to stabilize the spine. You can start with partial range of motion and progress to full range of motion before introducing marching bridges and single leg bridges.
Deadbugs: A good core-strengthening exercise that encourages stability and is easy to start with. You can start with an isometric deadbug for 20-30 second holds and progress by adding arm and leg movements.
Squats: This will work your glutes, core, and thigh muscles in a functional movement pattern. You can start with mini squats and then gradually increase the depth and eventually load it with a goblet squat.
Hip Hinges: These will work the glutes, hamstring, core, and lower back muscles to stabilize the spine in a functional movement pattern. You can start in tall kneeling and progress to standing and eventually load it with RDLs and deadlifts.
It's important to consult with a physical therapist to develop an appropriate exercise regimen tailored to your specific needs and recovery stage.
How to avoid scar tissue after microdiscectomy?
Scar tissue is a natural part of the healing process, but excessive scar tissue (also known as fibrosis) can cause complications, including chronic pain or stiffness. To minimize the formation of excessive scar tissue after microdiscectomy:
Gentle mobility: Performing light, controlled movements as soon as advised can help prevent the scar tissue from becoming too thick.
Physical therapy: A physical therapist can help guide exercises and stretches that can reduce the risk of abnormal scarring.
Massage therapy: Some patients find that gentle massage helps break up any adhesions and improves circulation in the healing tissue.
Post-surgical care: Proper wound care, including keeping the incision site clean and avoiding infection, is essential in preventing complications.
Topical silicone: According to this article, topical silicone dressings can help to soften or decrease the appearance of scars following surgery. The topical silicone dressing that we use with our patients for scar management after surgery is Mepiform, as supported by this article. According to this article, Mepiform can also help to prevent and treat hypertrophic scars and keloids.
How to sleep after lumbar microdiscectomy?
Sleeping after lumbar microdiscectomy can be a challenge in the initial recovery phase, as it’s important to keep your spine in a neutral position. Here are some tips:
Sleep on your back: Place a pillow under your knees to help maintain the natural curve of your spine. This can reduce pressure on the lower back.
Side sleeping: If you prefer to sleep on your side, place a pillow between your knees to maintain spinal alignment.
Avoid stomach sleeping: Sleeping on your stomach can stress the spine and exacerbate pain or discomfort after surgery.
Use a firm mattress: A supportive mattress helps prevent any misalignment of the spine during sleep.
Conclusion
If you’re recovering from lumbar microdiscectomy surgery and want to consult us in the rehab process, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy