Each physician has his/her own specific guidelines for the rehabilitation process. Deviations from
the protocol are dependent on prior level of function, general health of the patient, equipment available, goals of the patient, and specific orders written on the prescription. It is the treating therapist’s responsibility along with the referring physician’s guidance to determine the actual progression of the patient within the protocol guidelines.
Two important goals throughout the lumbar fusion physical therapy protocol are maintenance of neutral spine and stabilization. Neutral spine is a position between spinal flexion and extension that is most comfortable for the patient and produces the least amount of pressure on the disc. Stabilization is a balance between strength, flexibility, muscular endurance, coordination, and aerobic capacity which makes it possible to maintain neutral spine during static and dynamic loading. It is important to note that variations exist in the type of lumbar fusion surgical approach used and limitations are dependent on this particular surgical approach.
Once the patient can demonstrate proper stabilization without cueing, a progression of exercises to further develop and improve stabilization can begin. It is important that proper stabilization be achieved with each attempted exercise prior to progressing to moderate/advanced stabilization exercises.
The following clinical observations require a consultation with the referring/consulting physician:
- Failure of incision to close or significant redness, swelling or pain in the area of incision.
- Unexpectedly high self-reports of pain in comparison to presurgical state.
- Loss of Bowel or Bladder function.
- Failure to meet progress milestones according to protocol “guidelines” as may be modified by clinical judgment with consideration given to previous presurgical state and typical progression of patients during rehabilitation.
- Evidence of acute exacerbation of symptoms: significant increase of pain, sudden increase of radicular symptoms, and/or sudden loss of strength/ sensation/ reflexes.
- Development of new unexpected symptoms during the course of rehabilitation.
This is for information only and is not intended to substitute for sound clinical and professional knowledge.
Lumbar Fusion Protocol
- Decrease swelling / inflammation
- Prevent stiffness / soft tissue mobilization as needed
- Increase activity tolerance
- Begin stabilization / restrict lumbar ROM
- Pain / symptom modulation as needed
- Avoid range of motion at fusion level
- Allowance of range of motion is physician dependent
- Avoid excessive loading and distraction
- Avoid rotational activities until cleared by physician (min 4 mos.)