3.1 Back Care and Exercise Information

Transcription

1 Physiotherapy Services 3.1 Back Care and Exercise Information Patient Information

2 Introduction Welcome to the Orthopaedic Department at Kettering General Hospital. We have produced the following information to explain your surgery and post-operative treatment. It is provided to reinforce the information given to you on the ward. If you have any worries or queries, do not hesitate to ask any member of the physiotherapy staff. Anatomy The spine comprises of different levels, the lumbar spine (Lower back), is composed of 5 bones or vertebrae. These are numbered downwards from 1-5 and because they are part of the lumbar spine they are prefixed by the letter L. For example you will hear medical professionals refer to L3-4 or L4-L5. At the bottom of the lumbar spine is the sacrum and the top part of this is referred to as S1. In between each vertebra lies a cushion known as an intervertebral disc. These act as a shock absorber for the stresses placed on your back. There are also other important structures in your back, including the spinal canal which the spinal cord sits inside. At each level of the spine, between 2 individual vertebrae, pair of nerve roots come out. The nerve roots that come out at the lumbar spine go on to supply the muscles and skin in the legs. Normal disc Vertebra Bulging disc Spinal cord Spinous process 2

3 Problems In an injured or degenerated spine the centre of the disc may, under pressure, bulge or rupture which may produce compression on a spinal nerve. This may produce a number of symptoms including pain, numbness, or pins and needles in the area served by the nerve. An operation aims to relieve the pressure on the nerve and therefore improve the symptoms. Following a period of back pain and definitely following back surgery, the deep or core back muscles become ineffective. These muscles give the spine stability and support during movement and everyday activities. Therefore in order to speed up recovery and prevent recurrence of back problems it is important to retrain, strengthen and lengthen these muscles. Physiotherapy following Back Surgery After any back operation the aim of physiotherapy is to get your back to function normally and also to educate you in maintaining a good posture when sitting, standing, walking or lifting. Day of surgery Immediately following your operation you will be on bed rest for up to 24hours. During this time you will need to be doing circulatory and breathing exercises as follows: - 1. Take 5 deep breaths every hour, expanding your chest as fully as possible, and cough. 2. Wiggle toes. 3. Move ankles up and down. 4. With your legs out straight, squash the back of your knee into the bed and pull your toes towards you. 5. Tighten the buttock muscles and then relax. 3

4 Day 1 following your surgery The physiotherapist will come to see you and if you are feeling well enough, the plan will be to get you up and walking about, a walking aid may be required initially. You will be taught a technique called log rolling for getting in and out of bed (see back care advice). You will also be shown some back exercises and it is important to do these 3-4 times a day. You will be allowed to sit for up to 15-20mins at a time. Day 2-3 following your surgery The physiotherapist will review your exercises and ensure there are no problems. Your walking will be progressed hopefully you will be able to walk unaided. If appropriate you will be assessed on the stairs. You will be allowed to sit for up to 15-20mins at a time. Most patients are discharged home on either day 2 or 3. Back Care Advice For the first 4 weeks, whilst the initial post-operative pain settles and the tissue begins to heal, it is advised to take care with some activities. A sensible approach is advised and a gradual increase in activities is recommended. Current evidence supports a steady increase in activity whilst respecting post-operative soreness, disc healing times, neural sensitivity and patient s previous level of fitness. To follow is some basic back advice. 4

5 General Guide to sitting/walking following your surgery Sitting Week 1 : 15 minutes at a time Week 2 : 30 minutes Week 3 : 45 minutes Week 4 : 1 hour to unlimited sitting as able Walking Week 1 : minutes twice a day Week 2 : 30 minutes twice a day Week 3 + build up by 15 minutes extra a week so that by week 4-6 you should be able to walk for 1 and a half hours (90 minutes), twice a day. These time scales are approximate and will depend on your recovery. 5

6 In and Out of Bed Once you are allowed to sit, you can get in and out of bed following the way described below and continue to do so from now on as it will reduce the risk of you further damaging your back. 1. Bend both knees, tighten your stomach and roll onto your side. 2. Allow your feet to slide over the edge of the mattress. 3. Push up into your elbow, using your hand from the opposite side to help you sit upright. 6

7 The correct posture to aim for The side view of a human body shows that there is a small inward curve in the neck just above the shoulder girdle, a slight outward curve in the thorax (chest region) and another small inward curve in the small of your back. Unfortunately, many of us develop poor postures due to our occupations and lifestyles, and following an episode of back pain. Redeveloping a good posture and maintaining these curves will help to minimize the risk of further damaging your spine, and also decreases pain due to poor posture. Good Posture in Standing Your weight should be equally distributed between both legs, your head is balanced, shoulders are level and relaxed, abdomen is pulled in, pelvis is tucked under and knees are soft. 7

8 Sitting Sitting for long periods, especially on a soft or low seat i.e. a settee should be avoided as this encourages a slumped, rounded posture. Do not sit for more than half an hour at a time for the first 6 weeks. An upright chair with a small cushion, or rolled up towel, in the base of your back will give a more supported position. Lying in Bed A fairly, firm mattress or a board under your mattress will give you most support. You may then find it comfortable to lie on your side, knees bent, with 2 pillows between your legs, or on your back with both knees bent up and a firm cushion under your legs. 8

9 Lifting Again, it is important to maintain the curves in your spine while lifting. This is why you are advised to bend your hips and knees when lifting rather than bending your spine. Also, try to hold the load close to your body, as this again will reduce the strain on your back. You should not be attempting to lift anything more than a few kilograms / pounds for the first 3 months following your operation. Exercises These aim to prevent stiffness of the spine, encourage mobility of the nerves and strengthen the trunk muscles in order to help support and add stability to the spine. Do not push into pain at this stage. Perform exercises regularly through the day, slowly and rhythmically. 9

10 1) Transversus Abdominus (trans abs) Lie on your back with legs bent and feet together. Your lumbar spine should be in neutral that is neither arched up nor flattened against the floor but aligned normally with a small gap between the floor and your back. Breathe in deeply and relax all your stomach muscles. Breathe out and as you do so, draw your lower abdomen inwards as if your belly button is going towards the floor. Hold the contraction for 10 seconds and stay relaxed, allowing yourself to breathe in and out as you hold the tension in your lower stomach area. Repeat 5-10 times 10

11 2) Pelvic Tilt / Bridging Lie on your back with your knees bent and feet on the floor. Pull your stomach up and in to gently lift your tailbone off the floor. If this feels ok then continue to lift your pelvis and lower back gently off the floor. Hold this position. Then slowly lower, returning to the starting position. Repeat 5-10 times 3) Knee Rolls Lie on your back with your knees bent and feet on the floor. Take a deep breath in and tighten your trans abs Breathe out as you slowly lower your knees towards the floor to the left as far as you can comfortably manage. Pause then breathe in as you return your knees to the start. Repeat to the right. Repeat 5-10 times 11

12 4) Knee Drops Lie on your back with one leg bent and the heel beside the straight knee keeping your pelvis level. Draw in your trans abs (as in exercise 1) and slowly let the bent knee fall out to the side. Do not let the pelvis twist or rotate at all. Repeat 5-10 times 5) Clam Lie on your side with your pelvis square and your hips and knees bent. Draw in your trans abs. Keep your heels together and slowly lift the top knee by turning the hip out. Do not let the pelvis twist or rotate at all. Repeat 5-10 times 12

13 6) Nerve Mobilisation Lie on your back with both legs straight. Bend one hip to 90 degrees and hold the thigh in this position. The knee should be relaxed. Holding the thigh in position, slowly straighten the knee. Hold for 5 seconds. Repeat 5 times. 7) Heel Raises Stand up on your toes Hold for 5 seconds Repeat 10 times 13

14 General queries When can I Swim? Once the stitches/clips are removed and the scar is well healed, swimming may be commenced, slowly at first and gradually increasing the distance you swim. Avoid breaststroke until you have good abdominal / tummy control. When can I Drive? If your recovery has been routine you may resume driving at 3-4 weeks. (Check with your insurance company). When can I return to work? The earliest you can return to work is approximately 6 weeks after your operation, but this will be confirmed by your consultant. If your job is physically demanding you may have to wait until 12 weeks. When can I return to gym? You can return to gym after approximately 2 weeks for gentle exercise on the treadmill and cross trainer, provided you maintain correct posture. Your focus should be more on cardiovascular based exercise than heavy resistance training. It may be worth asking a gym instructor for a review of your technique. In Summary The important message to pick up is that we want you to return to a normal lifestyle and level of activity. The Physiotherapist and medical staff will be able to advise you on how to achieve this. Use your common sense and look after your back. 14

15 Date Issued:.. Name of Patient:.. Name of Therapist:.. 15

16 If you would like this information in an alternative format or language, please telephone Further information about the Trust is available on the following websites: KGH - NHS Choices - Ref: PI 941 May 2015 Review: February 2017