Physical Therapy after Microdiscectomy
Microdiscectomy is a minimally invasive spine surgery commonly done for the surgical management of sciatica. Sciatica usually occurs as a result of the prolapse of an intervertebral disc. The intervertebral disc may prolapse as a result of age-related wear and tear or due to trauma as a result of fall or repetitive action.
Sciatica is usually managed with nonsurgical treatment and surgical treatment is only indicated in patients who have had no relief with the non-surgical measures. Microdiscectomy surgery involves a small incision in the lower back. The spine surgeon separates or cuts the muscles and tissues to reach the diseased disc. The herniated disc is then removed and pressure over the spinal nerve is relieved.
The surgeon then repairs and closes the incision in layers. A bandage is applied at the incision area and the incision usually heals in about 10 – 14 days.
Physical therapy is usually held off during the initial postoperative period and is started around 2 weeks when the incision heals. During the initial 2 weeks, the post-operative pain subsides and the patients may no longer require narcotic pain medications. However, some physicians may recommend starting the physical therapy earlier or later than 2 weeks depending upon the patient’s condition.
Although targeted exercises may be withheld for about 2 weeks, the patients are advised to stay active after surgery by walking around and avoid complete bed rest.
Walking boosts blood flow throughout the body and helps to build cardiovascular endurance. The increased blood flow brings in more nutrients and oxygen to the tissues cut during surgery to help them heal.
Targeted physical therapy after microdiscectomy is aimed to strengthen the muscles around the diseased disc and also increase flexibility. The strength is achieved with graduated and repetitive exercises targeting the lower back muscles. Flexibility is increased with the help of targeted stretching.
The physical therapist works with the patients to improve posture and gait. Maintenance of a proper posture is important to prevent excess strain on the ligaments and to prevent muscle deconditioning. Proper posture during the early postoperative period helps in the early healing of the tissues.
Prone and supine leg raises are strengthening exercises due the lower back and the abdominal muscles. The lower back muscles are activated when the exercise is performed by lying on the belly (prone) and the abdominal muscles are activated when lying on the back (supine).
In prone leg raise, the patients lay on their belly and slowly raise the leg backwards up in the air. The leg is held in the position for 1-2 mins and the exercise is repeated similarly with the other leg. Supine leg raise is performed similarly with the patients laying on their back and raising one leg while keeping it straight.
The abdominal muscles provide support in the front of the spine while the back muscles provide support from the back. The support acts as a deterrent to disc prolapse.
Alternate knees to the chest is another exercise for strengthening spine flexion. The patients while lying on their back with their knees bent try to bring one knee towards the chest with the help of their hands. The exercise is repeated similarly with the other knee.
Similarly exercise for strengthening the core muscles involves lying on the back with knees bent. The patients tried to flatten their lower back to touch the ground and hold their muscles in the position for 1-2 mins.
Core strengthening and hip strengthening exercises are also performed under supervision of the therapist to help in early recovery. The exercises not only strengthen the muscles but also decrease postoperative pain. Physical therapy allows the therapist and the physician to assess the patient’s ability to return to work.
Workplace analysis may also be performed by the therapist to aid in their smooth return to activities. Physical therapy forms one of the most important aspects of postoperative recovery of the patients.
With proper therapy, patients return to their baseline activists sooner and have decreased incidence of complications such as reherniation after microdiscectomy. Speak with your surgeon regarding physical therapy after microdiscectomy.