Physiotherapy
This information gives advice for people during an acute episode of back pain or following back surgery. It is only to be used as a guide and is not a set of rules. If you have any problems, please contact the ward staff.
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This booklet has been designed to provide you with useful information if you have had lumbar spinal surgery or for management of acute low back pain. It focuses on the physiotherapy management following your admission. Consequently, it will help you during your stay in hospital and once you return home.
It is important to know this information should only be used as a guide rather than a set of rules.
Post operatively
You may have had leg pain or sciatica before your surgery. Your leg pain may be completely recovered following your operation but in some cases the improvement happens gradually over time. Tingling and numbness may take longer to improve and sometimes does not fully recover.
Recovery following surgery varies between patients. This could depend on different factors such as age, type of surgery and/or level of general fitness.
It is important to remember that this type of operation may not cure your back pain. Therefore, it is very important to keep your back strong and flexible by completing the exercises, slowly building up your fitness and return to normal activities. Research has shown that this will help to control your symptoms.
If you become inactive, stop moving your spine and stop your exercises your back will slowly become more stiff and weak. This will make your recovery slower and more difficult.
Physiotherapy
During your admission you may see the physiotherapist (if this is required). Many patients can be discharged home within 24 hours and do not need physiotherapy.
If it is decided that you require physiotherapy, you may be seen before or after your surgery. You will be given guidance regarding your recovery; your mobility will be assessed, and the exercises will be demonstrated to you. It is important you adhere to this advice and exercises given once you are discharged. If you do not need to see the physiotherapist, please follow the advice in this booklet.
After your surgery, exercise is the most effective way to speed your recovery and help to strengthen your back, abdominal and leg muscles.
You will be encouraged to mobilise as much as possible within your limitations. We advise you build the time and distance up gradually and do several short walks over the day. Walking will not harm your back, but it may be uncomfortable at first if you walk too far, too quickly. Continue to gradually build up your walking distance as you recover.
Activity advice
This advice varies depending on the type of surgery you have had. The main points are:
- Try to avoid sitting for longer than 20 minutes without changing position. Stand or walk regularly or lay down for a short period of time. Take regular breaks if you are making a long car journey.
- When sitting avoid soft chairs. Sit in a supportive chair.
Use a rolled-up towel or pillow in the small of your back for additional support. - For the first few weeks avoid activities that require a bent posture, or involve twisting, pushing or lifting. This includes gardening, cleaning, ironing and carrying shopping. You can gradually return to these activities as you recover but try to limit prolonged bending or stooping.
- Do not twist your back when you are bending or lifting.
- Avoid any vigorous exercise or sport, other than walking, exercises in this booklet or anything advised by a health professional, until you are seen again by your consultant.
- It is important that you gradually return to your normal daily activities and movements of your spine. This is a vital part of your recovery.
- Your back may occasionally feel sore or more painful, but this does not mean that you are causing more damage to your spine.
- You should avoid heavy lifting for at least three months after your surgery. Wait until your back feels strong and flexible. Do not attempt to lift anything you feel is too heavy or awkward. If heavy lifting is required for your job discuss this with your consultant first.
When lifting follow the advice below, even when lifting light objects. If in doubt, get help:
Bend your knees and use your leg muscles to take most of the load when lifting objects from below your waist. Try to keep your back relatively straight but not rigid
Avoid twisting your body when lifting and moving objects. Step around rather than twisting
Avoid over-reaching or stretching when lifting. Keep the load close to your body
Ensure you can comfortably lift and control objects from above head height
Remember
- Inspect the load.
- Know your capabilities.
- Make sure you have enough space.
- Try to split the load up if possible.
What to expect post operatively
You would expect to have some back stiffness in the morning and some soreness in your back after activities. This is nothing to worry about. It is not unusual to continue to experience back pain after your operation and the levels of pain may vary. This is normal and you should not be concerned. The most effective way to deal with this is to keep active and continue with your exercises.
If your pain becomes severe, and your muscles go into spasm, it may be difficult to move around for a short period of time until this settles. If this happens reduce your activities and rest for two to three days before gradually increasing your activity again. You may need to take pain relief 20 minutes before you start your exercises. Do not take to your bed for long periods of time as your back will become stiff and your muscles will weaken.
Outpatient physiotherapy
Following surgery not all patients require physiotherapy. You will be contacted by your local physiotherapy department and informed if this is necessary.
When can I …?
- Go home?
This depends on your consultant and the type of surgery you have had. In most cases if your pain is well controlled, you are independently mobile and there are no other complications you will be sent home quickly. This can be as early as the day of your operation or the day after. - Have a bath or shower?
You can normally have a shower one to two days after your operation. Check with the nurse first as you may need to have a waterproof dressing applied. Avoid using heavily scented soap, shower gel, bubble bath or body lotions around the wound. Avoid having a bath for at least three weeks. - Resume sexual activity?
Your consultant or nurse can advise you on this, however, unless you have been advised otherwise do what feels right for you. Try to make sure that you are comfortably positioned to avoid too much pressure or strain on your back. - Drive?
This can vary depending on your consultant. The usual recommendation is 4 to 6 weeks, however, ensure that you can operate the foot pedals comfortably and effectively. You should also notify and check with your car insurer. - Return to work?
This may depend on the type of surgery you have had, your surgeon and your job. You will be advised accordingly by your consultant.
The wound and dressing
This type of operation usually only requires a small incision with minimal disturbance to your spine. It should heal fairly quickly. The nurse will be in charge of looking after your wound. In theatre there may be an initial dressing applied.
Before you go home a new dressing will be applied if required. When at home it will need very little care. Try to keep the area dry and clean. It should heal in approximately two weeks.
Most wounds heal without any problems, however when you return home monitor for any signs of change. If you have a problem, contact your GP or ward 24.
Signs that might indicate an infection or allergic reaction to the sutures, clips or dressings are:
Increased pain or discomfort in or around the wound
Redness, swelling or oozing from the wound for example, blood or pus
A high temperature (above 37.7ºC)
An unpleasant odour from the wound
Rash, itchy or irritated skin around the wound
If you need to change your dressing
- Wash your hands
- Remove old dressing
- Apply new dressing taking care not to touch the pad or wound
- Wash your hands
- If you struggle to reach the dressing, you should ask someone to help you
Exercises
You should perform these exercises three times per day. They are important for your recovery and are safe to do. They will not harm your spine. They may cause some discomfort to start with so perform them slowly and gently. Do not force the movements so that it causes severe pain.
1. Pelvic Tilt
Sit on a firm chair with your feet on the floor. Gently roll your pelvis back to flex your lower spine (slouch). Then gently roll your pelvis forwards to extend or straighten your lower spine. Repeat 10 times and perform 3 times per day.
2. Prone Lying
Lay on your stomach for 1 to 2 minutes, 3 times per day. You can lay on your bed or the floor, whichever is easiest. Make sure you can get back up from the floor.
3. Single leg flexion
Lay on your back, gently pull one knee towards your chest until you feel a gentle stretch in your back. Repeat 10 times on each leg, 3 times per day.
4. Sitting leg stretch
Sit on a firm chair and slowly straighten one knee until you feel a gentle stretch in your leg or your back. Hold for 5 seconds.
Repeat 5 times on each leg, 3 times per day.
Contact us
If you require further information, please contact us:
- The James Cook University Hospital
Physiotherapy Department
Telephone: 01642 852617
Email: [email protected] - Ward 24: Telephone: 01642 854524
- Ward 27: Telephone: 01642 854527
Other handy contact details
- Darlington Memorial Hospital
Switchboard: 01325 380100, Physiotherapy department: 01325 743120 - University Hospital of Hartlepool
Switchboard: 01642 617617, Physiotherapy department: 01429 522471 - University Hospital of North Tees
Switchboard: 01642 617617, Physiotherapy department: 01642 624869 - Bishop Auckland Hospital
Switchboard: 01388 455000, Physiotherapy department: 01388 455422
This information booklet is to be used as a guideline. If there is anything that you feel unhappy about or if you have any comments about the physiotherapy service, please talk to a member of staff.
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]