Recovery and Rehabilitation

Recovery should be a slow but steady process of building strength and restoring movement. Knowing what to expect as you are recovering from back surgery will help to keep you from becoming frustrated or doing too much too soon. Patience and persistence are the keys!

• During the First Few Weeks - During your first few weeks at home, you are likely to feel weak and tired at first. Your incision may be sore. You may also feel some pain, tingling, or numbness in your back or legs. All of these feelings are natural and to be expected as your body heals and grows stronger. They should decrease as your nerves heal. Do not become frustrated. Keep moving as much as you can without making your pain increase
• Get Walking - Walking is the best exercise for you after back surgery. It strengthens your back and leg muscles, increases your endurance, and relieves stress. Begin by walking around the house. Build up to several walks a day. You may find it helpful to set a goal. Talk to your doctor or PT about setting a safe, realistic goal for yourself.
• Don't Overdo It - Increased pain for more than 2 hours after an activity means you have done too much too soon. When you feel pain, slow down and pay more attention to your posture and movements. By about the sixth week after your surgery, you should be well on your way to healing. But continue to let pain be a warning to slow down.
• Know When to Call Your Doctor - Call your doctor right away if you experience any of these symptoms:
  1. Persistent or severe pain, weakness, or numbness in your back or legs
  2. Drainage, swelling, or increased redness around your incision
  3. Difficulty breathing
  4. Problems controlling your bladder or bowels

While you are recovering and afterward, these tips can help make some common tasks easier to perform and help protect your back at the same time.

• Getting Dressed - Putting on and taking off socks, slacks, and underwear may be easier to do lying on your back. A tool called a dressing reacher can be of help. To make dressing and undressing easier, wear loose clothes and slip-on shoes with closed backs.
• Getting ready to Lie Down - Before you lie down, make sure that you have the things you need within reach. Gather items such as medications, eyeglasses, reading material, and other things you may want. Be sure to place them so you won't have to twist your back to reach them. If you are not able to gather the items yourself, ask a family member or friend to help.
• Washing at the Sink - While standing at the sink, bend your knees and hips and keep your back in a neutral position to take stress off your spine.
• Showering Use a hand-held shower to wash your hair, or bend at the knees and hips under the shower head to avoid arching your back. To avoid bending, use a long-handled scrub brush. Use liquid soap so you don't need to pick up a dropped bar of soap.
• Eating - Slide your chair as far under the table as possible. Do not lean forward or put your elbows on the table.
• Grocery Shopping - Buy small amounts of groceries at a time instead of one large order. Ask the checker to keep the bags light and to use bags with handles. Put the shopping bags on the car seat, not in the trunk or on the floor.
• Caring for a Child - If you have small children, arrange for help while you are recovering. Put the changing table on a raised surface, or adjust it to waist height. Use a reacher to pick up small objects, such as toys, from the floor. If you must lift a baby from a crib, lower the railing of the crib and bring the child close to your body before you lift.
• Working in the Kitchen - Store food and tools you use often on the counters or the middle shelves of the refrigerator where they are easy to reach without bending or stretching. While working, stand with one foot in front of the other or resting on a stool to take stress off your spine.
• Driving or Riding in a Car - Adjust the car seat so that your knees are level with or just below your hips. To get out of the car, pivot on your buttocks and swing your legs out, keeping your knees together. Do not twist your spine. Use your leg muscles to stand. To get into the car, do the reverse.
• Working at a Desk - When you are ready to go back to work, ask your PT how you can arrange your desk and workspace to protect your back.
• Being Intimate - Ask your doctor or PT when it will be safe for you to have sex. Side-lying positions may be more comfortable. If you lie on your back, support your neck and knees with pillows. Avoid arching your back. Also, avoid shifting the position of your spine too rapidly. Take it easy, and see what works for you and your partner.

Tips for Better Back Health

Taking care of your health can help you recover faster, feel better, and reduce the risk of reinjury. Factors that can affect your health and the health of your back include stress and excess weight. Addressing these issues now can help you keep your back healthy in the long run.

• Releasing Stress - Try these methods for releasing stress, which can lead to tight, painful muscles:
  1. Deep breathing: Slow, calm, deep breathing can help you relax. Breathe in for a count of 5 or more. Then slowly let the breath out
  2. Visualization: Imagining a peaceful, secure scene can give you a sense of control over your body and surroundings.
  3. Progressive Relaxation: Starting at the top of your head and working your way down your body, slowly tighten each muscle group for 10 seconds. Then release the muscle group for the same amount of time.
• Managing Your Weight - Excess weight increases the load on your lower back. Maintaining a healthy weight makes your back less prone to injury. If you need to lose weight, talk to your doctor about exercise and changes in your diet. Your doctor may recommend a weight loss program to help

Most people who have spine surgery experience good to excellent results. They get significant relief of pain and the return of functional movement and strength. Most are able to walk, sit, drive a car, and perform other activities of daily life.

After spine surgery, people often report feeling better soon after they awake from the surgery. Although you may see and feel immediate benefits, you will get the maximum benefits of surgery by taking participating in a comprehensive rehabilitation program. The sooner you become active, the sooner you will get back to your normal routine. At the same time, remember to protect your healing back. Increase your activity level at a slow but steady pace.

• Tubes to drain the incision
• An IV to give you fluids and medication
• A catheter (tube) to drain your bladder
• Boots or special stockings on your legs to help prevent blood clots

Prepare Your Home for Your Return

If your movement is limited during recovery, ask a family member or friend to help prepare your home for your return by removing hazards that could cause you to trip, slip, or fall. One place in particular to prepare for your return home from the hospital is your bathroom. The tips below will help make your bathroom safer and more comfortable while you heal. Keep in mind that some of the equipment listed will need to be ordered so it is ready for when you get home

Bathroom Safety Tips

• Prevent slips and falls by using non-slip surfaces in your bathroom
• Consider putting in grab bars and railings for support
• Watch out for hazards, such as wet floors
• Talk with your occupational therapist if you need more instructions in using bath aids
• Install a hand-held shower hose
• Use a long-handled sponge to wash hard-to-reach areas
• Use a non-slip bath mat to help keep the floor dry
• Use grab bars in your shower or tub for support as you get in and out
• Sit on a bath bench or shower chair while you bathe

If you had surgery that limits bending, use a commode chair or elevated toilet seat to raise the height of your toilet

Things You Can Do At Home to Help Yourself Get Better

When you are leaving the hospital, your doctor or PT may recommend some or all of the following to help you get better at home:

• Ice and Heat - cold treatments are usually recommended in the first few days after surgery. Ice makes blood vessels vasoconstrict (vase-oh-con-strict) (get smaller), decreasing the blood flow. This helps control inflammation, muscle spasm, and pain. Heat may also be recommended. Heat makes blood vessels vasodilate (vase-oh-dye-late) (get larger), increasing the blood flow. This helps flush away chemicals that cause pain. It also helps bring in healing nutrients and oxygen.
• Relaxation - pain after spine surgery can be physically and emotionally draining. Relaxation exercises can help you control pain and the stress that comes with it. You may be given instructions for breathing exercises to help air reach even deep into your lungs. You may also be instructed to slow your breathing to a more relaxed pace. Slower breathing can help muscles relax, while bringing much needed oxygen to sore tissues.
• Rest - giving your body a chance to rest can help ease soreness after surgery, giving your spine time to heal. Follow your doctor's instructions for using any prescribed supports or braces.
• Positioning - your PT may suggest ways to position your spine for the greater comfort. These positions may include the use of pillows or towels to support your spine and help take pressure of the surgical area.
• Movement - careful movements suggested by your PT can safely ease pain by providing nutrition and lubrication in the areas close to the surgical area. Movement of joints and muscles also signals the nervous system to block incoming pain. Using safe body movements can help you avoid extra strain on your spine in the weeks after your spine surgery.
• Lying in Bed - avoid lying in positions that twist or angle your spine. Do not curl up in the "fetal" position. Choose a firm mattress. Do not lay on a soft bed or sofa. Keep enough pillows nearby to support your head, shoulders, trunk, and legs.
• Moving in Bed - when getting in or out of bed, use the "log roll" technique. To get out of bed, roll onto your side and sit up while keeping your spine steady and secure. Instead of twisting your upper body when you roll to one side, try to roll your whole body as a unit, like rolling a log. Then let your legs ease off the edge of the bed toward the floor as you push yourself up into a sitting position. This reduces strain from twisting your spine and gives the surgical area time to heal. To get into bed, do just the opposite: sit first with your legs hanging off the side of bed, then lie on your side and roll like a log onto your back.
• Sitting - keep your spine upright and supported when sitting. A safe, upright posture reduces strain on your spine. Choose a chair that supports your spine. Avoid soft couches or chairs. Place a cushion or pillow behind your back while driving or riding in a car. When standing up, keep your spine aligned by leaning forward at the hips.
• Bending - your doctor or PT may tell you not to bend for a few weeks after spine surgery. Always follow your doctor's instructions. If and when you are given the okay to bend, do so safely. Keep your back straight and secure as you bend forward, making sure your spine is straight. Consider using a "grabber" to avoid bending over at the waist to put on socks or shoes, and to pick up items from the floor.
• Lifting - your doctor may tell you not to lift or carry anything for a period of time after surgery. Do not test your back by trying to lift or carry anything until your doctor says told it is okay. If you must pick up or carry lighter items, squat down by bending your knees. Do not lean forward by bending your spine forward. Keep the item close to your body, even if it is light. Holding the weight out in front of you puts extra strain on your spine. Check with your doctor or PT if you have any questions about the safety of lifting or carrying.
• Outpatient Therapy - your doctor may prescribe outpatient rehabilitation once your condition has begun to stabilize. Your recovery from spine surgery can be improved by learning new ways to strengthen your spine and prevent future problems. Your PT will teach you ways to help reduce your pain now, and help you develop new habits to keep your spine healthy.

From the moment your have spine surgery is completed, the nursing staff will begin monitoring your condition. When the anesthesia begins to wear off, you will be taken to a hospital room until you are ready to go home. When you wake up from surgery, you may feel groggy, thirsty, or cold. Your throat may be sore. For a few days, you may also have:

• Tubes to drain the incision
• An IV to give you fluids and medication
• A catheter (tube) to drain your bladder
• Boots or special stockings on your legs to help prevent blood clots

Day 1

The day after surgery is considered "Day 1." Some spine surgeries require that you wear a brace for a period of time afterward. If so, keep your brace on until your surgeon specifically instructs you to remove it. You may be encouraged to stand and sit (with assistance if needed) within the first 24 hours after surgery. If so, with the supervision of a physical therapist (PT), you will sit on the edge of the bed and stand with support. Walking, however, will be approached gradually and carefully to avoid injury and complications. Try not to over do it the first few times you get up and walk.

• Treatments - a nurse will check the circulation and motion of your legs and feet. You may be given spirometer (sper-ah-ma-ter) (a blue tube you breathe into) to help expand your lungs and prevent pneumonia. Surgical tape, sutures, or adhesive tape will have been used to close your incision. This dressing may be removed and changed. An ice pack or cooling pad may be used to help decrease swelling and increase your comfort. It is common to continue intravenous (IV) fluids for the first day or two.
• Medications - you may be given antibiotics through your IV for the first 24 hours to help prevent infection. Pain medication will be made available to help relieve any pain or discomfort you may be having. During the first 24 hours after surgery, you will probably be given pain medications that are injected into your IV line or directly into your arm or buttock. Or you may have a PCA (patient controlled analgesia) pump. The pump lets you give yourself small amounts of pain medication. These medications are usually much stronger and faster acting than pills taken by mouth. Some pain is normal, even with medication. But if you feel very uncomfortable, tell your nurse. Treating pain before it becomes severe often means that you use less pain medication overall. It is important to keep your pain in check so you can participate in your rehabilitation program.
• Diet - how quickly you recover from anesthesia varies from person to person. Your diet will be ordered by your doctor at first, and it will be adjusted as your intestinal function gets back to normal. Usually you will be allowed to have clear liquids as soon as you are able to eat. If you feel okay after drinking clear liquids, you will be given food that is more solid. Special precautions will be taken if you had surgery from the front of your neck.
• Activities - your PT will work with you to begin moving safely in bed and up to a sitting position. Soon after surgery, you will be encouraged to get up and walk. This helps to keep your blood and bowels moving. It also keeps fluid from building up in your lungs. You will gradually progress to standing and walking. You may require the use of a walking aid (cane or walker) for a short time, and a brace to support your spine.. Your PT He or she may suggest exercises to relieve soreness in your legs, such as tightening and releasing your thigh and buttock muscles and pumping your ankles back and forth to keep fluid from pooling in the lower limbs and help prevent blood clots. Your PT may also teach you how to protect your spine while moving, including tightening your abdominal muscles to "brace" yourself and prevent pain and reinjury. To strengthen your abdominal muscles, practice this simple exercise:
  1. Put your hands on the lower part of your stomach
  2. Gently tighten your abdominal muscles by pulling in your stomach
  3. Breathe normally without relaxing your abdomen
• Tests - you may need to have blood checked every day if your doctor has placed you on blood thinning medications. These tests are needed to regulate anti-coagulant (blood thinning) therapy. During the first few days, your doctor will monitor your blood thinning level.

Day 2

By your second day in the hospital after spine surgery, you may expect the following:

• Treatments - your IV line may be removed. If you have a urinary catheter, that may also be removed. You will probably continue to use the spirometer to help prevent pneumonia, and your wound dressing may be changed or removed.
• Medications - it is natural to feel some pain during the first few days after spine surgery. The pain you may have can usually be controlled with medication, so let your nurse know if you are in pain. By Day 2, you will begin switching from medications given through injection, or your IV, or PCA to pills that can be taken by mouth. Taking medications by mouth will make things easier when you are ready to go home.
• Activities - it is important to continue doing the exercises that have been prescribed by your doctor or PT to help improve motion and keep your muscles from getting sore and tight. Ice packs may be applied before and after therapy treatments to reduce swelling and relieve pain. With assistance from your PT, you will gradually increase the distance you are walking in preparation for going home.

Day 3 and Beyond

• Treatments - your wound dressing will be changed if needed or removed.
• Activities - your physical therapy will continue to focus on safety with mobility, with the goal of enabling you to be independent. In spite of any mild discomfort, it is important that you do your deep breathing and exercises as instructed. Breathing and moving well will help improve your lung capacity and circulation, and may help you heal faster.

You will be able to return home when your doctor feels that your medical condition is stable. You may be instructed to limit your activities for a period of time to give your body a chance to heal. As you prepare to leave the hospital, be sure to follow the instructions given by your health care team.