Two important concepts throughout the lumbar fusion therapy protocol are maintenance of a neutral spine and core stabilization. Stabilization can be defined as a balance between strength, flexibility and postural control and a neutral spine can be thought of as a dynamic position between flexion and extension, making it possible to maintain a neutral spine with functional movement and transfers.

The following lumbar fusion protocol has been synthesized from a variety of rehab and surgical protocols used in major hospitals and spinal centers in the US. The overlapping themes have been identified and from this information I will be creating an 8-week yoga series for yoga with a lumbar fusion. The rehab process begins immediately after surgery and boney fusion typically occurs 10-12 weeks postoperatively and continues for 12-24 months.

PRECAUTIONS:

Avoid range of motion at fusion level until bony fusion process established.
No-pain no gain axiom usually does not apply.
Increased swelling or pain in the area of incision.
Development of new unexpected symptoms during the course of rehabilitation.
Sudden increase of radicular symptoms, new weakness or numbness.
Avoid lifting, pushing or pulling objects greater than 10 lbs.
Avoid twisting and bending of the lumbar spine (at least 6 weeks).
Bending, twisting, lifting as pain permits (after 6 weeks).
Avoid rotational activities until cleared by physician (around 4 mos.).
Avoid abdominal crunches.
Limit prone lying.
TLSO OOB if recommended by surgeon
Sleeping on stomach not recommended.
Educate patient on self-mobilization of scar.
Lifting and activity restrictions will be gradually removed as the healing process takes place.

GENERALIZED LUMBAR FUSION PROTOCOL:

Performance of functional activities with neutral spine and maintain good posture throughout the day.

Increase activity tolerance with 15-30 mins of cardio activity (such as walking) per day.
Focus on low load high repetitions to improve endurance rather than high load low repetition for strength.

Posture education – use lumbar roll when sitting, neutral posture when standing, sit in chair for meals, sit at 30-minute intervals throughout the day.

Bed mobility; log rolling out of bed to chair.

Bed positioning: place pillow between knees when side lying and do not let upper knee extend over lower knee, place pillow under knees when supine. Avoid lying on stomach.

Begin trunk stabilization activities with glute/quad work, bridging, isometric abdominal work (lie on back and pull belly button towards spine, alternate knees to hips) and encourage diaphragmatic breathing.

Create independent movement of the pelvis with pelvic rocks, pelvic tilts, bridging,
and pelvic clocks performed in neutral positions.

During core stabilization, focus on lumbar multifidus, internal obliques,
transverse abdominals, psoas major and quadratus lumborum prior to working with rectus abdominus and external obliques.
Hip and knee stretches: hamstrings, piriformis, gluteal, quads, hip flexors, gastroc, soleus – stretching decreases stress on lumbar spine and makes it easier to maintain neutral spine. Long sit with caution.

Increase intensity of lower extremity exercises to include closed chain tasks e.g. ball squats, mini lunges, step ups, etc (week 4-12).

After 6 weeks: calf stretch at wall, supine hamstring, lunge with knee down, supine hip stretch, sit in chair knees wide and bend forward, supine knee raises, bridging, prone back ext with hips on pillow, modified cobra, thigh to chest, quadroped: arm up/leg up/opposite arm, leg up/wall squats.

Initiate standing balance exercises (week 10-12).

Advanced Hip/Core strengthening exercises: functional exercises like chops/diagonal lifts, squatting, lunging
- Lifting training with proper posture; floor to waist and waist to shoulder level. (after 12 weeks).

http://www.houstonspinesurgeon.com/post-op-lumbar-fusion.html
http://www.orthonc.com/physical-therapy/physical-therapy-postoperative-rehabilitation-protocols
http://www.spine-health.com/treatment/spinal-fusion/rehabilitation-following-lumbar-fusion
http://www.hopkinsortho.org/JHULumbSpineSurgeryGuide.pdf
http://ptsinc.org/Services/PublishedDocs/Lumbar%20Fusion.pdf
http://arizonaspinedoctor.com/wp-content/uploads/2012/05/Issada-Thongtrangan-Lumbar-Fusion-Protocol1.pdf

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