exercise post discectomy??

[physioeims]

Hi,
I have a patient who is 6weeks post L4 discectomy,and has now attended me in outpatient practice for review. I have searched articles and the net and cant seem to get any definitive info about rehab post discectomy. I have started my patient on Core stability exercises, strengthening for thighs (squats), pelvic tilting, and lowerback (pilates swimming level 1/level 2 prone and 4pt kneel), as well as mobilisation exc (Pilates - Hip twist 2). He is pain free now and returning to work in 2 weeks. I am just curious as to when i can introduce abdo excs (eg, abdo crunch, sit up), and what are the guidelines as regards full flexion??
I have learned from research that an aggressive exercise programme starting 4-6weeks post surgery yields the best results but not one article i have read outlines specific exrcises and the dos and donts post discectomy. how aggressive is aggressive exactly??
Any help or advice greatly appreciated
E

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[PhysioAdvisor]

Hi,
I would recommend taking care with returning to activities which caused the initial disc protrusion / disc bulge in the first place (e.g. sitting, bending, lifting activities) as these activities are likely to place tension on healing scar tissue and if excessive, may result in tearing of scar tissue (rather than remodelling) and therefore recurrence of the initial injury even following discectomy. I would also usually advocate pain free McKenzie based extension exercises to restore full extension ROM. Lateral flexion, rotation and flexion ROM exercises can usually be added gradually and provided they are pain free. Progressive core stability exercises can usually be added with emphasis on TA, Multifidus / ES. A functional restoration program is important to retrain the back and core stability during functional movements. Hydrotherapy / swimming can also be beneficial as well as building up general cardio exercises (e.g. walking / swimming). I wouldn't rush back into abdo crunch / sit ups - unlikely to be of major clinical benefit - i would initially focus more on neutral core exercises e.g. prone hold / bridge hold / side hold etc. Although if you really wanted to these could generally be added gradually provided there is no increase in symptoms. Here are some ideas for: lower back strengthening exercises. Use your clinical judgement to determine which ones are indicated.

Hope that helps

[physioeims]

Hi physioadvisor,
thanks so much for your reply. My client is doing really well with his exercises. I am a pilates instructor so have modified alot of the exercises i teach and given them to him, which hes doing really well with. I have found that using an exercise ball has been brilliant to introduce pelvic moevment as he is struggling with lumbo pelvic movement dissociation. He is quite limited into extension of the Lx spine so have been using mckenzie exercises as you suggested. He is a keen walker so thats keeping him fit. Seeing him one last time this week. Just wondering how often would you follow him up post surgery.
Thanks
e