Lumbar microdiscectomy is performed after a herniated disc and there’s some pressure being exerted on the spinal cord and/or the spinal nerve route. And, often times, with those procedures, you’re dealing with some residual leg symptoms. If you’re able to come into surgery and you’re having less symptoms, we are often able to progress you a little bit faster through that rehab process. We’re not having to deal with reducing leg pain; we’re not having to reduce strength in the specific muscles. So, when we’re looking at a post-discectomy, one of the major things that we’re trying to protect is the healing of the disc.
I can remember a situation where a patient of mine came in and was two months after post-lumbar discectomy and he was an avid golfer. And, I told him he’s not gonna be golfing at least for six months and he was feeling good. He had reduction of leg symptoms post-operatively, he had some mild back pain that was managed with therapy and he was progressing well on his strengthening. He started to goad me a bit on can he start golf early. I said no, don’t start golf early and he did. He went back and he golfed and he re-ruptured the disc and developed foot drop and that foot drop persisted.
I can treat somebody and get them better after a surgery without needing a lot of back movement. I want my patients’ hips to move. I want my patients’ legs to get stronger. I want their back mechanics to be solid. They need to be able to roll up and out of bed. They need to be able to relieve the postural stress that they experience any time through the day. They need to be able to get their exertion level back to where they’re walking on a regular basis.
So, when I have a patient that is coming in after a spinal fusion, that patient may not see me for three to six months sometimes after surgery. When they’re coming out of that stabilization protective mode, they may have been wearing a brace for some time. That brace is gonna cause some weakening of the back. That brace is gonna cause some stiffness in the leg muscles and other muscles in the body.
We’re gonna be managing pain and a slow introduction into exercises that are tolerated by each individual. Second phase is going to be introducing an increased level of exercise. It’s going to be showing a higher level of function from doing basic activities in the house to maybe doing some very light activities, very light lifting, less than 10 pounds and performing a routine that they can manage on their own.
Our final stages of post-operative rehab are going to introduce the activities that are consistent with that patient’s goals.