Sciatica & Physical Therapy

June 22, 2014

I see many patients who suffer from sciatica. These shooting pains in the lower back and legs can be debilitating. Sometimes surgical treatment is necessary to relieve this pain, but sometimes it can be brought under control or even eliminated with the proper exercises. Sometimes patients can be treated non-surgically with anti-inflammatory medications and pain relievers or steroids. These non-surgical treatments for sciatica are often paired with physical therapy so that the body can be trained to support the spine and protect the back from further damage or recurrence of sciatica. A program of gentle stretching and strengthening can often be paired with massage to help restore muscles that often stiffen or spasm due to back injury. A combination of pain and inflammation relief with physical therapy and massage or other soft tissue relief is ideal for returning the sciatica sufferer to normal daily activities and restoring range of motion.

While each physical therapy program is tailored to the individual patient, they often have many elements in common. People with back problems often have weakened abdominal muscles and tight back muscles. The hamstrings are also often tight in sciatica patients, so both massage or TENS treatment as well as stretching can be used. Strengthening the back and abdomen helps to support the spine and keep it in proper alignment. Weight training is often combined with stretching, Pilates, and low or no impact exercise to rehabilitate the body gently while medication controls the pain and inflammation. Ideally this treatment can postpone or prevent the need for surgery. Often this kind of conservative treatment brings the patient a good deal of relief from his or her symptoms and surgery is not necessary.

If the patient does need surgery, a minimally invasive approach combined with the above rehabilitative treatment can effectively treat the pain of sciatica. Depending on the cause of sciatica, a surgical patient often needs either a microdiscectomy or discectomy, or a laminectomy or laminotomy. All of these procedures can be performed using minimally invasive techniques, which allow for less anesthesia, little to no hospital stay, and a much faster healing time than traditional open surgery. Minimally invasive procedures do much less damage to the soft tissue surrounding the damaged disc or discs causing the symptoms, so physical therapy can begin soon after the surgery, which greatly increases a positive outcome.

Does Lumbar Fusion Surgery Require Inpatient Rehab?

June 11, 2014

When a patient undergoes endoscopic spinal fusion surgery, he or she must stay in the hospital for at least two days after surgery. The first day, someone from the hospital’s physical therapy staff (PT) will come to get the patient up and walking. It will be determined whether the patient needs a walker. Walking may be painful at first, especially if a bone graft was taken from the hip for the fusion surgery. PT will also show the patient how to perform basic daily tasks, such as getting out of bed, and discuss how to avoid putting stress on the spine after surgery.

On the second day, PT makes sure that the patient is walking independently and makes sure that he or she will be able to function at home. In order for the patient to be discharged, it is important that the patient be able to walk, go up and down stairs, and get in and out of bed independently. Some patients need a cane or walker for a couple weeks after surgery. This will be determined before the patient leaves the hospital.

Patients who have had endoscopic spinal fusion surgery, rather than traditional open spinal fusion surgery, can usually go home on the second day after surgery. Sometimes older or more frail patients have trouble walking or functioning independently after surgery and need extra rehabilitation. Usually the spine surgeon will be able to tell the patient ahead of time if he or she should expect extra rehabilitation after endoscopic spinal fusion surgery. After the surgery, the patient’s doctor, physical therapist, and occupational therapist will work together to determine whether the patient needs extra rehabilitation. Extra rehab can be done either at the patient’s home or at an inpatient rehab facility.