Low Back Surgery: 6 Steps To Full Recovery

Photo: Ted Hood. State Library of New South Wales.

If you have had a recent low back surgery, there are a few tips that will speed your recovery and help you to have a healthier back for the long term.

1. Practice good POSTURE. This may be difficult if you have a habit of slouching, but it is one of the most important ways to keep your spine healthy. Sit in upright, firm chairs with an extra lumbar support or rolled towel behind your low back. Avoid sitting in reclined positions.

2. AVOID BENDING FORWARD or bending down with your back. Learn how to do all your daily activities without bending your back. Many techniques can be used instead of forward bending, such as squatting, kneeling, sitting, pivoting on your hips, using a golfer's lift, or even crawling. Excessive forward bending is often the cause of back injuries, so eliminating bending decreases your risk of future back pain/injury.

3. AVOID TWISTING your back. This may be easy to do while still wearing your back brace, but once you are out of the brace, it is also important to avoid twisting. Maintaining proper spine alignment during daily activities and especially during strenuous activities will help to prevent back injury.

4. STAY ACTIVE. Find a low-impact exercise that you can start or continue, such as walking, stationary biking, or water aerobics. Depending on your stage of recovery, you may only be able to do 10 minutes at a time, but slowly progress as you are able. Mobility promotes healing, as long as you do not overdo and cause more pain.

5. FOLLOW DOCTOR'S ORDERS, such as lifting restrictions, activity restrictions, using a brace, using a cane, Physical Therapy, etc.

6. REQUEST PHYSICAL THERAPY. For the optimal prognosis after low back surgery, it is important for you to learn some strategies, exercises, postures, and functional activities from a Physical Therapist. It may take just a few visits if you are recovering quickly, or some patients need weeks or months of therapy if they are still having limitations or symptoms.

Why Sleeping In Fetal Position Is Bad For Your Back

Fetal Position: Does It Cause Back Pain?
Side sleeping can be ideal for most individuals, but curling up too much into fetal position can actually cause back pain or at least contribute to it. Fetal position puts your spine into a forward bent or flexed posture, which is similar to sitting slumped or standing and bending forward. As much as fetal position may be comfortable, it is not healthy for your spine to be in that flexed posture for hours at a time.

Forward vs. Backward Spine Positions and Back Pain:
If you have never had low back pain, you can learn this lesson from those who do: most individuals with low back pain respond best to backwards bending or back extension exercises, not flexion or forward bending. In other words, having your back in a forward bent or flexed position is not very healthy for your spine (low back, mid back or neck).

Neutral Spine Sleeping Posture To Avoid Low Back Pain:
I am not saying you should sleep in a backward bent position either. Simply find a neutral sleeping posture which puts your back into a relatively straight position. This can easily be achieved when sleeping on your side by not bringing your knees up toward your chest. Have your knees slightly bent but do not pull up your legs so that your low back becomes rounded or flexed.

Pillow Between Knees To Prevent Low Back Pain:
To further improve your neutral spine position, sleep with a firm pillow between your knees or use a body pillow. My pillow of choice is a small, firm, rectangular one. I have seen pillows made for this purpose at Bed, Bath and Beyond, but they are more expensive than simple, decorative pillows which are just as effective (check the clearance rack at your favorite discount store).

Prevent Low Back Pain With Good Posture:
While you are looking to achieve a neutral sleeping posture, also work on neutral sitting postures during the day. For example, avoid sitting in a recliner or chair/chaise with your legs extended in front of you because that also puts your low back into a rounded or flexed position. In a desk chair, sit at the back of the chair with a lumbar pillow for added support. Similarly, avoid bending forward when you are standing or sitting; instead, use your legs to squat and maintain your back in a straight position.

Back Health Survey Discussion: Risk Factors for Low Back Pain

The discussion points here respond to the questions from yesterday's post, entitled "Back Health Survey."

1. How frequently do you perform moderate-high intensity exercise? In general, back health is improved as you do regular exercise, especially cardio exercise and strength training. However, it is important not to injure your back during exercise with excessive, early high intensities or uncontrolled bending/twisting.
   
2. How many hours/day do you sit on most days of the week? Likely, you have minimal control over how much you sit at work, but the rest of your day is yours to stand and walk more! Too much sitting puts your spine in a rounded or flexed position for long periods of time (unless you practice perfect sitting posture with additional lumbar support). Also, sitting does not promote cell growth and circulation as well as standing/walking, so it can lead to spine issues later in life.

3. How often do you perform back strengthening exercise or core strengthening? I recommend you do this at least 2-3x weekly, even if only for 5 or 10 minutes each time. Good back strengthening includes back extensions (backwards bending or arching of the back). Abdominal strengthening is also good (crunches are better for your back than full sit-ups). Core strength exercises of all varieties are great for your spine health, as they strengthen the deep abdominal and spine muscles, which will give natural spine support when you do strenuous daily tasks.
   
4. What is your usual sitting posture? First, check the chair you sit in to ensure it is ergonomic. Then add a lumbar roll (rolled up towel or round pillow) behind your low back. Sit at the back of the chair, then add your additional lumbar support.
   
5. What is your present weight status? Extra weight puts more strain on all your joints, including your spine.

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)? Low back pain comes in repeating episodes, so if you have had several, you likely will have more in the future. But it is not too late to get treatment, of which Physical Therapy can help significantly! Not only will you learn exercises but also things to avoid and how to self-manage your symptoms.

7. How far down did your low back pain symptoms radiate? Symptoms that radiate further down the leg are worse than those in the back only. That is because nerve(s) are being pinched in the spine, causing the symptoms to shoot downward. The key to treatment is to find what eliminates the leg symptoms and moves them more centrally, to the spine (AKA centralization).
   
8. How did your low back pain resolve? Your risk of future back pain is increased if your prior back pain has never resolved or has become chronic. In this case, you and your medical team have not yet found the ideal treatment plan, so all options should be considered, perhaps multiple times.

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)? This may be the single most important factor to decrease your risk of future low back injury! Simply begin to implement body mechanics changes in your daily life. Soon they will become habitual.

10. How much heavy lifting do you regularly perform? Heavy lifting can increase your risk for back pain unless it is always performed correctly (spine straight and using the legs only to do the work of lifting).

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)? Trauma obviously can cause major back injuries or worse (becoming paralyzed or even death), so proceed only with extreme caution, and practice utmost safety measures.
   
12. How often do you perform standing forward bending exercises (such as touching the toes)? This is one of the single worst exercises you could perform. Your spine does not need to be stretched into a forward bent (flexed) position. What is your reason for doing this exercise? If it is for hamstrings stretching, use an alternate technique. If you do this out of habit or from something you learned in your past, change it because this can majorly damage your spine.

Ergonomics Rap with Sustainable John - Lawrence Berkeley Lab

Click on the title to view this video about workplace ergonomics! Good reminders for those of you who sit at a desk all day.

What Your Toothbrush Tells You About Back Pain

Where do you store your toothbrush? Most of us store it right on the bathroom sink. Why do you store it there? Why don't you store it up on the top shelf or down in the bottom drawer? Your answer gives a simple example of BODY MECHANICS! You store your toothbrush within close reach to make life easier and more convenient. Why bend if you don't have to?

BODY MECHANICS is using your body to its advantage so that you don't have to work harder than necessary for whatever task you are doing. Here is another example. Ladies: why don't you carry your heavy purse by holding it with 1 or 2 fingers? You have naturally learned that the easiest way to carry a large handbag is strapped over your shoulder. 

We all practice good body mechanics with things like where we place our cups/plates/silverware in the kitchen, where we put our socks in our drawers and where we position our debit cards in our wallets. We want easy access to the objects that we use the most every day. So good body mechanics comes naturally...until we deal with our backs. We use our backs for things that our legs and arms should do, such as lifting and bending. Our leg muscles are massive and powerful and can do much heavier lifting than our back muscles. And our shoulder and arm muscles are very strong and able to lift, carry or hold significant amounts of weight.

So to prevent back pain, keep your back straight and use your legs more. Try squatting down using only your legs (maintaining a straight spine position) the next time you need to reach down toward the floor. Here is one easy way to demonstrate bad body mechanics: hold one arm straight out in front of you (with elbow straight) and place a dictionary or phone book in your hand. Time yourself to see how long you can keep it there.

The Best Way To Treat Low Back Pain

The answer is prophylaxis (prevention)! What other things are best treated with prophylaxis? Cold, flu, heart attack, diabetes type 2, blood clot, stroke, HIV, lung cancer, etc.  Prevention is the easiest and best way to approach low back pain, so whether you have pain or not, this applies to you!

What factors put you at risk for low back pain (LBP)?
1. Prior episode of low back pain.
2. Repetitive lifting (with incorrect body mechanics).
3. Repetitive vibration at work or leisure (example: truck driving).
4. Repetitive forward bending and twisting of the low back.
5. Repetitive poor posture.

What are the components of low back pain prevention?
1. Staying fit/exercising consistently.
2. Progressing your fitness program slowly and with caution.
3. Keeping your back flexible.
4. Maintaining good POSTURE!
5. Changing positions frequently.
6. Standing frequently between longer bouts of sitting.
7. Standing and bending backwards (5-10 reps, 1-2x/day). (Note, this exercise is contraindicated for some individuals, so please consult your physician).


Reference: McKenzie, Robin. Mechanical Diagnosis & Therapy: Lumbar Spine. 2009: The McKenzie Institute International, Part A, pages 126-127.