Gregory T.
Poulter, MD
8450 Northwest Blvd.
Indianapolis, IN 46278
317.802.2424 OrthoIndy.com
Patient Name:
Diagnosis:
Notes:
Lumbar Laminectomy Physical Therapy Prescription
The intent of this protocol is to provide guidelines for rehab. It’s not intended as a substitute for clinical decision
making.
If any of the following occur, contact Dr. Poulter and hold off on physical therapy:
• Any signs of infection
• Worsening of radicular symptoms, including progressive weakness
• Unexpectedly high self-reports of pain in comparison to pre-surgical state
Phase I (0 to 2 Weeks): Protective Phase
Therapy
• First visit at two weeks post-op (outpatient)
Precautions
• Avoid bending and twisting, lifting, pushing and pulling 20 pounds or more for two weeks.
• Limit sitting, including the car, to no more than 30 minutes at a time (standing/walk breaks).
• No extension range of motion, nor rotation exercises for eight weeks.
Goals
• D
iminish pain/inflammation and minimize lower extremity radiating symptoms
(ice, modalities as needed).
• Learn correct body mechanics, transfers, positioning.
• Achieve proper muscle firing for transverse abdominis, multifidi and glutes.
• Focus on walking program, increasing tolerance to at least 10 minutes, two times a day.
Education
Postural Education: Upright sitting posture with lumbar roll at all times, frequent changes
•
in positions and sleeping positions
• Body Mechanics: Lifting, transfers (include log rolling), positioning, etc.
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Exercises
• Walking Program: Begin one to two times a day for ten minutes. Progress as tolerated.
• TA Bracing: 10” isometrics with normal breathing (without pelvic tilt)
• Multifidi: 10” isometrics with normal breathing in prone (if able to tolerate)
• Glute Sets: 10” isometrics with emphasis on proper glute firing (not hamstring)
• Light Stretching: Hip flexors, quads, hamstring, gastrocs
Phase II (2 to 6 Weeks): Initial Strengthening Phase
Therapy
• One to two times a week, for four or more weeks
Precautions
• Keep spine in neutral for strengthening with a focus on proper neuromuscular control,
do not progress without good control.
• Lifting Restrictions: Begin at 20 pounds and slowly increase to no restrictions at week six.
• No extension range of motion, no rotation exercises for eight weeks.
Goals
• Complete light strengthening with a neutral spine and correct firing of stabilization muscles
• Able to tolerate at least 30 minutes of cardio a day
• Release soft tissue restrictions/muscle spasm (monitor incision region)
• Independent with body and lifting mechanics
Cardio
• Walking Progression: At least 30 minutes or more
• Stationary Bike Recumbent: Can initiate at two weeks
Strength
Only initiate these once patient can complete Phase I exercises. Then begin with light resistance and slowly
progress. Emphasize good posture during each exercise and correct muscle firing of transverse abdominis.
(This is not a complete list.)
• Transverse Abdominis/Multifidi Progression (maintain neutral spine)
• Start at table (supine, prone, quadruped) 10” isometrics
• Progress with upper extremity/lower extremity movements (eg. marches, straight leg raises,
upper extremity lift and lowers, planks, etc.)
• Continue with Proper Glute Activation Exercises
• Eg.: prone hip extensions, bridges, side lying clams, side lying 90/90 leg lifts, side lying
abduction, quadruped hip extension, bird dog
Upper Extremity/Lower Extremity Strength Training
•
(once proper transverse abdominis and glute firing achieved)
• Step ups, leg press, wall squats, squats, etc.
• Balance (with transverse abdominis bracing): single leg stance, tandem, foam, etc.
• Upper extremity light resistive exercises (machines, theraband, free weights)
Flexibility
• Stretching: Hamstrings, gastroc/soleus, quadriceps, hip flexors, piriformis, etc.
• Neural mobilization: Performed as needed, gentle with caution not to flare up nerve roots
Aquatic Physical Therapy (more than three weeks if available once incision has healed)
• No rotation and transverse abdominis bracing during all exercises
• Walking all directions, balance, upper extremity/lower extremity strengthening
2
Phase III (6 to 8 Weeks): Progression to Advanced Strengthening
Therapy
• One to two times a week (as needed for return to sport or work)
Precautions
• No extension range of motion, no rotation exercises for eight weeks
Goals
• Independent home exercise program for advanced strengthening, return to sport and work.
• Increase lower quarter flexibility and strength with focus on proper transversus abdominis
and glute activation.
• Typically released to full activities without restrictions at six to eight weeks
(when approved by Dr. Poulter).
Strength
• Advanced core strength and stabilization exercises:
• Progress to weight bearing, balance, Swiss Ball, Reformer, etc.
• Progress to multi-planar exercises with upper extremity/lower extremity
• Progress upper extremity/lower extremity strengthening
• Begin running, agility and plyometrics for return to sport after 8 to 12 weeks
(if symptoms stable and cleared by Dr. Poulter)
• Possible referral to work reconditioning program
Flexibility
• Lumbar Spine: More than eight weeks to improve lumbar extension range of motion,
but avoid end-range
• Eg.: prone lying, prone on elbows, press-ups, and/or standing extensions (if no periphalization)
Cardio
• Time frames may vary per patient, consult with Dr. Poulter if you have questions
(eg.: an avid cyclist with proper bike fit might start sooner).
• Emphasize correct form and equipment setup (eg. elliptical, bike, walking terrain, etc.).
• Preference of Pilates over yoga. Once returning to Yoga, ensure it with an experienced instructor.
• When initiating running and sports below, slowly increase in the 8 to 12 week time frame.
No Earlier Than: No Earlier Than:
Walking Continue to progress Outdoor Biking Six weeks
Stationary Bike Add resistance Skiing Eight weeks
Swimming Six weeks Yoga Eight weeks
Pilates Six weeks Running 8 to 12 weeks
Hiking Six weeks Soccer/Basketball 8 to 12 weeks
Elliptical Six weeks Golf 8 to 12 weeks
