How to do functional exercises after lumbar disc herniation surgery? How to use the brace?

Author: Yi Zuling, deputy chief nurse, Beijing Friendship Hospital, Capital Medical University

Reviewer: Li Jun, deputy chief physician, Peking University First Hospital

Patients with lumbar disc herniation should pay attention to turning over and changing body positions after returning to the ward after surgery to prevent the occurrence of pressure sores. Usually, they should turn over every 2 hours during the day and every 4-6 hours at night. When turning over, they should pay attention to keeping the shoulders, waist and hips in line to ensure the stability of the spine. This needs to be done with the assistance of family members and medical staff.

In addition to turning over after surgery, you should also pay attention to functional exercises.

1. How to do functional exercises after surgery for lumbar disc herniation?

After returning to the ward, the patient can start respiratory muscle exercises, ankle pump exercises on the day after surgery, and toe-curling straight-leg raising exercises on the second day after surgery. Functional exercises for the lumbar and back muscles are determined depending on the surgical method.

(1) Respiratory muscle training, deep breathing and effective coughing can help restore respiratory function. Abdominal breathing, lying on your back or sitting comfortably, expand your abdomen as much as possible when inhaling, so that your abdomen bulges, and your chest remains still. When exhaling, keep your chest still and contract your abdomen as much as possible.

(2) Ankle pump exercise. The ankle is dorsiflexed (foot hooked) to the limit, at which point the calf muscles are tense, and then the ankle is plantar flexed (foot pressed) to the limit, at which point the outer calf muscles are tense, and the exercise is held for 3 seconds. The venous blood flow rate is faster when the ankle joint is plantar flexed 45° and dorsiflexed 30° than when it is plantar flexed 30° and dorsiflexed 20°. Studies have shown that the best effect is achieved when each movement is maintained for 3 seconds. The greater the range of motion of the joint, the greater the degree of muscle relaxation and contraction, the greater the effect of the muscle squeezing the blood vessels, and the better the effect of promoting venous return. The patient should try to perform the ankle pump exercise at the maximum angle to improve the effect of the exercise. The patient can do ankle pump exercises of ankle dorsiflexion and plantar flexion in bed to strengthen blood circulation in the lower limbs and prevent venous thrombosis in the lower limbs.

Figure 1 Original copyright image, no permission to reprint

(3) Lie flat on the bed, stretch your legs, tighten and straighten your thigh muscles, and make them form a 45-degree angle with the bed. Hold for 1 second each time, then slowly lower them. Do 10 sets per day, 5 sets per day. You can increase or decrease the number of sets as needed based on your personal situation.

(4) Exercise the back muscles according to the doctor’s instructions based on the surgical method. If necessary, patients can be taught to learn this method before surgery, so that they can use it to exercise their back muscles after surgery.

There are usually five-point, four-point and three-point exercises for back muscle function. The five-point exercise uses the pillow, elbows and heels as five points of support to straighten the waist. It is usually best to ask the patient to lift the waist and back 20 cm away from the bed, stay in the air for 5-10 seconds and then put it down. Do 10 times a day, 3 sets a day, and then gradually increase the number. The four-point exercise uses the hands and heels for four-point support. The three-point exercise can be used in the later stage, which means using the pillow and heels to straighten the chest and lift the waist and back.

Figure 2 Original copyright image, no permission to reprint

The "Little Swallow Flying" exercise is also a good way to effectively exercise the waist and back muscles, just like simulating the posture of a swallow flying. The specific method is: lie prone, lift your shoulders and arms off the plane, raise your head at the same time, and pull your shoulders back and up. At the same time, lift your feet, waist and back

Contract your muscles and try to support your body with your ribs and abdomen for 3-5 seconds, then relax.

2. How to use a lumbar brace after surgery for lumbar disc herniation?

Patients undergoing surgery for lumbar disc herniation choose to use a waist belt or brace depending on the surgical method.

Depending on the surgery, patients can get up and walk on the ground while wearing a waist belt or brace, especially when getting up and lying down. Patients may feel dizzy and nauseous when they start to get up, which is normal.

If a brace is used, the size will be measured before the operation. The doctor will decide the time to get out of bed and move around based on the patient's condition. The patient must wear the brace before getting out of bed to move around.

Figure 3 Original copyright image, no permission to reprint

It is critical to put on the brace before getting out of bed, because the main function of the brace is to protect the stability of the spine and the stability of the internal parts. When wearing the brace, there should be a shirt inside the brace. Do not let the brace directly touch the skin, which will make you feel uncomfortable. When wearing it, you should fix the brace well and pay attention to the tightness of the brace. It should not be too loose or too tight. If it is too tight, it will affect your eating. If it is too loose, it will be difficult to fix and will affect the stability of the spine.

When you put on the brace and prepare to get out of bed, it is recommended to sit by the bed for 10 minutes first, and then try to stand up and walk slowly after there is no obvious dizziness. The first step is to raise the head of the bed to a semi-sitting position, and stay for 1 minute after half-sitting; if you do not feel dizzy, sit on the bedside with your legs on the ground, then hold your chest and head high for 1 minute; if there is no discomfort, stand by the bed again, and continue walking after another minute without any discomfort. When the patient wears the brace to get out of bed and move around, someone must accompany him to ensure safety and prevent falls.

Generally, a brace needs to be worn for three months after surgery for lumbar disc herniation. In principle, it is not necessary to wear it in bed. A follow-up examination will be conducted after three months to observe the local healing situation, and then a decision will be made whether to continue wearing the brace. Usually three months is enough.

3. What should you pay attention to after surgery for lumbar disc herniation?

Generally, you can be discharged from the hospital 10-14 days after surgery after the stitches are removed. If the wound heals well, the body temperature is normal, and all indicators are normal, you can come back to remove the stitches after discharge. You don't have to wait until the stitches are removed before discharge. It depends on the patient's own situation. For intradermal suture incisions, there is no need to remove the stitches. The doctor will inform you of the relevant matters before discharge.

The surgical incision for lumbar disc herniation usually heals in 10-14 days, and you can take a bath after the incision heals. It is recommended to stay in bed for 4-6 weeks after being discharged from the hospital and try to avoid bending over. For example, if you want to pick up something that has fallen on the ground, you must pay attention to your posture and squat down to pick it up with your upper body relatively straight. Wear a suitable waist belt when walking, eating, washing, defecating, etc., and remove the waist belt after lying in bed.

Try to avoid excessive bending, twisting, bending, pushing or lifting heavy objects, and excessive force within 3 months after surgery. Improve your lifestyle, exercise properly, combine work and rest, and avoid standing or sitting for long periods of time, poor sitting posture, excessive weight bearing, and other bad living habits.

Generally, a follow-up examination will be conducted one month after the operation, and the decision on whether or not the patient can work will be made based on the results of the examination. If the patient can work, there are some precautions, such as the chair must have a backrest, and the backrest must be as high as the shoulders.

If you feel any abnormality in muscle strength or lower limb sensation and movement at home after surgery for lumbar disc herniation, such as numbness in the legs, or a feeling of weakness in the legs when getting up, or swelling in the legs, etc., it is recommended that you go to the hospital for timely treatment to prevent complications.

If there are no abnormalities after the operation, routine follow-up examinations should be conducted after one month, and then at three months, six months, and one year after the operation.

After discharge, most patients can perform some simple daily life activities. In the later stage, walking training, lower limb and core strength training can be gradually added according to individual conditions.