FIZJOTERAPI

A
OD CZEGO SIĘ ZACZĘŁA DYSKUSJA
 Overall, the results show that regular back exercise reduces back pain and improves the functional ability of
subjects with chronic LBP on a short-term basis.

 There exists, however, no consensus on the design of a program specific for enhancement of rehabilitation after
lumbar spinal fusion.
VIDEO GROUP
 Patients were shown a videorecorded demonstration of  Excercises:
the rehabilitation exercises (as normally practiced at  ordinary warm-up regimen
our department).
 few restrictions specific for spinal fusion patients 3
 a one-time oral instruction.
months after surgery were yet to be observed (no
 designed to provide dynamic muscular training contact sports, training on machines at a fitness center,
intended to gradually enhance the endurance jogging/running).
capabilities of the back/abdominal/leg muscle groups.
 The training was aimed at a rhythmic speed within the
normal ranges of movement and included stretching of
the body’s larger muscle groups.
GRUPA KAWOWA

 the same program as group 1 but were additionally of small talk,and took place three times over a period
encouraged to participate in a back-cafe´. of 8 weeks, each with duration of approximately 1.5
hours.
 At these cafe´ arrangements, the same physical
 Here, in meeting with a physical therapist and other
therapist was present each time, and the individual
spinal fusion patients, an opportunity was afforded for
interests of the participating patients were primary in
exchange of experiences of pain and physical
regulating the content of the discussions.
incapacity; expression of doubts that had arisen under
rehabilitation; reassurance in performing the exercises
correctly and straight tips and psychological support
from kindred spirits. The meetings were located in the
physical therapy section of the hospital, were begun
with a cup of coffee/tea and approximately 10 minutes
TRENUJĄCY
 twice weekly over 8 weeks.
 warm-up, condition training, dynamic, muscular
endurance training, and, lastly, stretching exercises.
 A warm-up segment comprised rhythmic dynamic
exercises for the body’s larger joints and muscle
groups, as well as different modes of walking
combined with arm/leg swinging, which served to
prepare the body for physical activity while inspiring
motivation to train and forestall injury to movement
apparatus (15 minutes).
 Condition training, intended to improve heart–lung
circulation, was begun with condi-cycling and
concluded with hop sequences.
 Dynamic muscular endurance training was focused on
the back, abdominal, and leg groups and preceded at a
rhythmic tempo of 7 to 10 repetitions followed by short
pauses.
 The final stage of each session, the stretching
exercises, was intended to forestall or minimize
soreness while maintaining or improving muscular
flexibility.
CO SIĘ
OKAZAŁO ??
JAK REHABILITOWANO

 20-minute exchange of experiences of pain and physical incapacity problems, and solutions in performing
activities of daily living—expressions of doubts that had arisen during rehabilitation and straight tips and
psychological support.
 A physiotherapist instructed the patients in home exercises, focusing on active stability training of the truncus and
large muscle groups.
 An exercise ball was used by those who found it difficult to perform floor exercises. The patients also used elastic
exercise bands for the exercises. When progress had been made, the patients were further instructed in more
powered exercises, again focusing on the truncus and large muscle groups.
PO MICRODISCEKTOMII

The ISSLS prize winning article in 2011 on rehabilitation after discectomy or lateral nerve root decompression
surgery found no difference in effect between a combined professional support and graded active exercise starting 6
weeks postsurgery and an educational booklet.
 W przypadku wielopoziomowych operacji fuzji kręgosłupa lędźwiowego procedury, znajomość optymalnego
punktu wyjścia do opłacalności rehabilitacji po operacji pozostaje przedmiotem dyskusji.
 Obecny praktyka jest taka, że pacjenci odwiedzają chirurga 12 tygodni po zabiegu fuzji kręgosłupa lędźwiowego i
od tego momentu rozpoczną aktywną rehabilitację.
  The current study’s results show that a discharge to a skilled-care or
ACDF - JAKIE SĄ rehabilitation facility is associated with higher odds of developing post-
FAKTY? discharge renal complications and 30-day readmissions.
 The player was referred to a neurosurgeon for assessment.
 An MRI a lateral disc protrusion at C7/T1 compressing the left C8 nerve root
 posterior microdiscectomy 3 weeks
 The neurosurgeon instructed the patient to rest with gentle range of movement exercises for the first 6 weeks.
PHASE 1 (WEEK 7 POST-OP)
 Technique acquisition.
 they remained isometric.
 † Phase 1: Technique acquisition: 1 week
 † Medium volume—low intensity: 3 sets!12 reps!50%
 1RM—recovery between sets 30 s
 † RPE 10
 † Four sessions per week
 The player would warm-up first using the seated
Versaclimber followed by four shoulder exercises
(examples are included in the list below) and three
isometric neck exercises.
 † Dumb-bell shoulder shrugs with front and rears
 † Dumb-bell bent over barrels
 † Dumb-bell short lever lateral raise
 † Dumb-bell biceps curls
 † Seated row (using a low pulley system)
 † Pulley system, posterior head harness, dumb-bell squat
 † Pulley system, lateral head harness, trunk side flexion
with contra-lateral dumb-bell shoulder shrug
 † Pulley system, posterior head harness, seated back
extension
PHASE 2 (WEEKS 8–10 POST OP)

 At week 2, dynamometry was introduced.  Note, the percentage of 1RM volume and intensity
 The aim of this exercise was to maximally load the side  prescribed does not apply to the dynamometer exercises,
flexors via movement of the dynamometer lever arm these are all maximal.
whilst the player kept their head and neck in neutral. †  Examples of additional exercises used in Phase 2
Phase 2: 3 weeks
 include:
 † High volume—medium intensity: 6 sets!12 reps!50–
 † Dynamometer steering wheel (grip)
 60% 1RM—recovery between sets 30 s
 † Dumb-bell triceps press
 † RPE 12C
 † Dumb-bell inclined biceps curls
 † CR10!3
 † Dynamometer pulley system left lateral head harness
 † Four sessions per week
 isometrics (repeat with right).
PHASE 3 (11–13 WEEKS POST OP)

 Phase 3 (11–13 weeks post op)  † Dumb-bell wings

 Neck extension and flexion were introduced using the  † Dumb-bell waves
dynamometer as the player continued to show no signs 
† Dumb-bell alternate front raise
of irritability.
 † Dynamometer head harness, neck dead lift
 † Phase 3: 3 weeks
 † Dynamometer pulley system left lateral head harness
 † Medium volume—medium/high intensity: 5 sets!6
 neck isometrics (repeat with right)
 reps!60–75%
 † Dynamometer head harness seated trunk flexion with
 † Four sessions per week
 neck isometrics
 Additional exercises used include:
  6- to 8-week, individualized, preoperative training programme for
exercise at home. It consisted of a daily 30- minute programme and the
patients monitored their training using a logbook.

A CO PRZED
OPERACJĄ ???
focused on improvement of muscle strength for the back and abdomen and included cardiovascular conditioning

intensively mobilized the patient on the day of the operation and 30 minutes twice daily in the following days.
we have not found any randomized studies looking at perioperative training in relation to spinal surgery in the
literature. This could be explained by the routines and clinical principles used by which patients lie down for a longer
period after surgery in order to reduce the risk of spinal instability.
 Evidence based guidelines for prehabilitation, however, do not exist. Similar is true for postoperative
rehabilitation. As a consequence, variability in practice is seen between spinal surgeons at pre- and postoperative
phase (i.e. variability in discharge criteria, outcome measures, hospital stay, follow-up frequency and intensity).
 Also from clinical experience we notice uncertainty among health care specialists about appropriate advice for
mobilization, loading, functional activities or rehabilitation after spinal fusion. It is possible that this fuels
uncertainty in some patients, leading to fear of movement and increased disability.
 The majority of the Dutch spinal surgeons recommended mobilization the first day postoperative
 (63%), while most Swedish spinal surgeons recommended mobilization directly (73%; Fig. 2).
 Almost all Dutch and Swedish spinal surgeons advised mobilization to be guided by a physiotherapist
 (NL 97%, SE 100%). At the first day postoperatively, the majority of the Dutch and Swedish spinal
 surgeons recommended sitting in bed (88% and 98%; Fig. 3) while most Swedish spinal surgeons also
 advised standing (98%), and walking with support (85%). The ability to climb stairs was the most
 reported physical discharge criterion (NL 74%, SE 56%).
 Most Dutch and Swedish spinal surgeons recommended supervision while start standing (94% vs.
 85%), walking with support (97% vs. 88%), walking without support (86% vs. 92%), and stair
 climbing (100% vs. 98%). Dutch spinal surgeons also recommended supervision while start sitting in
 bed (76%).
 Almost all Dutch and Swedish spinal surgeons advised walking and stair climbing in the first week
 (Table 2a and 2b). There was no consensus on when to return to other activities as advice varied
 considerably from the first day postoperatively to >6 months. A few surgeons discouraged running,
 rotating, extending and jumping.
 Advice on maximum lifting weight and jumping height varied in both countries from <5 kilograms or
 <5 centimeters to no limit at all (Fig. 4 and 5). Additional Swedish recommendations for lifting
 included; patient-dependent, not applicable if proper lifting techniques are used, and allowed until
 patient’s pain threshold. For jumping, one additional recommendation was reported; patient’s choice.
 Five Swedish spinal surgeons had no opinion and thirteen did not report maximum lifting weight.
 More than two-third of the Dutch and Swedish spinal surgeons advised against wearing a corset (68%
 and 69%). The small group recommending a corset, showed large variation in wearing advice (e.g.
 until 6 weeks, until 3 months, patient’s choice, during lifting or physical activities).
 Fewer Dutch (44%) than Swedish spinal surgeons (88%) referred to postoperative
 physiotherapy.
 Spinal surgeons who did prescribe physiotherapy varied in advice when to start physiotherapy; ranging
 from immediately to 9-12 weeks. Top three treatments that should not be provided were (1) manual
 therapy (NL 82%, SE 58%), (2) mechanical diagnosis therapy (McKenzie; NL 35%, SE 52%) and; (3)
 sensory stimulation (massage) (NL 32%, SE 38%). Of the Swedish spinal surgeons, 27% had no
 opinion. Also one Dutch spinal surgeon reported to have no idea.