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Old 04-22-2012, 01:25 AM   #1
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Smile How often? What water exercises for post lumbar fusion?

Hi there, I got some great advice from this group before and Im back for more I broke my back 2 and a half months ago, compressing my L1 by 35% and bursting my L3 completely. I had my L4-L2 fused and have been wearing a brace to support my L1 and T11 fractures. I took the advice of this group and did not fly the 9hours home as the flight would be too traumatic on my back whilst still in a brace. In 2 weeks i'll be at 3 months post surgery and my surgeon has said I can then start weening off my brace. He has also given me permission to go in the pool and remove my brace in the meantime. I went 'swimming' today for the first time and it felt good. MY QUESTION: how much and what type of water exercises are best? I walked a bit, used a floatie to steady myself whilst i kicked my back legs to do laps and stretched my knees to my chest. I have avoided breast stroke and using my arms to swim for now. I would like to go to the pool everyday for an hour but is this too excessive? Im not supposed to start physio until my brace comes off in 2-4 weeks. Thanks in advance - this group is amazing!!

 
Old 04-22-2012, 08:32 AM   #2
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Re: How often? What water exercises for post lumbar fusion?

I'm glad to hear you are making good progress, and I am so glad you are making an inquiry for some friendly advice from your spiney pals . I would say you are thinking about doing too much too soon. I will try to explain why.

Rehab is even more difficult for people like you because you are so enthusiastic to get back to your old life as quickly as possible that you tend to proceed at too brisk a pace. For those of us that have issues of a more degenerative nature rather than a sudden injury, we had months or years to go through a period of time where we were able to do less and less and gradually became less physically active.

When I would complain to my surgeon or therapists about how slowly I was progressing, I would be reminded that it had taken a long time for my problems to build to where they were prior to surgery and it would take at least that long to be able to recover. In your case, you skipped the first part of the lesson, but still have had the same big surgical assault to your spine, and it will take time to fully recover. You will not be able to speed up and increase your rate of recovery by working harder, pushing yourself harder, and, in fact, you can set yourself up for failure by not working smartly.

When your brace comes off and you start moving on your own, you need to guard against setting up a situation where you do a little "too much," cause a bit of inflammation...which causes a bit of nerve pain...which makes it really uncomfortable to do anything, so you have to back off a bit from that level of activity and wait awhile to the nerve calms back down...then you start over with the amount of activity. This results in a situation where you feel you are moving forward two or three steps and then falling back a step or two....this can be really frustrating, and detrimental to progress.

It would be wonderful if you could find someone to work with you in the pool for several sessions so you get a feel for what you should and should not be doing. I am going to tell you what I was told, and want you to keep in mind that we came at our fusions from very different places. I had an open surgery to fuse from L3 to S1...and wore a brace for about 10 weeks...but then I was not allowed to go near the water for many more months. I was only allowed to walk on a flat, level surface. But when I was allowed to go into the pool, I was only allowed to swim on my back or side. This is because swimming on the stomach is done in a position where the lower spine is in an extension position...which is OK once the fusion process is complete but can be hard while the bone cells are still growing and knitting together.

The best thing you can do right now is to walk in the pool. I know it is boring and you want to do more...but walking accomplishes what you need for now, and is safe. You can also stand in a stationary position and work your arms. Again, it would be most beneficial if you can find someone to show you some specific movements that will build core strength and improve the muscles of the back, improve balance and proprioception, etc.

It would probably be OK to go to the pool for an hour every day but I think you should spend the majority of your time walking. You can break it up with simple stretches down in the water. You can walk forward, backward and sideways, both taking a step to the side and drawing the second leg up to it, and doing "cross-over" steps, and then repeating it on the other side. These exercises are not designed to provide anything in the way of cardio-vascular conditioning. You are doing them slowly and carefully so as not to cause a nerve flare and to help the body grow the new bone that is necessary for the fusion. So always keep your purpose in mind. When you are at 4 months or 6 months, then it will be appropriate to consider some other reasons for exercising...but for now it is to keep those spinal nerves stretched out and to develop some strength in the core and back muscles.

You may want to ask about kicking for a lap with something helping to support your upper body. I was told specifically not to do that...but it may be because my L5-S1 was operated on and it can be very hard on the SI joints and inflaming the sciatic nerves. If I were you, I wouldn't go at it too enthusiastically until your surgeon gives you the OK.

Last edited by teteri66; 04-22-2012 at 08:30 PM.

 
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Old 04-22-2012, 05:14 PM   #3
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Re: How often? What water exercises for post lumbar fusion?

Glad to hear you are recovering! I did a lot of pool therapy, so I can share what I did. I was in the pool for a half-hour at the beginning, then progressing up to an hour over about two months. Keep in mind that I only had a one-level fusion but I started water therapy at four weeks post-op. If you can find a physical therapist to do at least one session with you, it would be best to have someone watch your form and tailor the routine to your needs.

First, I would walk for ten minutes total forward and backward, swinging my arms to engage the core. Then I would walk for five minutes sideways: feet apart then together with my arms mirroring my legs. (Where I say build to twenty below, you should probably start with ten, then go to fifteen after two weeks, then to twenty after two more weeks.)

Then I did a calf stretch and knee to chest stretch (one knee at a time).

Then I took a "noodle" floating device and put it under my foot to perform a "noodle stomp". Hip bent to 45 degrees, knee also bent so foot is facing down, then straighten both simultaneously. Ten on each side -- pushing down quickly to engage the glutes and controling the noodle on the way up.

After a month, I did pendulum swings with each foot. Swing leg forward and back, build to twenty on each side, don't swing leg too far (hips should not move/pivot, no arching back).

Side leg raises: Keep hips still and bring straight leg out to the side, not too far. Again, don't allow hips to move or back to arch. Build to twenty on each side.

For the arm movements, the idea to engage the core, while your arms do exercises, so that the core is engaged through force exerted in multiple directions.

I started with a floating dumbbell. Arms at shoulder-height, bring down the dumbbell down all the way, build to twenty. Control is more important than speed.

Also, worked with a partially closed paddle-thing. Arms in front, at shoulder height, paddles facing each other, bring paddles together and apart, build to twenty.

Hold paddles in front of you, shoulder-width apart, fists downward, pull paddles to thighs, build to twenty reps.

Finally at the end, I would hold onto the noodle around the back and under the arms and bicycle around the pool for five minutes to cool down and loosen any spasming back muscles.

If I remember any more, I will update. If you have any questions, let me know. If you don't understand my description, please don't do the exercise! Of course, if anything hurts, stop right away.

My doctor cleared me to swim at four months post-op, but again, I had a one-level fusion and had signs of fusing at four months. He still said no flip-turns. Up until I was cleared, everyone told me no swimming because of the back extension. Make sure your doctor is okay with swimming, rather than just okay with being in the water. A set-back could keep you from walking, which is still the most important exercise for recovery.

I had to go for an injection, so I am not yet back in the water, but I plan to start with fifteen minutes (five kicking on back, five backstroke, five freestyle), then increase my overall time in the water by five minute increments per week.

 
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back pain, compression fracture, lumbar fusion, rehabilitaion, swimming



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