Back pain is one of the most common complaints reported to healthcare providers across the nation. According to one source, nearly 65 million people have recently experienced back pain, and 8% of adults live with chronic back pain daily. While physical therapy and other noninvasive treatments are effective for many patients, some conditions require surgical intervention for pain relief, proper function, and mobility. Although being hesitant about returning to physical activity after spinal surgery is normal, you can safely explore exercises to strengthen your core after back surgery with these physical therapist-recommended moves.
Your core is the central part of your body. Think of it as a muscular box that contains 29 pairs of muscles. The abdominal muscles are in the front of the box and the glutes and back muscles are in the back. Imagine the diaphragm as the roof, and the pelvic floor and hip muscles as the floor. The muscles of the core stabilize the spine and pelvis during functional movements, maintain proper posture, and protect the inner organs.
If the muscles of the lower back are weak, the body must depend on other, passive structures like ligaments and spinal bones and discs for support. This may lead to inefficient movement. And over time, that can lead to back pain, strain, and overuse injuries.
Strong muscles allow you to move well. This is important particularly after back surgery to protect the spinal structures as they heal. The core muscles work in harmony to allow you to move throughout lots of different motions and will allow you to complete the activities of daily living you want to get back to after surgery.
Although we’re focusing on post-surgical rehabilitation, core conditioning is not just for people who’ve recently had back surgery. When your core muscles function efficiently, you will feel stronger, steadier, and more balanced.
Surgery is used to treat conditions like nerve damage, deformities, weakening due to fractures or disease. Spinal fusion is one of the most common procedures performed to address these conditions. It is essentially the “welding” of two or more vertebrae to form one solid bone to reduce pain and improve spine stability.
A word of caution: always check with your care team before attempting any exercise program to ensure physical activity is safe for your condition and your rehabilitative journey.
This exercise is a great introduction to core conditioning after surgery. Begin by laying on your back with your knees bent. Keep your pelvis neutral and shift your ribs down towards your pockets. Place your hands on the bony spots in the front of the pelvis. This will help you focus on keeping your core stable as you move.
Now slowly slide your left heel out forward until your leg is completely straight- keeping your heel on the ground the entire time. Inhale deeply as you return the leg to its starting position. Do 15 repetitions for 2-3 sets on both legs.
Return to the same starting position: on your back with your knees bent. Keep your back and hips in a neutral position. Tighten your abdominal muscles and slowly raise your hips off the floor, until they are aligned with your knees and shoulders. Resist tilting your hips. Hold this bridge for 2-3 breaths and release it back down to the floor. Do this 10 times.
Turn back onto your stomach. Extend your legs out straight behind you, and your arms straight out in front of you. Raise your arms and legs at the same time a few inches off the ground—as if you are flying. Hold for 2-3 deep breaths and release. Do 2-3 sets of 10.
If this is too difficult, you can alternate your legs and arms. Raise your left arm while lifting your right leg and hold for three deep breaths. Do 2-3 sets of 10 and repeat on the other side. Be sure to keep your head looking down so you don’t strain your neck.
Get on all fours with your knees beneath your hips and your hands under your shoulders. Extend your left leg behind you while pointing your toes down. Reach your right arm forward, with your thumb pointing up. Hold this position for 2-3 deep breaths. Do 2-3 sets of 10 and repeat on the other side.
Stand up straight with your back against the wall. Place your feet out about 12 inches in front of you. Bend your legs until they form a right angle and hold your arms out straight in front of you. Hold this for 2-3 deep breaths and return to an upright position. Do 2 sets of 10.
Planks are a higher-level exercise that can be added as you progress your strength and endurance. Flip over onto your stomach for planks. Keep your body straight and lift up off the ground, using your elbows and toes to support your body weight.
Hold this position for 20 seconds before releasing back down to the ground. Do this 10 times, gradually increasing the time you hold the position as your core strength increases. To modify this exercise, you can drop your knees to the ground. When you’re ready to increase the intensity, use your hands instead of your elbows to support your body.
Side planks work the muscles along the side of the body to increase stability and core strength. Begin by lying on your left side. Rest your right arm on the side of your body.
Raise your body up onto your left forearm, keeping your shoulders, hips, and knees in alignment. Tighten your abdominal muscles and hold this position for three deep breaths. Release and repeat. Do 2 sets of 10 on both sides.
Generally, it’s best to avoid exercises that involve twisting at the waist or bending too far forward or backward until the tissues affected by the surgery have healed. Also, skip heavy weights until you have approval from your surgeon and your physical therapist. Follow your body’s cues if you think something doesn’t feel right. Stop exercising and tell your provider if pain returns or gets worse, or if you notice weakness in either of your legs.
That depends on several variables including your specific procedure and your symptoms.
For example, it can take several months for the bone to solidify after spinal fusion. During that time, it’s important to maintain proper alignment. Physical therapy is often started within several weeks after a fusion to encourage regaining cardiovascular endurance and to work on mobility of adjacent joints.
For less invasive procedures, you may begin physical therapy after surgery earlier. Always wait for the “green light” from your surgeon before starting any exercise program after back surgery.
It is possible to be active and pain-free after back surgery. A bit of patience and a positive attitude will help you get the most out of your physical therapy. Trust your therapist and the prescribed exercises to strengthen your core after back surgery and keep up with your at-home exercise routine to achieve your recovery goals. Find a physical therapy clinic near you.