Comprehensive Guide to Spinal Fusion Physical Therapy Protocol: Your Road to Recovery with Long Island Neuroscience Specialists

A Breakdown of the Phases of Physical Therapy After Spinal Fusion Surgery

The recovery process after spinal fusion surgery is typically divided into distinct phases, each with specific goals and exercises tailored to the patient’s stage of healing. As a surgeon, I make it a priority to collaborate closely with physical therapists to ensure that each patient follows a tailored plan. 

Phase 1: 0-4 Weeks (Wound Healing and Protection)

This phase focuses on pain control, wound care, and limited mobility to allow the spine to begin healing properly. During these first few weeks, you’ll likely still be in some pain, but this is also a critical time to begin gentle movement and exercises to avoid stiffness. Read more here. 

• Pain Management: You’ll likely be taking prescription pain medications during this phase, but the goal is to gradually reduce reliance on them as your body heals. Over-the-counter pain relief may also be used as needed.
• Mobility Guidelines: Walking is encouraged, but movements should be slow and controlled. Avoid sitting for more than 30 minutes at a time, and refrain from bending, lifting, or twisting.
• Wearing a Brace: Depending on the complexity of your surgery (for instance, if you had more than two levels of vertebrae fused), you may be required to wear a brace to support the spine and aid in healing.

Exercises during this phase are minimal but important. Patients are generally advised to start with basic movements such as log rolling, gentle walking, and supine stretching to keep blood flowing and prevent blood clots. 

These exercises also help reduce the risk of stiffness setting in. 

Phase 2: 4-8 Weeks (Initiation of Functional Strengthening)

By this phase, the focus begins to shift towards building strength and improving mobility. You’ll continue to avoid heavy lifting (no more than 15 pounds), but you can begin to increase your activity levels.

• Scar Management: Once the incision is fully closed, you may start gentle scar massage to prevent adhesions.
• Exercises: You’ll start more structured physical therapy with a focus on strengthening your core muscles. This includes exercises like glute sets, abdominal bracing, and heel slides. These exercises are essential for stabilizing your spine and ensuring that the muscles surrounding it are strong enough to support you as you recover.
• Balance Training: Exercises like tandem balance and lateral step-offs can help you regain control over your body and improve your stability as you move around.

This is the phase where I often see patients begin to regain confidence in their mobility. You’ll likely still have some restrictions, but the improvements in your strength and stamina will be noticeable. 

Phase 3: 8-12 Weeks (Full Strengthening and Advanced Mobility)

At this stage, most patients are ready to progress to more intensive therapy focused on functional movements. The body’s natural healing process is well underway, but it’s important to continue building strength to support the fused spine and prevent further injury.

• Progressing Strength Exercises: Patients will start using more resistance during exercises, including bands and light weights. Mini squats, step-ups, and bird dogs are common exercises during this phase to strengthen the legs and core.
• Improved Mobility: You’ll likely feel more comfortable engaging in daily activities like driving, light household chores, and walking longer distances. It’s important, however, to avoid any jerking movements or heavy lifting at this time.
• Endurance Training: Increasing your endurance will be a key focus, so activities like walking or using a recumbent stepper for longer periods will help build up your stamina.

Phase 4: 3-6 Months (Return to Full Function) 

This phase is all about returning to your normal life with as much strength and flexibility as possible. The exercises and therapy during this phase will focus on functional strength, endurance, and preventing future injuries. Read more here.

• Return to Work: For many patients, this is when they can consider returning to work, especially if they have a desk job. If your job requires heavy lifting or more physical labor, you may need to wait longer or have additional therapy focused on work-specific movements.
• Core and Lower Body Strengthening: Exercises will become more challenging and may include movements like lunges, planks, and even light jogging if approved by your therapist.
• Gradual Return to High Impact Activities: Some patients may be able to return to sports or other high-impact activities, but this should always be done under the guidance of a physical therapist.