Rehabilitation after surgery to remove a herniated disc

Goals and objectives of rehabilitation

Severe back pain occurs when a hernia occurs when the cartilage disc connecting the vertebrae is destroyed. A nucleus emerges from it, which compresses the nerves going from the brain to different parts of the body. Because of the pain, a person cannot raise his arm, bend over, or turn his neck. Sometimes it is so strong that conventional hernia treatment does not help and surgery is needed.

There are 2 types of surgery to remove a herniated disc:

• Open surgery (discectomy, laminectomy)
  - the surgeon removes osteophytes, body parts, vertebral arches and other formations that caused pinching. To reduce pressure on nerve fibers, it strengthens adjacent vertebrae with special inserts. Open operations are complex and are used only in extreme cases. Recovery takes several months.
• Minimally invasive interventions
  - the doctor eliminates the hernia through a small incision using endoscopic equipment or nucleoplasty. The patient recovers after a few days.

After discectomy, pain caused by pinching of the spinal cord and its roots disappears quickly. The causes that caused problems with movement and bending are also eliminated.

But surgery is not the final stage of hernia treatment. Ahead of the patient lies rehabilitation, the goal of which is to speed up healing and restore the functions of the spine.

The doctor develops actions, the sequential implementation of which helps to solve the following problems:

• prevent relapses;
• reduce the risk of complications that appear after operations (thrombosis, keloid scars);
• restore normal muscle function;
• eliminate problems associated with gait and posture;
• develop the habit of correctly distributing the load on your back.

Performing surgery for intervertebral hernia

There are two ways to surgically treat a herniated disc: microsurgical removal of a herniated disc and endoscopic removal.

Microsurgical removal is carried out through a 3-centimeter incision using a microscope and microsurgical instruments.

Endoscopic surgery is performed through a 7 mm incision using an endoscope.

Depending on the size and location of the disc herniation, the operation is performed under general anesthesia or epidural anesthesia. With an epidural, the patient may feel discomfort at the surgical site and hear what is happening in the operating room. The duration of the operation is from 30 to 90 minutes. Endoscopic hernia removal is performed in the lateral or abdominal position. After making a skin incision, a special endoscope is inserted, through which you can see the area of ​​the operated area and the “protrusion” that compresses the nerve roots. The device makes it possible to visualize the area where it is necessary to remove the hernia, and the image is displayed on the screen. When bleeding occurs, the surgeon stops it using coagulation (cauterization of blood vessels). The doctor removes the “bulging” and damaged disc structures, which prevents the herniation from occurring again.

In the neurosurgical department of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency, operations are actively carried out using endoscopic techniques, which significantly reduces the duration of the recovery period and the length of stay of patients in the hospital!

What happens if you don't undergo rehabilitation?

If you ignore the rehabilitation period, the tissues will not heal properly, which will reduce the effectiveness of the hernia surgery. Muscles and ligaments will remain undeveloped, which will have a bad effect on flexibility and the ability to withstand stress. The result is a recurrence of the vertebral hernia, the return of discomfort.

Each type of intervertebral hernia has serious complications, so you should not delay treatment.
See how easy it is to get rid of a hernia in 10 sessions

Stages of rehabilitation

Conventionally, rehabilitation is divided into 3 stages.

Follow your doctor's instructions at every stage! Do all actions step by step, do not jump to more difficult movements or exercises ahead of time.

Stage 1 – initial

The early, initial stage lasts the first 15 days. After surgery to remove a spinal hernia, rehabilitation involves taking antibiotics, NSAIDs (non-steroidal anti-inflammatory drugs), sedatives, and sedatives, as the patient feels discomfort in the back. It subsides within a week. Antiseptic treatment of sutures is carried out regularly to prevent inflammation.

Drug treatment is aimed at:

• tumor reduction;
• reduction of pain syndrome;
• acceleration of tissue healing;
• reducing the risk of infection of the operated area;
• maintaining muscle tone;
• reducing the risk of thrombosis.

What not to do

You can walk at the early stage of rehabilitation only after the doctor’s permission, 5-10 minutes

Immediately after the operation, the body is weak, any sudden movement can provoke suture separation and complications. Therefore, many actions are prohibited at an early stage, including:

• Sit for 3-6 weeks after surgery (the duration of the ban depends on the complexity of the case).
• Walk around the ward on the 1st day after surgery. The doctor usually allows you to move for 2-3 days. However, you cannot walk for a long time at this stage.
• Deep bends – If you have to bend down to pick up something that has fallen, have someone hand it to you.
• Sharp, twisting movements in the spine, bending.
• Any sports.
• Massage.
• Travel by transport, car – 14 days after surgery, even better – 2-3 months.
• Lifting weights – more than 2 kg.

If there are no complications, after the sutures are removed (7-10 days), the patient is discharged from the hospital and given a list of recommendations indicating what can and cannot be done for a year after removal of the hernia. Additionally, the next visit to a rehabilitation specialist is agreed upon.

Stage 2 – recovery

Readaptation (recovery stage) lasts 3-8 weeks. During the second period of rehabilitation after surgery to remove a hernia, the patient is already at home, taking medications if necessary. The main actions are aimed at accelerating healing and developing the back muscles. To achieve these effects, the following is prescribed:

• Physiotherapy.
• Walking 30 minutes a day.
• Exercise therapy in the gym under the supervision of a doctor. Exercise equipment is prohibited.
• Swimming on your stomach.

During movements and physical exercises, the patient should continue to use a corset or collar, which will take the load off the sore back.

At 4-6 weeks after removal of the hernia, the doctor allows you to “sit.” This also needs to be done “correctly”: at first you can only sit on the edge of the chair, trying not to overload the tailbone. The knees should be lower than the pelvis. You need to rise by holding onto the armrests of the chair.

What not to do

Sports, cycling, sudden movements, massage, bathhouse, sauna remain prohibited. However, you need to do exercise therapy and walk for at least 20 minutes. per day with breaks. You cannot stand or sit for more than 20 minutes. Periodically unload the spine, rest lying down for 20-30 minutes.

Stage 3 – late

At stage 3 of rehabilitation after removal of a hernia, you can do more active exercise therapy

From the 9th week after surgery to remove a herniated disc, the late stage begins - intensive physical rehabilitation. It provides:

• more active physical therapy exercises;
• swimming;
• classes on special simulators;
• physiotherapy;
• mud therapy;
• balneotherapy;
• massage, other gentle manual therapy techniques (after 6 months).

What not to do

In the late period of rehabilitation, a person does not feel pain, but one must remember the limitations. Remain prohibited:

• Active sports, sudden movements (swimming allowed).
• Sharp tilts and turns.
• Heavy physical work, lifting weights more than 3 kg.
• Hypothermia - always dress well, if it is very cold, wear a warm belt. If you work as a seller on the street, it is better to find something else to do.
• Bath, sauna.

Jumping and long car rides are prohibited. You cannot sit or stand for a long time (for example, in the office). Get up and move around periodically. If it's cold outside or raining, wear a warming belt. You cannot wear a corset for a long time, so as not to atrophy the long back muscles.

Terms of rehabilitation

A rehabilitation program is drawn up immediately after the completion of surgery. Patients should take their first steps within 1-2 days. The rehabilitation period is from 4 months. It depends on:

• Type of operation. After a minimally invasive intervention, rehabilitation will take a month, while after a discectomy it will take at least six months.
• Patient's age. Rehabilitation for older people takes longer.
• Health. Rehabilitation will be delayed if there is a history of chronic diseases (diabetes mellitus).
• Weights. Obese people take longer to recover.
• The nature of the vertebral hernia. This is its size, how long ago the disease was, what difficulties it caused.

What does rehabilitation include?

High-quality rehabilitation is a set of measures, each of which is aimed at improving the patient’s health. They are selected individually. To achieve the desired effect, all actions must be carried out under the strict supervision of a physician. The doctor's recommendations must be followed strictly.

Drug therapy

To relieve pain and swelling after surgery in the cervical, lumbar, and thoracic regions, the doctor prescribes:

• Analgesics
  (Analgin, Lidocaine, Ketotifen) - relieve pain or reduce its manifestations.
• Antibiotics
  (Penicillin, Cefazolin, Vancomycin) are needed to prevent post-surgical infections.
• NSAIDs
  (Diclofenac, Diclak, Ketorol) - non-steroidal anti-inflammatory drugs prevent and relieve inflammation, swelling, pain.
• Muscle relaxants
  (Baclofen, Tolperisone, Tizanidine) - relax stiff muscles.
• Chondroprotectors
  (Teraflex, Artra) – strengthen bones and cartilage.
• Vitamin-mineral complexes
  – trigger metabolic processes, which promotes tissue healing.

Drugs prescribed during the rehabilitation period after hernia surgery

The course of drug therapy is selected by the doctor. You cannot independently reduce or increase the dosage, or shorten the course of rehabilitation after removal of a hernia. As healing progresses, the need for antibiotics, NSAIDs, and analgesics disappears. On the 10th day after removal of the hernia, antibiotics are discontinued if there are no bacterial complications.

Analgesics and NSAIDs are taken until the pain disappears. Chondoprotectors and vitamin complexes that strengthen bones and joints can be used in courses for the rest of your life.

Exercise therapy and gymnastics

The goal of exercise therapy is to restore lost functions of the spine. Exercises strengthen the back muscles, make the ligaments more flexible, without injuring or overloading them. They improve blood flow, and with it the supply of nutrients to the damaged disc, which accelerates tissue regeneration.

To achieve the desired effect, a set of exercises must be selected by the doctor taking into account the age, health, weight, and physical capabilities of the patient. Any attempts to independently adjust exercise therapy, without consultation with a rehabilitation specialist, can provoke an exacerbation of the hernia.

When performing exercises, remember these rules:

• Do not increase the load suddenly.
• Always wear a brace or collar during training.
• If an exercise causes pain, stop immediately or reduce the load. You are not ready for it yet. Contact your doctor for exercise correction.
• Do not do exercises that are prohibited at this stage of rehabilitation after surgery for a herniated disc.
• Avoid active, sudden actions. Swinging legs, jumping, strong bending, twisting exercises, and pull-ups on the horizontal bar are prohibited. Also, you should not make sharp turns of the body to the right or left.
• At the initial stage, the use of barbells, dumbbells, and any power loads is prohibited. If the doctor has approved push-ups, the exercise should first be done from the wall, and only then gradually move on to the classic version.
• Walk every day, preferably in a park or forest. Duration of walks is 30-60 minutes, rest periodically.

Best exercises

Immediately after surgery to remove a herniated disc, the doctor prescribes a gentle complex of exercise therapy. Exercises are done from a supine position:

• Rotation of hands and feet in a circle.
• Move your feet down/up.
• Bend your legs at the knee, bend your arms at the elbow.
• Pulling the right, then the left leg towards the stomach.

Over time, the complex becomes more complicated. The doctor gives more complex stretching exercises to strengthen muscle tissue. Depending on the situation, each action must be done from 4 to 10 (no more) times:

• Lying on your left side, lift your left leg straight. Bend your left elbow and place your hand behind your head. Then change the side.
• Lying on your back, lift your pelvis off the surface.
• Lying on your back, tuck your chin toward your chest.

What types of intervertebral hernias are most difficult to treat?

4 stages of treatment for intervertebral hernia

Complications after removal of a spinal hernia

Everyone wants to get an answer to the most exciting question: is surgery for a herniated disc dangerous? Absolutely every surgical treatment method has risks of possible complications. In our case, the danger of the operation is also not excluded, and in the dominant quantity it consists in the appearance of a relapse, which is solved by repeated intervention. Of course, the quality of the intraoperative session also plays a special role, but, as a rule, in successful clinics the operation goes well.

What may be the intraoperative consequences? Mostly they are associated with injury to the nerve or dura mater of the spinal cord.

• The first complication will be manifested by pain and loss of sensitivity in the legs or arms, depending on the location of the injured nerve. If the nerve structure is severely damaged, the prognosis for its recovery is, unfortunately, disappointing.
• If the dura spinal membrane is damaged, if the surgeon detects the defect in a timely manner, he will suture it. Otherwise, cerebrospinal fluid will leak. Impaired circulation of cerebrospinal fluid will cause problems with intracranial pressure and, as a result, the patient will experience severe headaches. The dura can heal on its own in about 2 weeks.

Negative reactions can be postoperative, early and late:

• Early complications include purulent-septic processes, including epiduritis, osteomyelitis, suppuration of the suture, and pneumonia. In addition, the group of early postoperative consequences includes deep vein thrombosis of the lower extremities and pulmonary embolism.
• Late negative reactions are repeated relapses, secondary degenerative pathologies. This also includes rough scar-adhesive growths, which in turn compress nerve formations, which, as with intervertebral hernias, is manifested by pain and/or paresthesia spreading along the pinched nerve.

If the operation is carried out efficiently, all preventive measures are followed and medical recommendations are flawlessly followed, the likelihood of any consequences occurring is reduced to the very minimum.

Physiotherapy

Physiotherapeutic procedures are prescribed when the main stage of rehabilitation is completed. Their action is aimed at improving blood circulation and lymph flow in the sore back. This helps relieve swelling, inflammation, and improves the supply of nutrients to the diseased area. The result is rapid tissue healing, restoration of muscles and nerve fibers.

In most cases, the doctor prescribes several procedures that improve the effect of each other. This:

• Electromyostimulation
  is electrical stimulation of nerves and muscles aimed at improving their functioning.
• Iontophoresis
  - a current of low strength and voltage is supplied through electrodes. Its action is aimed at improving the condition of smooth muscles and blood vessels. Also, using the procedure, you can deliver medications to the deeper layers of the skin.
• Magnetotherapy
  is the effect on the body using magnetic fields, which helps improve nervous, immune, and metabolic processes.
• UHF
  is the effect of a high-frequency magnetic field on the body, which increases the permeability of blood vessels. Penetration of nutrients and immune cells to the diseased area improves. This stimulates tissue growth, development and healing after the hernia is removed.
• Laser therapy
  is the effect of a beam of concentrated light on the diseased area, which helps to warm up the soft tissues, improve blood flow, and heal the diseased area.
• Diadynamic therapy
  is treatment with current of different frequencies, which has an analgesic effect, improves metabolism, nerve and muscle function.

Each physiotherapy course consists of 10-15 sessions. Treatment can be continued after a short break if there are medical indications.

Manual therapy, massage

Manual therapy methods, primarily massage, will improve the condition of muscles and nervous tissue. With their help you can:

• quickly restore range of motion;
• stimulate tissue regeneration;
• remove neurological symptoms, which often persist after surgery.

Massage is prescribed no earlier than the third stage of rehabilitation after spinal hernia surgery, otherwise recently healed tissue can be damaged. A good effect is achieved by combining manual therapy with other physiotherapeutic procedures. The massage must be performed by a qualified specialist, which is confirmed by a medical diploma, reviews, and client comments.

Corset and neck collar

Corset and cervical collar are fixing accessories that need to be worn after surgery to remove lumbar and cervical hernia

If there has been surgery for a lumbar disc herniation, rehabilitation involves wearing a semi-rigid corset. If the hernia was in the upper back, you need a Shants collar.

The purpose of fixing accessories:

• correctly distribute the load, reducing pressure on the cervical, thoracic or lumbar spine;
• protect your back from overload;
• prevent sudden movements;
• reduce pain;
• recover faster after surgery.

The corset and/or collar is worn when performing exercise therapy or doing housework. According to reviews, they are very helpful when walking and at work. When the doctor allows you to drive in a car, you also cannot do without a corset.

The corset is put on and removed while lying on your back. You must wear it for at least 2 months. after surgery from 3 to 6 hours a day, and remove only at night and before daytime rest. If your doctor allows you to go to work, check with him how many hours you need to be in a corset. You cannot wear it all the time, because the back muscles will weaken too much, which will have a bad effect on the functioning of the musculoskeletal system.

Diet

During the rehabilitation period, pay special attention to diet. The body extracts nutrients from foods that are used to build cells. Therefore, food should be healthy and easily digestible.

Meat broth, cartilage, jellied meat are a natural analogue of chondoprotectors that strengthen the tissues of the intervertebral disc and prevent recurrence of the hernia. Also, products must contain fiber, vitamins A, B, C, D, phosphorus, manganese, potassium, calcium. That is why include products containing them in your menu:

• lean meat;
• offal - kidneys, heart, liver, brains;
• eggs;
• nuts;
• legumes;
• vegetables fruits;
• honey;
• dairy products.

Avoid foods that contribute to weight gain, which puts stress on the spine. Nutritionists do not recommend fatty, pickled, salted, smoked foods; they advise limiting sweets.

During the rehabilitation period, it is important to follow a diet

Reminder after hernia removal: two important additions

We will not list all the points of the instructions; you know it, since it is always given to you upon discharge from the hospital. But we consider it necessary to inform about some requirements that are not covered in the issued instructions, which patients most often ask on forums. So, the two most common questions are: is a bath allowed after surgery and when can you have sex?

• Somewhere you can read that the bath is effective against the adhesive-scarring process after removal of a vertebral hernia. Attention! This fact has no confirmation . Moreover, it is forbidden to go to the bathhouse after the operation for at least 6 months, or even better, a year. Temperature procedures are stimulants of metabolism and normalization of body functions, and if there is at least a small sign of internal or external inflammation in the area of ​​the surgical field, they can also intensively stimulate the progression of the inflammatory reaction. The steam room can cause swelling of the surgical wound and divergence of “fresh” sutures. And this is a favorable environment for the entry of pathogenic bacteria and the development of purulent-infectious pathogenesis.
• As for sex, it should be excluded for a while . Doctors usually do not advise resuming sexual activity for at least 14 days from the date of intervention. And even from this moment, until you finally recover, sexual contact should be as safe as possible. You must be a passive partner. In order not to cause injury to the operated part of the ridge, gentle sex is allowed, not characterized by high tension. The rule of no excessive load on the spine, in particular on the lumbosacral region (hernias are most often removed in this segment), should be observed for approximately 6 months.

Important! To achieve a full restoration of your quality of life and avoid consequences, strictly follow all contraindications and indications that are set out in the leaflet given to you upon discharge from the surgical hospital. And be sure to continue your recovery in the rehabilitation center. The standard period of mandatory rehabilitation, subject to positive dynamics, is 3 months.

When to see a doctor during rehabilitation

Contact your doctor immediately if the following symptoms appear:

• back pain that does not subside and intensifies;
• burning in the area of ​​the damaged disc;
• urinary disturbance;
• pain in the abdomen, arms, legs;
• numbness of hands, feet;
• heat;
• spasm, tension in the back muscles;
• too much swelling in the area of ​​the diseased disc;
• ichor that oozes from the stitches.

These symptoms indicate complications that may result from infection in the wound, purulent inflammation, the onset of pathological narrowing (stenosis) of the spinal canal, when bone/cartilaginous structures affect the nerve roots, and other complications, including recurrence of intervertebral hernia.

Cervical intervertebral disc herniation: consequences and rehabilitation

Rehabilitation after an intervertebral hernia of the cervical spine requires special attention, since any surgical intervention in this area can have serious consequences:

• damage to the meninges;
• infection;
• speech and breathing disorders;
• injury to the esophagus.

In the postoperative period, the patient is prohibited from standing up or making sudden movements. You should also not sit for a long time to avoid additional complications. The patient needs to be very attentive to his condition and at the first signs of deterioration (acute pain, numbness, dizziness) immediately consult a doctor.

Cervical spine rehabilitation will include:

• wearing an orthopedic corset, cervical collar;
• massage;
• physiotherapy;
• physiotherapy.

Approach to rehabilitation at Paramita

At the Moscow Paramita clinic, rehabilitation after surgery to remove a spinal hernia takes place in stages. A detailed recovery program is established based on:

• medical history;
• complexity of operations;
• concomitant diseases;
• age;
• gender;
• physical capabilities;
• data from laboratory tests, x-rays, MRI, etc.

After removal of a hernia, our doctors work with each patient according to an individual program. In the treatment of hernia, we use both Western and Eastern methods - physiotherapy, massage, hirudotherapy, acupuncture, etc.

The center has modern equipment at its disposal, which helps to quickly recover after surgery. Doctors closely monitor the progress of rehabilitation and adjust the program in a timely manner. We are always in touch with our patients and respond to all requests instantly.

We use non-surgical hernia treatment techniques
Read more about our unique technique

Preparing for surgery to remove a herniated disc

FSCC FMBA has all the necessary diagnostic equipment, which makes it possible to prepare for surgery in the center in just one day. A comprehensive examination includes:

• MRI;
• CT;
• X-ray with functional tests (to exclude instability of one of the vertebrae).
• Lab tests:
• Blood chemistry;

General blood analysis;

• Analysis of urine;
• Blood test for infectious group;
• General urine analysis.

It is important to note that blood test results must be obtained the day before surgery. The list of laboratory and instrumental tests can be expanded based on the individual characteristics of the body and the state of health in general. Before surgery, consultation with a therapist and anesthesiologist is necessary. 8 hours before surgery you need to stop eating.

FAQ

When can you sit down after surgery?

Not until the spine is strong enough. If there are no problems, you can sit 4 weeks after the hernia surgery.

Are there relapses during the rehabilitation period?

They happen, but proper rehabilitation will reduce the risk of hernia recurrence.

How to eliminate leg pain during rehabilitation?

Leg pain after hernia removal is normal. The reason is the long-term pressure of the hernia on the nerves through which the brain controls the functioning of the legs. During surgery, the pressure is relieved, but it may take several weeks for the nerve tissue to recover. During this time, your lower leg will hurt, your hip will pull, and your limbs will experience numbness. If, while recovering, your leg suddenly begins to hurt sharply and go numb, be sure to tell your doctor. The sooner he determines the cause of the complication, the faster the chances of a speedy recovery, and you will not have to spend several years on treatment.

When can I plan a pregnancy after finishing rehabilitation?

You cannot plan to conceive within a year after removal of the hernia. The fetus will put pressure on the spine, causing a relapse. If you become pregnant, contact your doctor right away.

Is disability granted after completion of rehabilitation?

Rarely, only if the patient’s mobility has not been restored. The decision on disability is made by the ITU commission after a comprehensive examination. The status is assigned for six months, after which it must be confirmed. Your doctor will tell you whether you can get disability.

When is sick leave closed during the rehabilitation period?

If rehabilitation is successful, there are no complications, the doctor closes sick leave after the end of rehabilitation - after 2-3 months. After this, the patient can return to work or change it if it involves difficult working conditions.

Bibliography

1. Badalyan L. O. Neuropathology. - M.: Education, 1982. - 317 p.
2. Bogolyubov, Medical rehabilitation (manual, in 3 volumes). // Moscow - Perm. - 1998. - 1885 p.
3. Popov S. N. Physical rehabilitation. 2005. - 608 p.
4. Feshchenko, Ya. V. Non-surgical treatment and prevention of recurrence of intervertebral disc herniations / Ya. V. Feshchenko, L. D. Kravchuk // Pain. Joints. Spine. ─ 2014. ─ No. 3(15). ─ P. 59-61.

Themes

Intervertebral hernia, Spine, Pain, Treatment without surgery Date of publication: 03/26/2021 Date of update: 03/28/2021

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