Current Concepts in Post-Op Care: Lumbar Spine—Introduction (03:03)
Scott Cheatham is a physical therapist and personal trainer. Patients with a lumbar issue can be a difficult case. Cheatham explains the objectives of this presentation; function within your scope of practice to reduce liability.
Tissue Healing (06:30)
Phases include: inflammatory, fibroblastic/proliferation, and maturation/remodeling. Scar tissue is 70-90% of the strength of the original tissue. Review general guidelines for healing.
Post-Surgical Assessment (01:37)
Perform a comprehensive screen, identify any medical red flags, perform test measures, and develop an exercise prescription. Consider if the patient is appropriate for exercise or if he/she should be referred out.
Bone and Joint Anatomy (06:34)
Cheatham explains the anatomy of the lumbar spine including: the three curves, the intervertebral disc, posterior/dorsal root, and anterior/ventral root. He demonstrates spinal motions and discusses disc bulges.
Muscle Anatomy (02:51)
Review the inner unit, the posterior oblique system, and the lateral system of the core. Cheatham explains how the core relates to the lumbar patient.
Core Muscle Fiber (02:54)
Will Jorgensen and his group believe core muscles showed a dense portion of slow-twitch muscle fibers. Cheatham considers inner core activation and training the core. Review the inner and outer core.
Degenerative Joint Disease (05:17)
Learn the risk factors and mechanisms of damage associated with the degenerative processes. Cheatham describes the "cascade of events" that occurs as we age and disc pathology progression.
Client Profile (01:21)
See the disc pathology of a client including: age, mechanism, pain, aggravating factors, relief, and facts.
Lumbar Stenosis (04:58)
Learn the characteristics of stenosis; stenotic patients often experience leg cramps. See radiographs of stenosis.
Lumbar Referral (02:14)
Muscle referral pattern considerations include causes of referral and psychosocial issues. The farther down the spine the injury is, the farther down the leg the symptoms will be.
Surgical Intervention (02:02)
Cheatham briefly summarizes the presentation on the lumbar spine up to this point. The order of operations if a conservative approach does not work includes: disectomy, laminectomy, and spinal fusion.
Cheatham explains the conservative surgical procedure for a lumbar patient and post-op guidelines; see photos. Patients are at risk for re-injury.
Lumbar Laminectomy (04:51)
Cheatham explains two surgical procedures for a lumbar patient and post-op guidelines. Patients are at risk for re-injury.
Spinal Stabilization Processes (05:34)
Cheatham explains the lumbar fusion, graft selection, anterior lumbar interbody fusion, and posterior lumbar interbody fusion. Learn the rationale for each surgical procedure and post-op guidelines.
Post-Surgical Client: Hazards of Immobility (03:15)
Learn the sequences of immobility and possible conditions clients may encounter. Patients with low back pain have muscle inhibition; everything atrophies with low back pain.
Functional Movements for Post-Op Clients (01:53)
Learn the flexion relaxation response model and activities that increase disc pressure; be careful of implementing functional exercises.
Post-Surgical Overtraining (02:18)
Obvious signs and symptoms of over training include: soreness that lasts more than four hours, increased stiffness, decreased range of motion, swelling, and more. Learn types of pain and the affected structures.
Exercise Prescription (00:56)
Follow general guidelines for prescribing exercises to post-surgical clients and review contraindications/precautions.
Corrective Exercise (05:32)
Cheatham reviews research that addresses whether rehab/therex works after first time lumbar disc surgery. Audience members reflect on client cases.
Fitness Tools (03:23)
Studies reveal the effects of physioball activities, Pilates, and pelvic floor exercises on the inner core.
What are the Best Core Stabilization Exercises? (07:01)
Activities include: abdominal draw-in, bridging, bridging on a physioball, lumbar extension with stabilized lower extremity, prone hip extension over a physioball, bird dogs, planks, side bridge, and prone opposite lift.
Final Thoughts (02:51)
Talk with the physical therapist or the doctor. Screen for red flags. Monitor for any changes in symptoms. Educate the client.
Credits: Current Concepts in Post-Op Care: Lumbar Spine (00:34)
Credits: Current Concepts in Post-Op Care: Lumbar Spine
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