Patient Journey
Spinal Rehabilitation Guide
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Patient Journey
Spinal Rehabilitation Guide
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Introduction
Your recovery from spine pain or injury can be improved by learning new ways to
strengthen your spine and prevent future problems. A physical therapist can teach you
ways to help reduce your pain now and form new habits to keep your spine healthy.
Learn about spinal rehabilitation including
» What happens on your first visit to a physical therapist
» What treatments are used to control pain and symptoms
» How exercise helps you recover
» How therapy can train you to do your activities safely
First Visit
Your physical therapist (PT) will gather information about your spine condition.
You may be asked questions about when it started, where you hurt, and how
your symptoms affect your day-to-day activities. This helps your PT to begin
zeroing in on the source of your problem and to know what will be needed to help
relieve it.
Therapy Exam
After reviewing your answers, your therapist will do an exam that may include
some or all of the following checks.
Posture – Imbalances in the position of your spine can put pressure on sore joints,
nerves, and muscles. Improving your posture can oftentimes make a big difference in
easing pain.
Range of motion (ROM) – Measurements are taken of how far you can move in
different directions. Your ROM is recorded to compare how much improvement you are
making with treatment.
Nerve Tests – Your PT may do checks of reflexes, sensation, and strength. The
results can help determine which area of the spine is causing problems and the types of
treatment that will be best for you.
Manual Exam – Your PT will carefully move your spine in different positions to make
sure that the joints are moving smoothly at each level. Muscle and soft tissue flexibility is
also tested.
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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Patient Journey
Spinal Rehabilitation Guide
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Ergonomics – Ergonomics involves where and how you do your work or hobby
activities. By understanding your ergonomics, your PT can begin to learn if the way you
do your activities is making your condition worse. Sometimes even simple corrections of
your hobby or workstation can make a big difference in easing spine problems.
Palpation – Palpation involves feeling the soft tissues around your spine. This is
used to check the skin for changes in temperature or texture, which could tell if
you have inflammation or nerve irritation. Palpation also checks whether there
are tender points or spasms in the muscles near the spine.
Care Plan
Your therapist will evaluate your answers and your exam results to determine the best
way to help you. Your therapist will then write a plan of care, which lists the treatments to
be used and the goals that you and your therapist decide on to do your daily activities
safely and with the least amount of discomfort. The plan also includes a prognosis,
which is your therapist's idea of how well the treatments will work and how long you'll
need therapy in order to get the most benefit.
Treatment
The main goal of therapy is to make sure you have ways to take care of future spine
pain or problems. You'll be shown ways to help control pain or symptoms if they don't go
completely away and if they return in the future. Because you've experienced spine pain,
there is a possibility you may have soreness in the future. You may be encouraged to
continue with some of the exercises to help keep your spine healthy over time.
» Controlling Pain and Symptoms
» Therapeutic Exercise
» Functional Training
» Home program
Controlling Pain and Symptoms
Your therapist may choose from one or more of the following treatment
interventions to help you control your pain and symptoms.
Rest
Resting the painful joints and muscles helps calm soreness, giving your spine time to
heal. If you are having pain with an activity or movement, it should be a signal that there
is still irritation going on. You should try to avoid all movements and activities that
increase the pain. In the early stages of your problem, the doctor or therapist may have
you wear a brace to limit movement.
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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Patient Journey
Spinal Rehabilitation Guide
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Specific Rest
Specific rest encourages safe movement of the joints and muscles on either side of a
painful area, while protecting the sore spot during the initial healing phase. If a brace
was prescribed, you may be instructed to take it off a few times each day so you can do
some gentle and controlled exercises.
Positioning
Your PT will work with you to find ways to position your spine for the greatest comfort
while sleeping or resting. You may receive advice on positions that reduce stress on
your spine while you are at work.
Ice
Ice makes blood vessels vasoconstrict (get smaller), decreasing the blood flow. This
helps control inflammation, muscle spasm, and pain.
Heat
Heat makes blood vessels vasodilate (get larger), increasing the blood flow. This action
helps flush away chemicals that cause pain. It also helps bring in healing nutrients and
oxygen.
Ultrasound
Ultrasound can reach tissues that are over two inches below the surface of your skin.
The ultrasound machine directs high-frequency sound waves toward the sore area. As
the waves pass through the body's tissues, they vibrate molecules. The vibration causes
friction and warmth. The remaining sound waves are converted to heat in the deeper
tissues of the body. This heating effect helps flush the sore area and brings in a new
supply of blood that is rich in nutrients and oxygen.
Electrical Stimulation
Electrical stimulation is a gentle treatment used to stimulate nerves. The current passes
through pads applied on the skin. Some people say it feels like a massage on their skin.
Electrical stimulation can ease pain by sending impulses that are felt instead of pain.
Once the pain eases, muscles that are in spasm begin to relax, letting you move and
exercise with less discomfort.
Soft Tissue Mobilization/Massage
Therapists are trained in many different forms of massage and mobilization. Massage
has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh
supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants
that come from inflammation. Soft tissue treatments can help tight muscles relax, getting
them back to a normal length. This will help you begin to move with less pain and
greater ease.
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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Patient Journey
Spinal Rehabilitation Guide
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Joint Mobilization
Graded pressures and movements for joint mobilization may be performed by skilled
therapists. Gentle graded pressures help lubricate joint surfaces, easing stiffness and
helping you begin moving with less pain. As your pain eases, more vigorous grades of
mobilization may be used to lengthen tissues around the joint in order to restore better
movement in your spine.
Traction
Sore joints and muscles often feel better when traction (pull) is used. Therapists apply
traction manually or with a traction machine. There are also traction devices that can be
issued to you for use at home. The amount of pull that is used will depend on your
condition. A gentle on/off pressure may be better early on to help control arthritis pain.
More vigorous traction can help take away pain if a spinal joint is mildly sore or tight.
Therapeutic Exercise
Specialized treatments and exercises can help maximize your physical abilities,
including flexibility, stabilization, coordination, and fitness conditioning.
Flexibility
Exercises that increase flexibility help to reduce pain and make it easier to keep your
spine in a healthy position. Flexibility exercises are helpful for establishing safe
movement. Tight muscles cause imbalances in spinal movements. This can make injury
of these structures more likely. Gentle stretching increases flexibility, eases pain, and
reduces the chance of re-injury.
Stabilization
The "core" muscles you'll be working on are closer to the center of the body and act as
stabilizers. These key muscles are trained to help you position your spine safely and to
hold your spine steady as you perform routine activities. These muscles form a stable
platform letting you move your limbs with precision. If the stabilizers aren't doing their
job, your spine may be overstressed with daily activities.
Coordination
Strong muscles need to be coordinated. As the strength of the spinal muscles increases,
it becomes important to train these muscles to work together. Learning any physical
activity takes practice. Muscles must be trained so that the physical activity is under
control. Spine muscles that are trained to control safe movement help reduce the chance
of re-injury.
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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Patient Journey
Spinal Rehabilitation Guide
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Fitness conditioning
Improving overall fitness levels aids in recovery of spine problems. Fitness conditioning
involves safe forms of aerobic exercise. The term aerobic means "with oxygen." When
using oxygen as they work, muscles are better able to move continuously, rather than in
spurts.
Exercise has other benefits as well. Vigorous exercise can cause chemicals, called
endorphins, to be released into the blood. These chemical hormones act as natural pain
relievers in reducing your pain. Examples of aerobic exercise include:
» Swimming laps
» Walking on a treadmill
» Using a cross country ski machine
» Using a stair stepper
If you decide you want some extra conditioning, always check with your doctor or
therapist before beginning a program on your own. It is important that you choose an
aerobic activity you enjoy. This will help you stick with it-guaranteeing you the long-term
benefits that come with a well-rounded fitness program.
Functional Training
Therapists use functional training when you need help doing specific activities with
greater ease and safety. Examples include posture, body mechanics, and ergonomics.
Posture
Using healthy posture keeps the spine in safe alignment, reducing strain on the joints
and soft tissues around your spine. The time and effort you take to use good posture are
vital to spine care, including prevention of future spine problems. As you gain strength
and control with your stabilization exercises, proper posture and body alignment will be
easier to remember and apply with all your activities.
Body Mechanics
Think of body mechanics as putting safe posture into action. It's one thing to sit or stand
with good posture, it's another to keep safe posture as you actually move with activity.
You want to keep your body in its safest alignment as you go about your daily tasks,
such as:
» Getting out of a chair
» Taking out the trash
» Getting clothes out of the dryer
» Brushing your teeth
» Lifting
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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Patient Journey
Spinal Rehabilitation Guide
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Safe body movement is especially important during lifting. To avoid extra spine strain
when lifting, use these safety tips:
» Plan and prepare for the lift.
» Make sure you have good footing.
» Straddle your feet with a wide base of support.
» Keep the load close.
» Keep the spine stable and aligned.
» Avoid twisting by pivoting with your feet.
Ergonomics
Ergonomics looks at the way people do work. It's possible that even minor changes in
the way you do your work or hobby activities could keep your pain and symptoms in
check, while protecting your spine from further injury. Ergonomics doesn't usually involve
expensive changes. Even minor adjustments in the way you do your activities can make
a huge difference in easing your pain and preventing further problems.
Home program
Once your pain is controlled, your range of motion has improved, and your strength is
returning, you will be progressed to a final home program. Your therapist will review
some of the ideas listed above to help take care of any soreness at home. You'll be
given some ways to keep working on your range of motion and strength. Before you are
done with therapy, more measurements may be taken to see how well you're doing now
compared to when you first started in therapy.
©DePuy, Inc. 2010. All Rights Reserved. This information is published by DePuy, Inc., which is
solely responsible
for its content. This site is governed solely by applicable U.S. laws and governmental regulations.
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