Reviewed by Dr. Kshitij Chaudhary — Last reviewed October 2026
This plan is for you and your physiotherapist to follow together. It is written for people who have had lumbar decompression (laminectomy, laminotomy or keyhole decompression) for spinal canal stenosis. Most people notice their leg pain and heaviness ease soon after surgery. Numbness and tingling can take weeks to months to settle. That is normal.
The weeks are a guide, not a deadline. Move on only when you pass the moving-on checks at the end of each phase. Your physiotherapist should record your ODI or RMDQ score and pain score at the start, at 6 weeks and at 12 weeks.
Call us if
Most people recover smoothly. Get in touch quickly if you notice any of these:
- New weakness in your leg or foot, or a foot that drags
- Numbness around your private parts
- Trouble passing urine, or loss of bladder or bowel control
- Fever above 38°C (101°F), or a wound that is red, hot, leaking or opening
- Leg pain that is getting worse, or spreading further down the leg during exercises
- A headache that is worse when you sit or stand, or clear fluid leaking from the wound
Call the clinic on 8291420004 (9am–5pm) or contact us, or go to the emergency department at Hinduja Hospital. For numbness around private parts, or bladder or bowel problems, go straight to the emergency department.
Pain rules
- Mild backache or stiffness during or after exercise is expected. It should settle within about an hour.
- If an exercise brings on or worsens leg pain, tingling or numbness, stop it and tell your physiotherapist.
Phase 1 (0 to 2 weeks): Protective phase
Therapy
- Your first physiotherapy visit is at 2 weeks after surgery (outpatient)
- Until then, do the home programme below
Precautions
- No lifting more than 10 lb (4.5 kg) until 2 weeks
- Sit for no more than 30 minutes at a time, including in the car. Stand up and walk for a minute before sitting again
- Do not arch your back backwards for 6 weeks
- No bending forward at the waist or twisting for 8 weeks
- Sleep on your back with a pillow under your knees, or on your side with a pillow between your knees. Click to read more.
Goals
- Ease pain and swelling
- Get walking and moving gently
- Learn safe ways to move, get out of bed and bend
- Wake up your deep belly and back muscles
- Build walking up to 10 minutes at a time
Education
- Posture: sit upright on a firm chair with your lower back supported. Change position often
- Body mechanics: log roll to get in and out of bed. Use the hip-hinge every time you reach down. Your hospital physiotherapist will show you both before you go home
Exercises (2–3 times a day unless noted)
- Walking: start with 5 minutes, 3–4 times a day. Add 1–2 minutes each day
- Pelvic tilt (lying on your back): 10 reps, hold 5 sec
- Ankle pumps: 20 reps per leg. Keeps the blood moving in your legs
- Heel slides: 10 reps per leg. Lie on your back and slowly slide one heel towards your buttock, then straighten the leg
- Deep belly breathing: 5 minutes, 3–5 times a day
- Gentle draw-in: 5 reps, hold 5 sec. Lie on your back with your knees bent. Breathe out and gently tighten your lower belly. Keep breathing normally
- Log roll (getting in and out of bed): your physiotherapist will show you
- Hip-hinge practice: 5 reps. Stand tall with your feet shoulder-width apart. Push your hips back, soften your knees and tip your chest forward, keeping your back straight. Squeeze your buttocks to stand up
- Neural glide (as needed): use it when your leg feels tight or sticky. 10 slow reps per leg, up to 2–3 times a day. Lie on your back and hold the back of your thigh, with your hip bent. Slowly straighten your knee as you point your foot away. Then bend your knee as you pull your toes up. Stop if you feel leg pain, tingling or numbness
‣
‣
‣
‣
‣
‣
‣
Moving-on checks
- Wound is clean, dry and healing
- Walking for 10 minutes at a time feels comfortable
- Leg symptoms are settling, with no new weakness
- Log roll and hip-hinge feel easy
Phase 2 (2 to 6 weeks): Initial strengthening phase
Therapy
- Physiotherapy 1–2 times a week, for 4 weeks or more
- Home exercises 2–3 times a day
Precautions
- Lifting: add weight slowly. Dr. Chaudhary and your physiotherapist will raise your limit step by step
- Keep your back in its natural, neutral position during strengthening. Do not move on without good control
- No arching backwards until Dr. Chaudhary clears you (usually at your 6-week review)
- No twisting or rotation exercises until 8 weeks
- Sit for no more than 30 minutes at a time
Goals
- Do light strengthening with a steady, neutral spine
- Walk 20–30 minutes a day
- Loosen scar tissue and tight muscles (once the wound has fully healed)
- Move and lift safely on your own
Cardio
- Walking: start at 5–10 minutes, building to 20–30 minutes a day, in one go or in sessions
- Stationary bike: from week 4. Start with no resistance, 10–20 minutes
Strength (start only when Phase 1 feels easy)
- Draw-in with leg movement: 10 reps, hold 10 sec. Slowly lift one foot off the floor and put it back. Keep your lower back still
- Hands-and-knees brace: 10 reps, hold 5–10 sec. Keep your back flat, not sagging or arching
- Bridge (two legs): 10 reps, hold 5 sec. Tighten your belly, squeeze your buttocks and lift your hips. Do not arch your back
- Partial wall squat: 10 reps, hold 5 sec. Stand with your back against a wall and your feet a small step forward. Slide down to about 60° (a quarter squat) with your back flat on the wall. Slide back up
- Pelvic clocks (lying on your back): 10 reps
‣
‣
Flexibility
- Single knee-to-chest stretch: 5 reps each leg, hold 20–30 sec
- Double knee-to-chest stretch: 5 reps, hold 20 sec
- Gentle stretches for hamstrings, calves and hip flexors. Skip the hamstring stretch if you have leg pain
- Neural glides: as needed, gently. Do not flare up the nerves
‣
‣
Water therapy (from 3 weeks, once the wound is completely healed)
- Optional
- Walking in all directions, balance work, and gentle arm and leg strengthening
- Tighten your belly during every exercise. No twisting
Your physiotherapist may also
- Do grade I–II joint mobilisations (gentle, small movements)
- Massage the scar once the wound has fully healed
- Loosen tight muscles in your lower back and buttocks
Moving-on checks
- Dr. Chaudhary is happy with your progress at review
- Walking 20–30 minutes, in one go or in sessions, without leg symptoms getting worse
- You can hold the draw-in for 10 seconds while breathing normally
- Pain is mild and settling, with no new numbness or weakness
Phase 3 (6 to 12 weeks): Progression to advanced strengthening
Therapy
- Physiotherapy 1–3 times a week, as needed for return to work or sport
- Home exercises daily
Precautions
- No twisting or rotation exercises until 8 weeks. After that, add them slowly
- Keep your back neutral during strengthening
- Watch for leg symptoms coming back as you do more
Goals
- Do your advanced exercises on your own at home
- Build stronger core, hip and leg muscles
- Full activity release at 6–8 weeks, when Dr. Chaudhary approves
Strength
- Bird-dog (hands and knees, opposite arm and leg lift): 10 reps/side, hold 5–10 sec. Imagine a tray with a glass of water on your back. It should not spill
- Bridge with draw-in: 10–15 reps. Move to a single-leg bridge when the two-leg bridge feels easy
- Side plank (knees bent): 5–10 sec hold, 5–8 reps/side
- Front plank (knees bent): 5–10 sec hold, 5 reps. Rest on your forearms and knees, in a straight line from head to knees. Tighten your belly. Do not let your hips sag
- Dying bug: 10 reps/side. Lie on your back with your hips and knees bent to 90° and your arms pointing to the ceiling. Draw your belly in. Slowly lower the opposite arm and leg towards the floor, then bring them back. Keep your lower back flat. Stop if it starts to arch
- Seated draw-in with marching: 10 reps/leg
- Squats and step-ups: 10 reps, 2 sets
- Upper body strengthening: light pull-downs, rows and chest press with a band or machine
‣
‣
‣
Flexibility
- Standing hip flexor stretch: 30 sec hold, 3 reps/leg
- Gentle hamstring stretch (only if no leg pain): 30 sec hold, 3 reps/leg
- Gentle backward bending (only after Dr. Chaudhary clears you): start lying face down, then on your elbows, then standing. Stay in a comfortable range. Stop if leg pain or tingling starts. Never push to the end of the range
‣
‣
Cardio
- 20–30 minutes continuous: walking, stationary bike, cross-trainer, swimming
- Check your equipment set-up and posture before you start
Moving-on checks
- Dr. Chaudhary has released you to full activity
- Bird-dog and bridge are done with a steady spine
- 20–30 minutes of cycling or walking without symptoms
- Daily tasks feel easy
Phase 4 (3 to 6 months): Return to full activity
Therapy
- Physiotherapy weekly or every 2 weeks, as needed
- Home programme 3–5 times a week
Precautions
- Avoid heavy impact until Dr. Chaudhary or your physiotherapist clears you
- Avoid forcing your back backwards as far as it will go
- Watch for leg symptoms during harder movements
Goals
- Go back to your job and sport
- Strengthen your whole body
- Move naturally and confidently
Exercises
- Lunges (bodyweight): 2 sets of 10 each side
- Squats with core engagement: 3 sets of 10. Tighten your belly before you squat
- Standing resistance band diagonals: 2 sets of 10
- Side plank with leg lift: 2 sets of 5 reps/side
- Walking on varied ground: 30–45 minutes, including slopes
- Graded lifting practice: build up slowly with your physiotherapist. Use your hip-hinge every time. Step to turn instead of twisting
- Walk-run programme (if you want to run): start on a treadmill with your physiotherapist after 12 weeks
- Work and sport drills: based on your job or sport
When can I start?
Activity | No earlier than |
Walking | Start now, keep building |
Stationary bike | 4 weeks |
Water therapy | 3 weeks, once the wound is completely healed |
Swimming | 6 weeks |
Full activity | 6–8 weeks, when Dr. Chaudhary approves |
Walk-run | After 12 weeks |
Discharge criteria
- ODI/RMDQ shows functional improvement
- You walk for 30 minutes or more without leg symptoms
- Back extensor endurance: you hold the Sorensen test for about 180 seconds (physiotherapist to test)
- You do your home programme on your own
- You are back to daily activities and/or work without restrictions
- Sport or job-specific drills are done without pain, if returning to either