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 a lumbar fusion, including keyhole (minimally invasive) TLIF. Most people walk the day after surgery and go home in 2 to 3 days. The bone then takes 3 to 6 months to knit and keeps getting stronger for up to a year. Recovery is steady, not fast, and 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. If you had a multi-level fusion or an open operation, move through the phases more slowly. Your physiotherapist should record your ODI or RMDQ score and pain score at the start, at 12 weeks and at 6 months.
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 pain much worse than before surgery
- Calf pain or swelling, or sudden breathlessness
- 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, bladder or bowel problems, or sudden breathlessness, 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 at home
Therapy
- Your first physiotherapy visit is at 2 weeks after surgery (outpatient)
- Until then, do the home programme below
Precautions
- No bending forward at the waist, no lifting and no twisting. Lift nothing heavier than 10 lb (4.5 kg)
- Sit for no more than 30 minutes at a time, including in the car. Stand up and walk for a minute before sitting again
- Avoid anti-inflammatory painkillers (ibuprofen, diclofenac and similar) for 6 months, as they may slow bone healing. Paracetamol is fine
- A back brace is optional. Dr. Chaudhary will tell you if you need one.
- 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
- Walk every day
- Learn to get out of bed and bend safely
- Wake up your deep belly and buttock muscles
- Build walking up to 10 minutes at a time
Education
- If you smoke, STOP, and stay stopped. It is the biggest thing you can do to help the bone heal. Smoking raises the chance that the fusion does not heal.
- Look after your bones. Eat enough protein, get some sunlight, and ask us about calcium and vitamin D
- 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
- Ankle pumps: 20 reps per leg, every hour you are awake. Keeps the blood moving in your legs
- Buttock squeezes (glute sets): 10 reps, hold 10 sec
- Deep belly breathing: 5 minutes, 3–5 times a day
- Gentle draw-in: 5 reps, hold 10 sec. Lie on your back with your knees bent. Breathe out and gently tighten your lower belly. Keep breathing normally. Do not tilt your pelvis
- 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
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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 12 weeks): Physiotherapy and core control
Therapy
- Physiotherapy 2–3 times a week, for 4 weeks or more
- Home exercises 2–3 times a day
Precautions
- Still no bending, lifting more than 10 lb (4.5 kg), or twisting until 12 weeks
- Keep your back in its natural, neutral position during every exercise. Do not move on without good control of your deep belly muscles
- Sit for no more than 30 minutes at a time
- Driving: wait until you have stopped opioid painkillers and can brake hard without pain. For most people this is 4 to 6 weeks
- Desk work: most people go back at about 6 to 12 weeks. Talk to us before going back to heavier work
Goals
- Switch on your deep belly and buttock muscles without moving your spine
- Walk 30 minutes twice a day by 6 weeks
- Loosen scar tissue and tight muscles (once the wound has fully healed)
- Move and sit with good posture
Cardio
- Walking: build from 10 minutes to 30 minutes, twice a day, in one go or in sessions
- Stationary bike: from week 4. Start with no resistance, 10–20 minutes
- Water walking is optional, from 3 weeks, once the wound is completely healed. Walk in all directions and tighten your belly during every exercise. No twisting
Strength (start only when Phase 1 feels easy)
- Draw-in in different positions: 10 reps, hold 10 sec. Do it lying, on hands and knees, sitting and standing, breathing normally
- Supine marching: 10 reps/leg. Lie on your back with your knees bent. Draw your belly in, then slowly lift one foot and put it back. Keep your lower back still
- Bridge (two legs): 10 reps, hold 5 sec. Tighten your belly, squeeze your buttocks and lift your hips. Do not arch your back
- Hands-and-knees brace: 10 reps, hold 5–10 sec. Keep your back flat, not sagging or arching
- Bird-dog (opposite arm and leg lift): 10 reps/side, hold 5 sec. Start with the arm only, then the leg only, then both
- Side-lying clams: 10 reps/side
- 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). Slide back up
- Pelvic clocks (lying on your back): 10 reps
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Flexibility
- Gentle stretches for hamstrings, calves and quadriceps. Tighten your belly while you stretch, so your back is not pulled
- Hip flexor stretch: only from about 8 weeks, once Dr. Chaudhary agrees
- Neural glides: as needed, gently. Do not flare up the nerves
Your physiotherapist may also
- Do grade I–II joint mobilisations (gentle, small movements) on the upper back and shoulders, and above and below the fused area
- Massage the scar once the wound has fully healed
- Loosen tight muscles in your buttocks and thighs
- Avoid testing how far your lower back bends in the early weeks
Moving-on checks
- Dr. Chaudhary is happy with your progress and X-rays at review
- Walking 30 minutes, twice a day, 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 (12 weeks to 6 months): Strengthening phase
Therapy
- Physiotherapy 1–3 times a week, as needed
- Home exercises daily
Precautions
- Build your lifting limit up slowly with your physiotherapist, to about 40 lb (18 kg) by 6 months. Always use your hip-hinge
- Keep twisting to a minimum, even after you have healed. Step to turn with your feet instead of twisting from your back
- Watch for leg symptoms coming back as you do more
Goals
- Build stronger core, hip and leg muscles with a steady, neutral spine
- Do your exercises on your own at home
- Walk 30–45 minutes comfortably
Strength
- 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, then feet): 5–10 sec hold, 5 reps. Rest on your forearms, 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
- Seated draw-in with marching: 10 reps/leg
- Squats and step-ups: 10 reps, 2 sets
- Leg press and standing hip work: light weights, 10 reps, 2 sets
- Upper body strengthening: light rows, pull-downs and chest press with a band or machine. Avoid heavy overhead pressing
- Balance with draw-in: single-leg stance, then tandem stance, then a foam pad
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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
- Light, controlled bending and arching, in a comfortable range
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Cardio
- 20–30 minutes continuous: walking, stationary bike, cross-trainer
- Swimming from 12 weeks
- Check your equipment set-up and posture before you start
Moving-on checks
- X-rays look good at your review
- Bridge, bird-dog and planks are done with a steady spine
- 30 minutes of walking or cycling without symptoms
- Daily tasks feel easy
Phase 4 (6 to 12 months): Return to full activity
Therapy
- Physiotherapy every 1–2 weeks, as needed
- Home programme 3–5 times a week
Precautions
- Walk-run only from 6 months, and only once your X-ray looks fine
- Sports only after Dr. Chaudhary clears you, typically 9 to 12 months after a successful rehab
- Avoid repeated twisting and heavy impact until you are cleared
Goals
- Go back to your job and daily activities fully
- Keep your whole body strong
- 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 pulls: 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
- Walk-run programme (6 months onwards): start on a treadmill with your physiotherapist. Alternate walking and short jogs, then build up slowly
- Work drills: based on your job, with supervision
When can I start?
Activity | No earlier than |
Water walking (optional) | 3 weeks, once the wound is completely healed |
Stationary bike | 4 weeks |
Walking 30 minutes, twice a day | 6 weeks |
Swimming | 12 weeks |
Pilates and yoga (experienced instructor, no deep twists) | 4 months, after Dr. Chaudhary clears you |
Walk-run, then build up | 6 months, once your X-ray looks fine |
Sports | Only after Dr. Chaudhary clears you, typically 9 to 12 months |
Discharge criteria
- ODI/RMDQ shows functional improvement
- You walk for 30 minutes or more without leg symptoms
- X-rays show the fusion is healing well, as reviewed by Dr. Chaudhary
- 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
Note for physiotherapists
- Keep the spine neutral for all strengthening. Do not test end-range lumbar movement or resisted hip flexion in the early weeks
- Progress multi-level and open fusions more slowly
- Contact Dr. Chaudhary if the patient has signs of infection, worsening leg symptoms or progressive weakness, or pain much higher than before surgery