Rehab protocol following lumbar discectomy

Goals:

• Pain control
• Promote gentle movement
• Decrease fear and improve confidence
• Keep the nerve gliding freely so it does not stick to scar tissue

Exercises (2–3x/day unless noted):

1. Walking:
• Begin with 5 minutes, 3–4 times/day
• Progress by 1–2 minutes daily
2. Pelvic Tilt (Supine)
• 10 reps, hold 5 sec
• Promotes gentle lumbar mobility
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3. Ankle Pumps
• 20 reps per leg
• Prevents DVT
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4. Deep Diaphragmatic Breathing
• 5 mins, 3–5x/day
• Reduces sympathetic drive
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5. Log Roll Training (Bed Mobility)
• With instruction from PT
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6. Neural Glide (Supine)
• 10 slow reps per leg, 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. Move smoothly. A mild pull behind the knee is fine. Stop if you feel leg pain, tingling or numbness.
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7. Hip-Hinge Practice
• 5 reps, 2–3 times a day
• 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. Use this every time you need to reach down.
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Precautions:

• No lifting more than 10 lb (4.5 kg)
• Avoid sitting for more than 20 minutes at a time. Sit on a firm chair with your back supported, and stand up and walk for a minute before sitting again
• No forward bending at the waist or twisting
• Sleep on your back with a pillow under your knees, or on your side with a pillow between your knees. Do not curl up in the fetal position

Moving-on checks:

• Wound is clean, dry and healing
• Walking for 10 minutes at a time feels comfortable
• Leg pain is settling, with no new weakness
• Log roll and hip-hinge feel easy

Goals:

• Initiate core activation
• Restore lumbar and hip mobility
• Normalize gait

Frequency: 2–3x/day at home, supervised PT 2x/week

Exercises:

1. Transversus Abdominis (TA) Activation – Supine Draw-In
• 10 reps, hold 10 sec
• Cue: “Gently pull belly button toward spine”
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Transversus Abdominis Bracing #exercise #strength #abdominals #physicaltherapy #abs
Transversus abdominis is an extremely important muscle in core strength and stability. This muscle helps support your abdominal wall and also your lower back when doing every day movements and lifting tasks. 💪 In order to engage this muscle, the cue of gently squeezing like you are trying to stop from going to the bathroom works well for most people. However, a lot of patients that we see over-contract this muscle and are working other muscles instead. Try to go for about 20% of your maximum contraction to really get the right muscle. It may not feel like much, but this specific muscle can be hard to figure out how to engage! We'll have our patients start to engage this muscle throughout the day to practice. Let us know if you've heard of this muscle before in the comments! ⬇️ https://wildhawkphysicaltherapy.com/ 📞 828-365-8133

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2. Multifidus Activation (Prone or Quadruped)
• 10 reps/side, hold 5–10 sec
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How to do it?
1. Lie face down (prone) on a firm surface, arms relaxed by your side.
2. Place a small pillow under your stomach if needed for comfort.
3. Identify the multifidus: It’s located beside the spine in the lower back. Place your fingers just lateral to the spinous processes (e.g., L4–L5).
4. Without moving your pelvis or spine, try to gently swell the muscle under your fingers. Cue:
• “Gently push your lower back into your fingers without arching or lifting your pelvis.”
5. You should feel a subtle bulging or tightening under your fingers.
6. Hold for 5–10 seconds. Repeat 10 times.
⚠️ Tips:
• Avoid using glutes or hamstrings (common compensations).
• It should be a deep, small contraction—not a large movement.
• Use a mirror or PT biofeedback (e.g., ultrasound or pressure biofeedback device) if available.
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Video (prone)
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Video (quadruped)
3. Single Knee-to-Chest Stretch
• 10 reps each leg
• Hold 20–30 sec
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4. Lower Trunk Rotation (Supine)
• 10 reps
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5. Double Knee-to-Chest Stretch
• 5 reps, hold 20 sec
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6. Walking
• 15–30 min daily, broken into sessions
7. Pelvic Clocks (Supine)
• Improve neuromotor control
• 10 reps
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8. Partial Wall Squat
• 10 reps, hold 5 sec at the bottom
• Stand with your back against a wall and your feet a small step forward. Slide down slowly until your knees bend to about 60° (a quarter squat). Keep your back flat on the wall. Slide back up.

Precautions:

• Avoid end-range lumbar flexion
• If leg pain is present, skip the hamstring stretches and keep doing the gentle neural glides from Phase 1

Moving-on checks:

• Dr. Chaudhary is happy with your progress at review
• Walking for 30 minutes, in one go or in sessions, without leg pain 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

Goals:

• Improve dynamic stabilization
• Build endurance
• Increase range of motion

Frequency: Home: Daily. Supervised PT: 2–3x/week

Exercises:

1. Bird-Dog (Quadruped Alternate Arm/Leg Lift)
• 10 reps/side, hold 5–10 sec
• Spine should not move, Imaging a tray with glass of water on your back, It should not spill.
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2. Bridge with TA Activation
• 10–15 reps
• Add resistance band after 8 weeks if tolerated
• Once the two-leg bridge feels easy, try a single-leg bridge
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3. Side Plank (Knees Bent)
• 5–10 sec hold, 5–8 reps/side
• Progress to full side plank as tolerated
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4. Seated TA Activation with Marching
• 10 reps/leg
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5. Standing Hip Flexor Stretch
• 30 sec hold, 3 reps/leg
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6. Gentle Hamstring Stretch (ONLY if no leg pain)
• 3 reps/leg, 30 sec hold
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7. Stationary Cycle / Walking
• 20–30 min continuous aerobic exercise
8. 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.
9. 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.

Precautions:

• Maintain spinal neutral during exercises
• Watch for leg pain recurrence with increased activity

Moving-on checks:

• Bird-dog and bridge are done with a steady spine
• 20–30 minutes of cycling or walking without symptoms
• Daily tasks feel easy

Goals:

• Return to work/sport
• Strengthen global musculature
• Normalize movement patterns

Frequency: Home program 3–5x/week, PT weekly or biweekly as needed

Exercises:

1. Lunges (Bodyweight or Assisted)
• 2 sets of 10 each side
2. Squats with Core Engagement
• 3 sets of 10
• Cue: “Engage core before squat”
3. Standing Cable Chops / Resistance Band Diagonals
• 2 sets of 10 reps
• Integrates core with functional movement
4. Walking Program with Variable Terrain
• 30–45 min
5. Side Plank with Leg Lift
• 2 sets of 5 reps/side
6. Open Kinetic Chain Leg Extensions (Seated)
• 2 sets of 10
7. Return-to-sport drills / Work Simulation Tasks
• Based on patient needs

Precautions:

• Avoid impact and deep forward bending until cleared
• Monitor for neural symptoms during advanced movements