Rehab protocol following lumbar discectomy

Reviewed by Dr. Kshitij Chaudhary, Last reviewed October 2026

How to use this plan

This plan is for you and your physiotherapist to follow together. It tells you what to do, how often, and when to move on.

• You: do the home exercises every day and note how your back and leg feel.
• Your physiotherapist: checks your technique, adjusts the exercises and decides when you are ready for the next phase. They should record your ODI or RMDQ score and pain score at the start, at 6 weeks and at 12 weeks.
• Dr. Chaudhary: reviews your wound and recovery at your follow-up visits and tells you when it is safe to progress.

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 are not there yet, stay in the same phase for another week or two. That is normal.

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): Immediate postoperative

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)
• 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

Goals

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

Education

• Body mechanics: log roll to get in and out of bed. Use the hip-hinge every time you need to reach down. Your hospital physiotherapist will show you both before you go home (see the exercises below)
• Posture: sit upright on a firm chair with your lower back supported. Change position often

Exercises (2–3 times a day unless noted)

1. Walking: begin with 5 minutes, 3–4 times a day. Progress by 1–2 minutes daily
2. Pelvic tilt (lying on your back): 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 minutes, 3–5 times a day. Reduces sympathetic drive
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5. Log roll (getting in and out of bed): your hospital physiotherapist will show you before you go home
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6. Neural glide (lying on your back): 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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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

Phase 2 (2 to 6 weeks): Early recovery

Therapy

• Supervised physiotherapy 2 times a week
• Home exercises 2–3 times a day

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

Goals

• Start waking up your deep core muscles
• Restore lower back and hip movement
• Walk normally again

Cardio

• Walking: 15–30 minutes daily, broken into sessions
• Stationary bike: from week 3, once your core control is good. Keep your lower back's natural curve and do not slouch or let your hips sway
• Water therapy and swimming: from 2–3 weeks, once the wound is completely healed and Dr. Chaudhary says you can go in water. Swim freestyle only, without craning your neck up to breathe. No jumping or diving. No butterfly or breaststroke

Strength

1. Transversus abdominis (TA) activation, draw-in (lying on your back): 10 reps, hold 10 sec. Cue: "Gently pull belly button toward spine"
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2. Multifidus activation (lying face down or on hands and knees): 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 (quadruped)
3. Pelvic clocks (lying on your back): 10 reps. Improves control of your lower back and pelvis
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4. 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.

Flexibility

1. Single knee-to-chest stretch: 10 reps each leg, hold 20–30 sec
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2. Lower trunk rotation (lying on your back): 10 reps
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3. Double knee-to-chest stretch: 5 reps, hold 20 sec
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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

Phase 3 (6 to 12 weeks): Intermediate

Therapy

• Home exercises daily
• Supervised physiotherapy 2–3 times a week

Precautions

• Keep your back in its natural, neutral position during exercises
• Watch for leg pain coming back as you do more

Goals

• Improve control and stability while moving
• Build endurance
• Increase range of movement

Strength

1. Bird-dog (hands and knees, opposite arm and leg lift): 10 reps/side, hold 5–10 sec. Your spine should not move. Imagine a tray with a glass of water on your back. It should not spill.
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2. Bridge with TA activation: 10–15 reps. Add a 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. 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.
6. 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.

Flexibility

1. Standing hip flexor stretch: 30 sec hold, 3 reps/leg
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2. Gentle hamstring stretch (only if no leg pain): 3 reps/leg, 30 sec hold
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Cardio

• Stationary bike, walking or swimming: 20–30 minutes of continuous aerobic exercise

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

Phase 4 (3 to 6 months): Advanced and functional

Therapy

• Home programme 3–5 times a week
• Physiotherapy weekly or every 2 weeks, as needed

Precautions

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

Goals

• Return to work and sport
• Strengthen your whole body
• Move naturally and confidently

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 or resistance band diagonals: 2 sets of 10 reps. Connects your core with everyday movement
4. Walking on varied ground: 30–45 minutes
5. Side plank with leg lift: 2 sets of 5 reps/side
6. Seated leg extensions: 2 sets of 10
7. Return-to-sport drills and work simulation tasks: based on your needs

When can I start?

Discharge criteria

• ODI/RMDQ shows functional improvement
• Full range of movement and core endurance without compensation
• Independent home programme
• Return to daily activities and/or work without restrictions
• Back extensor endurance: hold the Sorensen test for about 180 seconds (physiotherapist to test)
• Sport or job-specific drills done without pain, if returning to either

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. 🏃🏾About Dr. Chaudhary