This document provides guidance on rehabilitation for non-operative and operative back pain. It discusses assessing abnormalities and treating to correct them. For severe back pain, it recommends reducing pain and inflammation through comfort positions, movement, medications, modalities, and exercise away from aggravation. For sub-acute back pain, it recommends manual therapy, restoring range of motion and flexibility/strength training. Post-episode, it recommends modifying activities, correcting biomechanical abnormalities, and implementing a home exercise regime. Core stability and stabilization exercises are emphasized for retraining deep muscles to maintain functional stability. Post-operative rehabilitation focuses on early mobility, exercises in neutral spine, and functional control prior to discharge with a home program.

1. How to Manage
Non-operative and Operative
BACK REHABILITATION

2. REHABILITATION PRINCIPLE
• Assess any Abnormality and treat to correct
the Abnormality

3. SEVERE LOW BACK PAIN
• AIM TO REDUCE PAIN AND INFLAMMATION
• COMFORT POSITONS – NEUTRAL SPINE
• ENCOURAGE MOVEMENT THAT RELIEVES
• BED REST<48HRS
• +/- TAPING
• ANALGESIA /NSAIDS
• LOCAL MODALITIES FOR PAIN/SPASM ( HEAT, ICE , ELECTRO, MANUAL
TH.)
• EXERCISE AWAY FROM AGGRAVATION
• WATCH FOR NEURAL SIGNS

4. SUB-ACUTE LOW BACK PAIN
OFTEN WITH ASSOC. MUSCLE SPASM / IRRITATION, INCREASED NEURAL
TENSION
HYPOMOBILE SEGMENTS –UTILISE MANUAL THERAPY
• POOR POSTURES, BIOMECHANICS
• REDUCE PAIN / INFLAMMATION
• RESTORE ROM ( MANUAL THERAPY, EXERCISE)
• FLEXIBILITY AND STRENGTH
• CARDIO FITNESS
• EDUCATION

5. REHABILITATION AFTER BACK
PAIN EPISODE
• MODIFY ACTIVITIES
• CORRECT BIOMECHANICAL ABNORMALITIES
• POSTURAL ASSESSMENT OF FUNCTIONAL POSITIONS
• LIFTING MECHANICS
• CORE STABILITY : LOCAL THEN GLOBAL
• ASSESS / STRETCH TIGHTNESS
• EDUCATION
• HOME EXERCISE REGIME

6. FUNCTIONAL STABILITY
NEED TO UTILISE BOTH MUSCLE FORCES AND PASSIVE STRUCTURES TO
DYNAMICALLY STABILISE THE SPINE FUNCTIONALLY
ANY DEFICITS ASSESSED NEED TO BE ADDRESSED IN A REHAB. PLAN

7. CORE STABILITY
• MUSCULAR CONTROL TO MAINTAIN FUNCTIONAL STABILITY
• MUSCULAR CORSET
• STABILITY INVOLVES PASSIVE AND ACTIVE STIFFNESS
• INSTABILITY WHEN EITHER COMPONENT DISTURBED

8. CORE STABILITY
• GLOBAL : DYNAMIC / PHASIC MUSCLES = ACTIVE TRUNK MOVEMENT
• RECTUS ABDOMINIS
• EXTERNAL OBLIQUES
• ILIOCOSTALIS (THORACIC PART)
• LATISSIMUS DORSI
• LINK PELVIS TO THORACIC CAGE

9. CORE STABILITY
• LOCAL : POSTURAL / TONIC = INTERSEGMENTAL STABILITY
• TRANSVERSUS ABDOMINIS
• MULTIFIDIS
• PSOAS MAJOR
• QUADRATUS LUMBORUM
• DIAPHRAGM
• ILIOCOSTALIS ( LUMBAR SEGMENT)
• INTERNAL OBLIQUE

10. STABILITY TEACHING/RETRAINING
• EDUCATION : ANATOMY AND FUNCTION
• ISOLATE DEEP LAYER T.A
• MOTOR RELEARNING
• TRAIN STABILISERS IN ISOLATION
• ADD FUNCTIONAL MOVEMENTS WITH STABILITY
• PAINFREE
• NEUTRAL SPINE INITIALLY
• FEEDBACK : TACTILE , PBU, ULTRASOUND

11. STABILISATION EXERCISES
• INITIATE PELVIC FLOOR HELPS ISOLATE T.A.
• PALPATE 1CM IN 1CM DOWN A.S.I.S.
• FEEL TENSION, NOT BULGE
• CONTROLLED BREATHING
• SUPINE / 4 POINT KNEEL / STANDING / SITTING

12. STABILISATION EXERCISES
• ISOMETRIC ABDOMINALS IN
SUPINE
• SIDE LYING + GLUTEUS
MEDIUS
• SUPINE BRIDGE
• ABDOMINAL CURL
• 4 PT KNEEL
• PRONE PLANK
• SIDE PLANK
• STANDING LUNGES
• STEP UPS
• GYM BALL SEATED
• GYM BALL LIFTING
• BALANCE DISC

13. POST-OPERATIVE REHABILITATION
• UNDERSTANDING THE SURGERY
• REALISTIC GOALS / TIMELINES
• PAIN CONTROL
• EARLY EXERCISE
• EARLY MOBILITY
• DISCHARGE WITH REHABILITATION PACKAGE

14. POST-OPERATIVE EXERCISE
• NEUTRAL SPINE
• INTERSEGMENTAL STABILITY REGIME
• GLOBAL ABDO WORK
• ADDRESS SPECIFIC WEAKNESS
• MOBLISE DAY 0 OR 1
• FUNCTIONAL ABDOMINAL CONTROL, GAIT
• AVOID NEURAL STRETCH

15. POST-OPERATIVE DISCHARGE
• DISCECTOMY : DAY 0
• LAMINECTOMY : DAY 1/2
• FUSION : DAY 2/4

16. 3 WEEK POST-OPERATIVE REVIEW
• WOUND REVIEW
• OSWESTRY
• PAIN ISSUES
• ACTIVITY LEVEL
• EXERCISE UPGRADE
• STABILITY
• GYM, BALL, POOL, CARDIO INCREASE

17. 6 WEEK POST-OPERATIVE REVIEW
• WITH SURGEON
• OSWESTRY
• PROGRESSIVE BACK CARE
• INVOLVE EX.PHYSIOLOGIST / GYM / WORKPLACE
• SELF MANAGED PLAN

18. MULTIMODAL ROLE
• UNDERSTANDING
• RELATIONSHIP
• EARLY ACTIVITY
• EARLY EXERCISE
• EARLY MOBILITY
• SHIFT ONUS OF RESPONSIBILITY
• SELF MANAGEMENT

19. STRETCHING
• LUMBAR ROTATION
• LUMBAR FLEXION
• HIP FLEXION
• HIP EXTENSION
• HIP ADDUCTION
• STRAIGHT LEG RAISE
• DEEP HIP ROTATORS
• THORACO-LUMBAR ROTATION
• LUMBAR EXTENSION

20. ASSESSING FUNCTIONAL CORE
STABILITY
• MANUAL SHEAR TEST
• LUMBAR TORSION TEST
• PRONE BRIDGE
• LATERAL BRIDGE
• SEATED TORSO FLEXION
• PRONE EXTENSOR ENDURANCE TEST
• SINGLE LEG SQUAT

21. CONDITIONING
• GENERAL AEROBIC FITNESS
• POSTURAL CORRECTION
• 20-30 MINUTE PERIODS
• WEIGHT LOSS
• POSITIVE RATHER THAN PURELY CLINICAL SETTING
NORMALISE SETTING : TAI CHI, PILATES, YOGA, GYM CLASSES, SWIM
FOCUS ON SELF MANAGEMENT