Your thoracolumbar region is the area in your spine where your thoracic vertebrae meet your lumbar vertebrae, about two-thirds of the way down your spine. Surgery to this area is necessary if you have sustained a traumatic injury to your spine, damaging your vertebrae or your vertebral discs, or as a result of a degenerative disease of the bone that weakens it to the point of failure. The type of surgery you have depends on the cause and extent of your injury. Some surgeries require the insertion of metal pins and rods to hold your spine together while other surgeries attempt to fuse your bones together. Regardless of the type of surgical intervention, thoracolumbar surgery requires postoperative physical therapy in order for you to be able to return to normal daily life. Physical therapy progresses in stages and can begin almost immediately after surgery and can last several years. Consult your physician to determine what kind of post-surgery physical therapy is right for you.
Stage 1
The first stage, also called the acute phase, of physical therapy involves specific modalities to reduce swelling and inflammation in your thoracolumbar region as a result of your surgery. This typically involves the use of cryotherapy, or cold therapy, which can include placing ice packs or circulating cold water over the area of your spine containing the inflammation. Cooling down the soft tissues of your back will help reduce inflammation by restricting blood flow, as well as provide temporary pain relief. You may also be prescribed nonsteroidal anti-inflammatory medications to further control inflammation in your thoracolumbar region. This stage may last several days to over a week, depending on the extent of your surgery.
Stage 2
Once the inflammation and swelling in your back has started to subside, your physical therapist may begin the second stage of rehabilitation. In this stage, the goal is to increase your range of motion and flexibility around your spine. This involves using various kinds of stretching exercises, as well as deep tissue massage and ultrasound therapy. By using these recovery tools, the muscles, ligaments, and tendons that support your thoracolumbar region will regain the flexibility they are likely to have lost as a result of your injury and subsequent surgery. This stage can last weeks to months following surgery.
Stage 3
After surgery, the muscles that support your spine may atrophy, or loose size and strength. Your physical therapist will prescribe a series of strength training exercises that are designed to increase muscle size and strength in your back and other areas that were affected by your surgery. By doing so, you can reduce the risk of re-injury because the muscles that move and support your back will be able to effectively stabilize your spine, especially when you are in motion. This stage of physical therapy is expected to last several months to two years following your thoracolumbar surgery.
Stage 4
Even after you have been cleared to return to normal daily activity, you still may be required to perform a long-term physical rehabilitation program. Long-term physical rehabilitation typically involves a continuation of some of the range of motion and strength training exercises you were given in the second and third stages of physical therapy. This is to ensure the muscles, tendons, and ligaments that support your spine remain strong and balanced, reducing the risk of reinjury in the future. Long-term physical rehabilitation can last for several years following your surgery.
References
- "Therapeutic Exercise: Foundations and Techniques (5th edition)"; Carolyn Kisner and Lynn Colby; 2007
- "Introduction To Physical Therapy"; Michael A. Pagliarulo; 2011
