19.6. Illustrated Exercise Library After Endoscopic Surgery
@ProfFishchenkoVideo demonstrations help review the techniques of exercises the patient has already learned with the physical therapist. For home sessions, the specialist selects movements according to the procedure performed, residual weakness, and current stage of recovery. Repetitions, holding time, and resistance are specified in the personal exercise plan.
The materials provided concern recovery after lumbar endoscopic procedures. The session sequence after discectomy is described in §19.2, after decompression for stenosis in §19.3, and after BELIF/UBE-LIF in §19.4. Neck and shoulder girdle exercises are addressed in §19.5.
Initial stage
Begin with simple movements lying down. The physical therapist checks free breathing, pelvic control, and the absence of excessive lumbar strain. Demonstrations in this block are taken from the exercise program for the first postoperative week.
1. Foot movements
Lie on your back, straighten your legs, and place your arms alongside your body. Alternate pointing your feet away from and toward you, then make smooth circles in both directions.
2. Knee flexion with a heel slide
Lying on your back, slowly bend one knee while sliding your heel along the surface. Return the leg to the starting position and repeat with the other leg.
3. Squeezing a ball or pillow between the knees
Lie on your back, bend your legs, and place a soft ball or pillow between your knees. As you exhale, gently draw in your abdomen and squeeze the ball, then relax the muscles. Continue breathing while holding the contraction.
4. Isometric gluteal activation
Lie on your back with your legs straight. Slowly contract and relax the gluteal muscles while breathing calmly. Keep the pelvis on the surface.
Further recovery of movement control and strength
Progress to more complex variations after mastering simpler ones. After discectomy, exercises with elastic resistance, pelvic lifting, and movements on all fours are selected according to the program for weeks two to four in §19.2. After decompression for stenosis, balance and leg strength are considered. After BELIF/UBE-LIF, progression timing is determined according to fixation and the operating surgeon's restrictions. The following demonstrations are taken from the first and second parts of the postoperative exercise program.
5. Knee abduction with an elastic band
Lie on your back, bend your legs, and place an elastic band around your knees. Slowly move your knees apart to stretch the band, then return them to the starting position in a controlled manner. The physical therapist selects the initial resistance.
6. Diagonal extension on all fours
Support yourself on your palms and knees. Smoothly extend one arm forward and the opposite leg backward without lifting them high. Keep the pelvis stable and avoid increasing the lumbar arch. Return to the starting position and change sides.
7. Low pelvic lift
Lie on your back, bend your knees, and rest your elbows and heels on the surface. Lift the pelvis a short distance, maintaining trunk control and avoiding excessive lumbar arching. Lower the pelvis smoothly.
8. Stretching the pelvic muscles
Lie on your back with your knees bent. Hold the lower leg near the ankle, rotate the knee outward, and, as you exhale, smoothly pull the foot toward you to a comfortable stretch. Return to the starting position and repeat with the other leg.
Monitoring performance
During home sessions, maintain the range and workload practiced with the physical therapist. If an exercise aggravates pain radiating into the leg, stop it. New numbness, weakness, or gait deterioration requires medical examination. The response to the session is also assessed the next day.
The rationale for exercise selection, gradual increases in activity, and session organization is provided in §19.1 and §19.2.
References
- Wang S., Yu H.-L., Zheng L., et al. Randomized controlled trial of overall functional exercise process in perioperative of percutaneous transforaminal endoscopic discectomy. Medicine. 2022;101(52):e32544. DOI.
- Newsome R.J., May S., Chiverton N., Cole A.A. A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study. Physiotherapy. 2009;95(4):273–279. DOI.
- Bono C.M., Leonard D.A., Cha T.D., et al. The effect of short (2-weeks) versus long (6-weeks) post-operative restrictions following lumbar discectomy: a prospective randomized control trial. European Spine Journal. 2017;26(3):905–912. DOI.
The study by Wang et al. concerns endoscopic discectomy. The studies by Newsome and Bono were conducted after other forms of lumbar discectomy; their results are considered indirect evidence regarding early activity and the duration of restrictions.