Physical therapy after back surgery: a recovery guide

There’s no getting around it: Recovering from back surgery is challenging. Right after surgery, you’ll be dealing with pain, stitches and wound care, reduced mobility, muscle weakness, and the effects of anesthesia. Exercise might be the last thing on your mind. But it’s important to start moving again after back surgery as soon as your doctor recommends — which might be sooner than you think. 

Movement after surgery can promote healing, reduce stiffness, strengthen muscles, improve circulation, reduce pain, boost your mood, and reduce post-surgical complications. Your doctor will provide guidelines for activity in the first days and weeks after surgery, including specific exercises and activities that are safe and beneficial for your recovery. 

Physical therapy is a key part of your recovery from back surgery. A well-structured rehabilitation program under the care of a physical therapist and tailored to your individual needs and specific surgery can help you regain strength and mobility, manage pain, speed up recovery, and prevent future injuries. 

Here, learn more about how physical therapy after back surgery can improve your recovery, the optimal timing for starting therapy, and the best post-surgery exercises and recovery tips from Hinge Health physical therapists.

Recovery after back surgery

There are many different types of back surgeries, each with its own recovery process. Common types of surgery include:

• Discectomy or artificial disc replacements. These involve removing all or a portion of a disc to relieve pressure on a nerve or address other disc problems.

• Laminectomy. This procedure removes part of the bone over the spinal cord to relieve pressure on nerves.

• Foraminotomy. Widens the passageways where nerve roots exit the spinal canal to relieve nerve compression.

• Spinal fusion. This surgery may use metal rods, screws, and sometimes bone grafts to fuse two or more vertebrae together to stabilize the spine. It can be used to treat disc problems, instability, spondylolisthesis, or other conditions.

• Spinal decompression. This describes any spine surgery performed to relieve pressure on the spinal cord or nerves.

Your healing and recovery timeline after back surgery will depend on your specific condition, surgery, and individual factors. Always follow your surgeon’s post-surgery instructions. In general, back surgery recovery might involve these phases:

Phases of recovery

• Immediate post-surgery (0-2 weeks). Your focus will be on managing pain with prescribed medications, proper wound care to prevent infection, and basic activities of daily living such as moving from bed to a chair and personal care. Your doctor will likely recommend gentle movement to help with recovery, and avoiding heavy lifting and bending. 

• Early recovery (2-6 weeks). Your focus will shift to reducing pain and increasing mobility. You may start to notice a decrease in pain but may still need pain medication. You may be able to gradually increase your activity level, but continue to avoid lifting anything heavier than a few pounds and avoid bending or twisting.

• Mid-recovery (6-12 weeks). You should notice significant improvements in your mobility and ability to perform daily activities. Depending on your job, you may be able to return to work, possibly with some restrictions. 

• Late recovery (3-6 months). You should see further improvements in strength, flexibility, and overall function. You may be able to return to most normal activities, including light to moderate exercise. 

• Long-term recovery (6+ months). You may achieve a significant level of recovery by this point, though full recovery can take up to a year or more.

When to see a doctor during back surgery recovery

While it's normal to experience discomfort and minor setbacks during your recovery, certain symptoms may indicate a more serious issue that requires immediate medical attention. Here are some signs that you should contact your doctor or seek immediate medical attention:

• Severe or worsening pain that is not relieved by your prescribed pain medication.

• Fever, chills, unexplained sweating, nausea, or vomiting.

• Worsening swelling, redness, or warmth around the surgical site. 

• Worsening bleeding or unusual drainage from the incision site.

• Change in sensation (numbness, tingling, or weakness) in your legs, arms, or other parts of your body.

• Worsening difficulty with walking, moving, loss of balance, or significant weakness.

• Changes in bowel or bladder function such as difficulty urinating or incontinence.

• Difficulty breathing, chest pain, or any other symptoms that may suggest a problem with your heart or lungs.

• Unusual symptoms such as new or worsening dizziness, confusion, or severe headaches.

Physical therapy after back surgery: benefits

Physical therapy (PT) focuses on improving movement, reducing pain, and enhancing overall physical function. “After back surgery, physical therapy plays a crucial role in your recovery,” says Courtney Fitzpatrick, PT, DPT, a physical therapist at Hinge Health. “A physical therapist can guide you through a series of exercises and techniques designed to promote healing and restore your ability to perform daily activities.” Goals and benefits of post-surgery physical therapy include:

• Early mobility. Physical therapy can help you start moving again as soon as is recommended. Gentle movement helps to stimulate blood flow, which can speed up healing and recovery and reduce your risk of complications.

• Pain reduction. Physical therapy can help manage and reduce pain in the long term. Physical therapists use a variety of techniques, including manual therapy, to alleviate pain and discomfort. They can guide you through regular, controlled exercise, which can help reduce inflammation and improve your pain levels. Physical therapists can help you navigate discomfort during movement and help you move despite some normal pain.

• Improved function and quality of life: Physical therapy can help you regain your mobility, flexibility, and the ability to perform daily activities. It includes exercises and stretches that improve your range of motion, reduce stiffness, and help you bend, twist, and move more freely. Physical therapy can also help you get back to your normal routine, including work and recreational activities.

• Restore core and back strength. Physical therapists can guide you through a series of exercises that gradually increase in intensity. This paced approach helps to build strength without overwhelming your body.

• Reduce your risk of injury. Physical therapy can help restore spinal stability and prevent future back issues by strengthening your core and back muscles. Learning techniques for lifting, bending, and other movements can also help prevent future injuries.

• Establish a plan for return to activity. Your therapist will work with you to set realistic goals for returning to your favorite activities, such as walking, gardening, or playing sports.

• Psychological benefits. Supervised rehabilitation can also help boost confidence in your ability to move and be active. Regular physical activity and the support of a therapist can help improve your mental health and reduce feelings of anxiety or depression.

Physical therapy after back surgery: what to expect

Your physical therapy plan will be tailored to your individual needs and type of surgery. Your therapist will conduct a thorough assessment to understand your current condition and set goals for your recovery. Short-term goals might include improving glute strength, achieving normal lumbar flexion, and reducing pain levels. Long-term goals could involve being able to walk for extended periods without pain or returning to your favorite recreational activities. 

Physical therapy after back surgery is highly personalized, but you can generally expect the following:

• Personalized assessment. Your therapist will conduct a detailed assessment to understand your specific needs and tailor your treatment plan accordingly. They will review your surgeon’s specific guidance and help clarify any post-operative instructions.

• Conservative approaches. Your therapist will provide guidance about using conservative methods to manage any post-surgical pain, such as ice, heat, and gentle stretching.

• Strengthening exercises. You will be guided through a series of exercises designed to build strength in your core and back muscles, starting with low-impact exercises and gradually increasing  intensity as your strength improves.

• Stretching and flexibility work. Stretching exercises will help improve your flexibility and reduce stiffness. These exercises are essential for maintaining a full range of motion and preventing muscle tightness. 

• Postural guidance. Your therapist may provide guidance on posture, including how to sit, stand, and move with a focus on finding positions and movements that are comfortable and supportive.

• Manual therapy techniques. When appropriate, your therapist may use soft tissue and joint mobilization techniques to reduce stiffness and improve mobility.

• Education. You will receive education on managing back pain, body mechanics, ergonomics, and how to perform daily activities. Your therapist will provide tips on lifting, bending, and other movements to keep your back healthy.

• Breathing and relaxation techniques. Deep breathing exercises and relaxation techniques can alleviate tension and promote a sense of calm, which is beneficial for both physical and mental recovery.

When to start physical therapy

The optimal timing for starting physical therapy after back surgery can vary depending on the type of surgery and your specific condition. Generally, physical therapy can begin as early as a few days after surgery, but this should always be guided by your surgeon's recommendations. Early initiation of physical therapy can help you manage pain, reduce inflammation, and promote healing, setting a strong foundation for a successful recovery.

Phases of physical therapy

Timelines for these phases vary depending on your specific surgery, your health and fitness before surgery, how quickly pain and swelling subside, and many other factors. Ask your physical therapist to detail how long you might expect each phase to last and the markers for progressing to the next phase. Possible treatment focus areas, goals, and PT activities may include:

Phase 1: Immediate post-surgery (0-2 weeks)

• Focus areas: Pain and inflammation management, gentle mobility, optimal healing environment

• Goals: Reduce pain and swelling; promote wound healing; begin safe movement patterns; educate on precautions and self-care

• PT activities: Ice therapy; gentle stretching and range of motion exercises; education on safe transfers, positioning, and activity modifications; reinforcement of your home exercise program (HEP); guidance on sleep, rest, and nutrition to support recovery

Phase 2: Recovery and strengthening (2-6 weeks) 

• Focus areas: Restoring mobility, building foundational strength

• Goals: Improve joint range of motion; begin strengthening muscles in the back; improve posture and core engagement

• PT activities: Progressive mobility exercises; strengthening of core, glutes, and hip stabilizers; postural correction and body mechanics training; modified weight-bearing activities, as tolerated

Phase 3: Advanced strengthening and function restoration (3-6 months)

• Focus areas: Functional movement, endurance, advanced strength

• Goals: Restore full strength and control; improve balance, coordination, and flexibility; return to daily activities and hobbies

• PT Activities: Higher-intensity strengthening (resistance bands, weights); functional training (stairs, sit-to-stand, gait training); dynamic balance and coordination exercises; flexibility and endurance training

Phase 4:  Maintenance and long-term prevention (6+ months)

• Focus areas: Long-term health, injury prevention

• Goals: Maintain strength and flexibility, prevent future injuries, support an active lifestyle

• PT Activities: Regular home or gym-based exercise routine; lifestyle education (ergonomics, joint protection); continued strengthening of hip, core, and lower body; incorporation of aerobic activity (e.g., walking, running, cycling, swimming);  return to sport

Movement after back surgery

Movement plays a key role in a successful recovery after back surgery. It helps improve circulation, reduce stiffness, and promote healing, while also gradually building your endurance and strength. Your recovery timeline and readiness for specific exercise will be unique to your surgery and condition. Always follow the exercise program provided by your healthcare provider and progress gradually to ensure safety.

Walking

“Walking is one of the best back exercises after surgery because it helps improve circulation, reduce stiffness, and promote healing without putting excessive strain on your spine,” says Dr. Fitzpatrick. You can start walking very soon after surgery, even within the first few days, she explains. “Walking also helps to gradually build your endurance and strength, which is crucial for a successful recovery." 

The following stretches and exercises might be appropriate around 8-12 weeks after surgery (always check with your doctor before starting or changing your exercise program).

The exercises above are appropriate for around 8-12 weeks after surgery because they focus on gentle, controlled movements that enhance flexibility, strength, and stability without overstraining your back (always check with your doctor before starting or changing your exercise program). These exercises are designed to support your healing process and help you safely regain your mobility and function. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Tips for successful recovery

Following these tips can help you achieve the best possible outcome and a smoother recovery process.

• Stay consistent with appointments. Regular attendance at post-surgical appointments and physical therapy sessions is crucial for a successful recovery. “These follow-ups are essential for monitoring your progress and making any necessary adjustments to your treatment plan,” says Dr. Fitzpatrick. “For example, if you're experiencing more pain than expected, your physical therapist can modify the exercises to help you continue making progress and promote healing."

• Communicate openly. Keep your surgeon and physical therapist informed about your progress, any difficulties, and any new symptoms. Open communication ensures that your treatment plan remains effective and safe. "It's important to be honest and transparent with your healthcare providers," says Dr. Fitzpatrick. "They are there to support you and adjust your plan as needed."

• Incorporate home exercises into your daily routine. Follow the home exercise program (HEP) provided by your therapist. Consistent practice at home reinforces the benefits of in-clinic sessions and helps you maintain your progress. "Incorporating these exercises into your daily routine can make a significant difference in your recovery," advises Dr. Fitzpatrick. Hinge Health can help support your consistency and routine, ensuring your stay on track with your HEP.

• Have patience and realistic expectations. Recovery times can vary, and it’s important to be patient and manage expectations. Celebrate small victories and stay committed to your rehabilitation plan. "Recovering from back surgery is a journey that’s unique to each person," says Dr. Fitzpatrick. It requires a lot of patience and a very slow, steady, and strategic approach, she explains. “You’ll have the best outcome if you take recovery as an opportunity to align deeper with wellness, prioritizing good sleep, nutrition, stress management, and gentle movement."

• Anticipate setbacks. Be prepared for setbacks and don’t let them frustrate you. Recovery is not always linear, and it’s normal to have good days and bad days. Stay positive and keep moving forward.

• Resist the temptation to overdo it. Avoid the urge to push yourself too hard. Overexertion can lead to setbacks and prolong your recovery. Listen to your body and follow the guidelines provided by your healthcare providers.

• Reach out for help. Don’t hesitate to ask for help with tasks you’re not quite ready to handle, such as carrying groceries or doing heavy lifting. Accepting assistance can prevent setbacks and ensure a smoother recovery.

How Hinge Health can support recovery

After back surgery, continuing to move and stretch is crucial for reducing pain and regaining strength and mobility. Hinge Health can be a valuable resource, whether used alongside in-person physical therapy, or after in-person sessions have concluded. As a digital clinic for joint and muscle care, Hinge Health offers access to physical therapists, personalized exercise therapy, health coaching, education, and more.

Unlike traditional physical therapy visits, Hinge Health provides virtual access to physical therapists via video appointments. Your therapist can conduct a movement assessment, create a personalized exercise plan, and help you perform exercises with confidence — all from the comfort of your own home.

You can ask your physical therapist questions about your pain, function, and progress — during video visits or anytime via messaging in the Hinge Health app. Your physical therapist can adjust exercises as needed to keep you on track. 

Staying consistent with exercise therapy can be challenging, but research shows it’s the key to building habits and achieving results. Hinge Health’s physical therapists, health coaches, and care team work together to help you integrate movement into your daily life, so you can get back to doing what you love.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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