Best Core Exercises After Back Surgery (And which to avoid)

What is the Best Core Exercise After Back Surgery? 

The simple answer: the best exercise is the one you can do with the best form that doesn’t exacerbate your pain or symptoms.

When I work with patients recovering from back surgery, one of the most common concerns is how to safely exercise to regain strength and mobility. Back surgery can be a daunting experience, but with the right guidance, recovery can be smooth and encouraging. Since exercise is an important component of the post-surgical rehab process, the big question I always hear is what are the best core exercises to do after back surgery?

I know this isn’t the answer you came here for but it is the guiding principle of exercise selection, especially in the earlier stages of rehab. However, we will go over exercises that I have successfully used with clients that are well tolerated while providing the greatest amount of benefit in terms of building strength and mobility. As always, everyone’s situation is different and I recommend checking with a rehab professional or your surgeon if these exercises would be appropriate for you.

Best Core Exercises After Back Surgery:

As mentioned before, there is no “best” exercise after back surgery as one exercise may be appropriate and tolerated well for one individual and could be problematic for another. However, we can begin to categorize “best” if we look at exercises that meet certain criteria such as EMG activity, or the amount of muscle activation we get from a particular exercise.

Using that perspective, an exercise called the "bird dog" demonstrated high EMG activity in trunk stabilizers and the bridge demonstrated high glute activation making both of these exercises beneficial exercises to strengthen the core after back surgery.

Another way we could categorize the "best exercise" is by which promote positional awareness of the pelvis and spine in space. Having your brain appropriately understand where your body is in space is important for pain perception and utilizing those core muscles you are working hard to strengthen. Pelvic tilts are gentle exercise that does just that.

Bird Dog:

• Start on your hands and knees.
• Extend one arm forward and the opposite leg back, keeping your back straight.
• Hold for a few seconds, then switch sides.
• Perform 2-3 sets for 8-10 reps on each side.
• No you don't NEED a foam roller! 

Bridges:

• Lie on your back with knees bent and feet flat on the floor.
• Lift your hips towards the ceiling, squeezing your glutes and core.
• Hold for a few seconds, then lower back down.
• Perform 2-3 sets for 10-15 repetition

Pelvic Tilts:

• Lie on your back with knees bent and feet flat on the floor.
• Tighten your abdominal muscles and press your lower back into the floor.
• Hold for a few seconds, then relax.
• Repeat 10-15 times.

What About Exercises Such as Planks and Push-ups?

Typically when we think of a core exercise, one of the first things we think of is a plank. Yes, planks can be beneficial after back surgery and are generally an exercise I will progress to in earlier phases of rehab. What makes a plank a good exercise is the emphasis on maintaining a neutral spine position which helps to limit moving the spine into uncomfortable end-range positions.  It's crucial to ensure you have the green light from your physical therapist or surgeon. Beginning with an easier, or modified, plank may be a better route for you.

Modified Plank:

• Begin by placing your elbows on an elevated surface such as a chair, couch, bed, etc
• Draw your attention to your stomach and glute muscles and maintain a straight spine position
• Start with 10-30 second holds and gradually increase the duration as you build strength.

Can I Do Push-Ups After Back Surgery?

Yes, you can do push ups after back surgery.

The pushup is a good general upper body exercise but also incorporates elements of core strengthening that are seen in the plank exercise, a double whammy of upper body and trunk strengthening. Now, a pushup done with poor form can put the spine in more extension and, depending on the type of back surgery and stage of recovery, could potentially be uncomfortable but fortunately not damaging. I good starting point could be a modified pushup.

Recovery is all about progression and that can apply to the pushup as well.

Modified Pushup:

• Use an elevated surface such as a couch, sofa or chair
• Start in the same position as a modified plank.
• Bend your elbows to bring your chest close to the surface your hands are on, then return to starting position
• 2-3 sets of 5-10 reps or whatever you can perform within acceptable symptoms is a good starting point

Common Back Surgeries:

Not all back surgeries are the same. Some involve shaving off small amounts of bone or disc tissue and some involve the surgical implementation of hardware. It makes sense that what was done during surgery determines what can and cannot be done after surgery because different tissues have different healing times. The following are the most common spine procedures I see in my practice:

Spinal Fusion:

• Fusing two or more vertebrae to eliminate motion and reduce pain (Connecting bone to bone)

Laminectomy:  

• Removing part of the vertebra to relieve pressure on the spinal cord. (Removing bone)

Discectomy:

• Removing a portion of a bulging or herniated disc to relieve nerve pressure. (Removing tissue similar to cartilage)

How Long Does it Take For Back Muscles to Recover After Surgery?

The healing process can vary greatly between individuals so it is always best to compare your recovery journey against yourself and not to your peers or other individuals you know who may have had a similar procedure. 

Also, the type of back surgery you undergo can greatly affect the recovery timeline.

For example, in a discectomy or laminectomy surgery, the surgeon is removing specific portions of disc or bone and much of the surrounding tissue is left intact which makes the recovery time much shorter than a procedure like a spinal fusion.

In a spinal fusion, surgeons are trying to fuse bone to bone. Just like when someone breaks their arm, the bones take time to stick to each other again. Surgeons use different compounds as "glue" to help keep the bones where they want them. This "glue" along with the bone growth overtime makes the bones stay where they were placed. To give this time to happen, this is an example timeline that respects tissue healing.

Spinal Fusion:

• Inflammatory stage (1 to 4 weeks): Emphasis on pain and symptom management. Physical therapy may be started here for gentle exercise depending on surgeon and patient.

• Light activity (5 to 9 weeks): Physical therapy begins at this stage if not before. Light activity and exercise.

• Increase in activity (10 to 24 weeks): Exercise is usually progressed in this window and patients are engaging in cardiovascular exercise. Patients are able to engage in exercise on their own with the guidance of a rehab professional.

• Return to all normal activities (6 months to 1 year): Generally at this point there aren’t any major restrictions from work. 

• Full recovery (1 to 2 years): It is usually not until the year mark or more where individual may “forget” they had the surgery when they wake up in the morning. However, tissues such as nerve will continue to heal beyond a year so it is completely normal to still have some levels of intermittent discomfort at this stage.

A discectomy is a completely different procedure from a fusion so the recovery looks very different. In a discectomy, a small piece of tissue, somewhat similar to the cartilage of your ear is taken out. The healing that occurs is from the entry of the surgeon to get to the disc and the structure that was angry with the disc taking up its space. Here is an example of what recovery may look like.

Discectomy:

• Return to light activities (2 weeks): Higher levels of pain and stiffness during this phase. Focus on rest and gentle movements within tolerable discomfort levels.
• Resume routine activities (6 weeks): Gradually introduce low-impact exercises.
• Return to strenuous labor or contact sports (12 weeks): Begin more intense strengthening and conditioning exercises.

As you can see, the recovery timeline for a surgery like a discectomy versus a spinal fusion has drastically different timelines. But always remember, no matter which procedure you have undergone, you will never recover as fast as you want but you will get better and you will become more functional if you are proactive and an involved participant in your rehabilitation journey.

Best Cardio After Back Surgery?

A multi-faceted rehabilitation program includes exercise and activities that emphasize mobility, stretching, strengthening and building cardiovascular endurance. You will notice a decrease in cardiovascular endurance due to being less active during the post-operative recovery. The good news is that it is generally safe and recommended to begin cardiovascular exercise as tolerated sooner than later. The following are recommendations for cardiovascular exercise:

1. Walking: Gentle on the back and easy to control intensity. Start with whatever distances and durations are tolerable without significantly aggravating symptoms, whether that is 1 minute or 30 minutes. (Uncover the The Benefits of Walking and Core Strength)
2. Stationary Biking: Offers cardio benefits while being able to adjust for spinal positions that can be tolerated.
3. Aquatic exercise: Aquatic exercise can be very beneficial for those who may be experiencing higher levels of pain or mobility impairment following surgery and those with other health considerations such as weight status which may make land based exercise more challenging in the earlier stages of rehab.

How Do You Build Muscle After Back Surgery?

Building muscle after back surgery follows the same principles as building muscle under normal circumstances. You can expect to require 6-8 weeks of exercises to notice an increase in muscle after back surgery. However, we must respect the healing process and generally our progressions with movement and exercise will be slower than when we are not recovering from surgery or injury. The following are general guidelines to adhere to during the recovery process:

1. Start Slow: Begin with low-impact exercises and gradually increase intensity.
2. Focus on Core: Strengthening the core supports the spine.
3. Use resistance when appropriate: Building muscle tissue, known as hypertrophy, typically requires increased loading and when appropriate introducing resistance such as bands and weights can be effective.

Exercises to Avoid After Back Surgery?

Typically after surgery the surgeon will say no bending, lifting, or twisting for a few weeks. That applies to exercise as well. So immediately after surgery exercise will be much more limited and exercises such as weighted squats will be avoided.

That said, in most cases that means unweighted squats would be just fine. So I typically recommend the you follow your physical therapists guidance at first and once you are healed, start trying something harder such as a weighted squat.

The human body would be so much easier to navigate if there were just black and white rules to follow. As we know, it is not that simple but that is where the beauty of rehab comes in. Our bodies are more resilient than we tend to give them credit for and because of that, we tend to self-limit what we think we can or can’t do when recovering from surgery or injury.

The spine craves threat-free movement and when we restrict or limit movement of the spine beyond normal physiological healing times we can actually do more harm than good.

Therefore, the same principles we use to guide exercise selection and progression are applicable. If you perform an exercise and there is no increase in pain during or afterwards, that is a green light! If you perform an exercise and there is an increase in pain or symptoms but they subside within a few minutes that is considered a yellow light, proceed with caution. If an exercise produces discomfort and that continues to linger even after several minutes, that is a red light: time to find a different exercise or take a break. 

Conclusion

Recovery from back surgery is a journey that requires patience, dedication, and the right guidance. By focusing on safe, effective exercises and listening to your body, you can rebuild strength and regain your quality of life. Remember, always consult with your healthcare provider before starting any new exercise regimen to ensure it aligns with your specific recovery needs.

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