Core strengthening exercises after back surgery
Core strength is essential for a healthy back. However, with so many core exercises to choose from, knowing where to begin is confusing. While it is a good idea to seek medical advice and attend your physical therapy sessions, here you will learn all of the core strengthening exercises after back surgery I use regularly in my practice. The following exercises build off of each other. Knowing when to progress depends on the healing process and your ability to activate your deep core muscles.
To begin, after spinal surgery, you must learn to master abdominal draw-ins. This excellent core exercise activates your transverse abdominis. Beginning at your ribs and pelvis, this muscle surrounds your abdominal area and attaches to your spine. Think of it as your internal back brace which helps you maintain a neutral position in your spine. In my professional opinion, this is the foundation of a strong core.
Core strengthening post-surgery workouts
The safe introduction of an exercise program is all about timing. For example, you are not allowed to perform crunches on the first day after spinal fusion surgery. In the early stages of recovery from lumbar fusion gentle exercises including walking, light mobility for your leg muscles like a hamstring stretch, and deep breaths are recommended. These precautions will remain in place for the first 6 weeks after an instrumented fusion and up to 3 months for a non-instrumented fusion.
On the other hand, following a laminectomy and decompression, training your abdominal muscles to maintain a neutral spine can begin as early as 2 weeks. Although, it will be a while before you can squat with heavy weights. Even the best exercises done at the wrong time can negatively affect your recovery process. Now let’s begin from the beginning.
Types of core exercises
Core exercises can be divided into 2 basic types, stabilization versus strengthening. Stabilization exercises are intended to activate your core muscles without your spine moving. Strengthening exercises work the muscle through the entire range of motion. Following any spinal surgery, the initial focus is on stabilization. Stabilization protects the spinal discs following a decompression and protects the fused spine.
Core strengthening exercises after back surgery begin once you are cleared by your healthcare provider and have mastered core stabilization exercises. Following a decompression, I wait until 3 months after surgery before introducing this type of exercise to my patients. For a fusion, I introduced these specific exercises after the 6-month mark.
Core strengthening exercises after back surgery: level 1
Level one core strengthening exercises after back surgery include simple exercises. The goal is to stabilize the spine. Here is a typical sequence I recommend.
Transverse abdominis (TA) draw-in
This easy exercise can be done in any position. To activate your transverse abdominis you will want to pull your belly button in without holding your breath. If done correctly you will feel as if you are lengthening your spine. I encourage my patients to do this many times throughout the day. Once you can do this while maintaining your breath, I encourage patients to increase how long they keep the contraction. This is appropriate for any surgery in the early stages.
TA heel slides
To progress a simple draw-in movement of the legs and arms is introduced. The goal is to use your transverse abdominis to prevent movement. The heel slide is a great exercise to start with. The starting position begins lying on your back with your knees bent. Keep your shoes off to make it easier for your leg to slide. Draw in your belly button and then slowly slide your leg away from your body.
Go as far as you can while maintaining the position of your spine. Once you feel yourself losing the contraction, return to the starting position and repeat on the opposite leg. Begin with 10 repetitions and progress as you feel comfortable
TA marching
With TA marching you begin laying on your bed or a yoga mat on the floor. Activate your transverse abdominis by pulling in your belly button. While holding this contraction, begin to march. Alternate legs and start with 10 repetitions. Feel free to progress as you build endurance.
TA leg extensions
To begin, lay on your back with your knees bent. Activate your transverse abdominis. While holding your belly button in, straighten one leg. Make sure to maintain pelvis neutral during the movement. The lower your leg is to the floor or bed, the harder it will be. The goal is 10 repetitions to start.
TA straight leg raises
This is a slight progression from the previous exercise. Lay on your back with one leg straight and one knee bent. Activate your transverse abdominis then raise one leg off the floor or bed. Raise it to the leg of the bent knee before lowering it with control to the floor. Try 10 on each side.
Bridge
Bridge exercises are one of the most popular physical therapist-recommended moves. You will begin lying on your back with your knees bent and feet on the floor. The movement requires you to engage your core then lift your buttocks and lower back off the floor. Your shoulder blades will remain in contact with the floor during the movement.
Core strengthening exercises after back surgery: level 2
Level 2 exercises are a progression of core stabilization exercises, but with increased movement of the upper and lower body to make it more of a challenge to hold. As you progress it is important to avoid holding your breath. Holding your breath increases the pressure in your abdomen and lower spine. So practice your deep inhales and exhales with the more challenging exercises.
TA 90/90 Heel Taps
The starting position is lying on your back with your hips bent and your feet off the floor. There should be a 90-degree bend at your hips and knees. This position requires your abdomen and surrounding muscles to fire the entire time. Once you are in the position slowly lower one leg to the floor tapping your heel. Make sure you maintain the position of your spine throughout the movement. Return to the original position and do the same on the opposite side.
Dead Bug
The dead bug is a well-known exercise where you stabilize your spine while your opposite arms and legs move simultaneously. Start in the 90/90 position with your arms start up. The movement requires your right hand/arm to reach over your head while your left foot/leg extends and hovers over the floor. Return to the starting position and repeat with the left arm and right leg.
Modified Planks
Modified planks use a wall or elevated surface such as a counter as an entry point after surgery. You can do this with front planks or side planks. Start with a 5-10 second hold. As you get stronger increase the duration of the hold. Once you are ready, try to lower your position to make this exercise more challenging.
Core strengthening exercises after back surgery: level 3
After the exercises in level 1 and 2 seem like a breeze, you are ready to progress to level 3. Truthfully, the level of progressions can be endless. Using a combination of stability balls, increasing repetitions, or introducing single-leg activities elevates the challenge, if you are up to it!
Bird Dog
The bird dog is another popular exercise that has roots in yoga. The bird dog begins on your hands and knees in quadruped. With control, you will reach your right arm forward while your left leg extends. the goal is to make a straight line using your abdominal and back muscles to reduce trunk movement. After returning to the starting position repeat on the opposite side.
Bridge progressions
There are so many variations of the bridge exercise. First, in order of difficulty bridges with your legs straight on a box. Second, would be bridges with bent legs on an exercise ball. Third is a single-leg bridge. Finally, the highest difficulty level is single-leg bridges on an exercise ball. Several modifications can be made to even these variations.
Plank progressions
Just like bridges, there are many variations of planks. Ultimately many of these variations are part of an advanced program. Once you are ready to try planks from the floor, begin on your knees for the easiest level. From there you can progress to straight legs with your knees off the floor.
Once you can maintain this position for an extended period you can try planks with leg movements. This could include front planks with hip extensions or planks with step-outs. The same can be said for side planks. You could try side planks with clamshells or side planks with hip abduction.
Next up on the tree of difficulty is the addition of an exercise ball under your feet. Finally, for all those overachievers who have mastered the previous progression, you can add movement of your legs to the planks and stabilize with a single leg.
TA progressions
The progression of core exercises can extend as far as your creativity can take you. After 90/90 comes the pike position. These include double leg raises, 100s, alternate leg raises, and so on.
However, a word of caution. In my 20 years of practice, I have never had a single patient safely achieve these levels in the first 6 months after surgery. Certainly, these variations give you something to work towards, but good form is of the utmost importance. The last thing you want to do is end up with an additional surgery.
Core strengthening exercises after back surgery: final thoughts
While this post serves as a basic guide to core strengthening exercises after back surgery, I can’t stress the importance of seeing a spine therapist. This professional experience will know when and how to add a new exercise to your rehabilitation program. A well-trained physical therapist will also be well-informed about the surgical protocol to help guide your recovery. Now get to work on building a strong core!