Post Discectomy Cervical Rehabilitation Protocol

This protocol outlines a comprehensive physical therapy rehabilitation program following a cervical discectomy (surgical removal of a herniated disc) with or without fusion. It is designed to be a guideline and should be adapted based on the individual patient's presentation, surgical notes, physician's orders, and progression. Close communication with the surgeon is crucial throughout the rehabilitation process.

Pathophysiology

Cervical discectomy is performed to alleviate pressure on the spinal cord or nerve roots caused by a herniated or degenerated intervertebral disc in the neck. This pressure can lead to pain, numbness, weakness, and/or tingling in the neck, shoulder, arm, and hand (radiculopathy or myelopathy). The surgery involves removing the damaged portion of the disc, thereby decompressing the neural structures. A fusion may be performed in conjunction with the discectomy to stabilize the spine at the level of surgery.

Goals of Rehabilitation

• Reduce pain and inflammation.
• Restore range of motion.
• Improve muscle strength and endurance.
• Improve posture and body mechanics.
• Enhance functional activities.
• Promote return to work/sport/desired activities.

Precautions and Contraindications

• Follow all post-operative precautions specified by the surgeon (e.g., lifting restrictions, cervical collar use, activity limitations).
• Monitor for signs and symptoms of nerve root compression or spinal cord compression (e.g., increased pain, new neurological deficits).
• Avoid activities that exacerbate pain or symptoms.
• Be cautious with cervical movements, especially in the early phases.
• Contraindications may include unstable fusions, active infection, or other medical conditions.

Phase I: Protection (Weeks 0-4)

Goals: Protect surgical site, reduce pain and inflammation, initiate gentle range of motion, educate patient on proper posture and body mechanics.

• Pain Management:
  • Ice or heat packs (as prescribed by physician).
  • Gentle massage to surrounding muscles (e.g., upper trapezius, levator scapulae).
  • Electrical stimulation (TENS) for pain relief.
• Cervical Collar:
  • Follow surgeon's instructions regarding collar use (may be worn at all times except for hygiene and exercise, or only during activities).
• Range of Motion (ROM):
  • AROM (Active Range of Motion): Initiate gentle AROM exercises within pain-free limits:
    • Cervical retraction (chin tucks).
    • Shoulder shrugs and scapular retractions.
    • Elbow flexion/extension, wrist and finger ROM.
  • Gentle PROM (Passive Range of Motion): (if AROM limited) by a therapist, focusing on pain-free ranges.
• Isometric Exercises:
  • Gentle isometric neck exercises in neutral position (flexion, extension, lateral flexion, rotation) with minimal resistance. Hold for 5 seconds, repeat 10 times.
• Posture and Body Mechanics Education:
  • Proper sitting and standing posture.
  • Lifting techniques (avoid lifting objects greater than the surgeon's specified weight limit).
  • Sleeping positions.
• Breathing Exercises:
  • Diaphragmatic breathing to promote relaxation and reduce muscle tension.

Phase II: Loading (Weeks 4-8)

Goals: Improve strength and endurance, increase ROM, progress functional activities, wean off cervical collar (if applicable).

• Range of Motion (ROM):
  • Continue AROM exercises and progress to full pain-free range.
  • Gentle cervical stretching (e.g., lateral flexion stretch, rotation stretch) after warming up.
• Strengthening Exercises:
  • Progress isometric exercises to resisted exercises using theraband or light weights.
  • Strengthening exercises for neck flexors, extensors, lateral flexors, and rotators.
  • Scapular stabilization exercises (e.g., rows, scapular squeezes, wall slides).
  • Upper extremity strengthening (e.g., bicep curls, triceps extensions, shoulder abduction/flexion) with light weights.
• Endurance Exercises:
  • Low-impact aerobic exercise (e.g., walking, stationary cycling) to improve cardiovascular fitness.
• Postural Exercises:
  • Continue to emphasize proper posture and body mechanics.
  • Strengthening exercises that support good posture (e.g., rhomboids, lower trapezius).
• Functional Activities:
  • Gradually increase participation in functional activities, such as light housework or computer work, as tolerated.

Phase III: Return to Function (Weeks 8+)

Goals: Maximize strength and endurance, improve functional capacity, return to work/sport/desired activities.

• Strengthening Exercises:
  • Progress strengthening exercises by increasing resistance (weight or theraband) and repetitions.
  • Incorporate more functional strengthening exercises (e.g., medicine ball exercises, cable exercises).
• Endurance Exercises:
  • Increase duration and intensity of aerobic exercise.
• Sport-Specific Training:
  • For athletes, begin sport-specific training activities, gradually increasing intensity and duration.
• Work-Specific Training:
  • For workers, simulate work-related tasks to improve functional capacity.
• Maintenance Program:
  • Develop a home exercise program to maintain strength, flexibility, and posture.
  • Encourage participation in regular physical activity.

Common Special Tests

• Spurling's Test: (For cervical radiculopathy) Compression and lateral flexion of the cervical spine may reproduce radiating pain.
• Distraction Test: (For cervical radiculopathy) Manual distraction of the cervical spine may relieve pain.
• Upper Limb Tension Tests (ULTT): (For neural tension) Various ULTTs assess the sensitivity of specific nerves (median, ulnar, radial) to stretch.
• Shoulder Abduction Relief Test: (For cervical radiculopathy) Placing the hand on the head may relieve symptoms.

Disclaimer: This protocol is a general guideline and should be adapted to the individual patient. It is not a substitute for professional medical advice. Always consult with a qualified healthcare provider before starting any new exercise program.