Cervical Surgeries Precautions:

DO NOT twist or bend your neck, or lift with your arms, without getting clearance from your doctor. If you must bend down to pick up an object, use a grabber instead. Tighten your core muscles and keep your back straight before you bend forward at your hips. To lift an item, contract your core muscles, keep your back straight and your head up, and then bend at the knee. Hold the item close to your body, and then lift up by straightening your knees.

Bed Positioning

Reclined Position

Have the head of the bed up to a comfortable height. Place a pillow behind your head, a pillow under each arm, and a pillow under the knees. If more support to your neck is needed, place a small towel roll under the curve of your neck.

Lying on Your Back

Lie on a firm mattress with a pillow behind your head, a towel roll behind your back and a pillow under your knees. If more support to your neck is needed, place a small towel roll under the curve of your neck (see diagram below).

Exercises to perform while lying on your back:

Ankle pumps for edema control

Isometric contractions of your lower extremities to decrease soreness

Abdominal strengthening:

Put your hands on the lower part of your stomach

Gently tighten your abdominal muscles by pulling in your stomach

Breathe normally without relaxing your abdomen

Lying on Your Side

Have a pillow under your head, a pillow under your waist and a pillow between your knees. If more support to your neck is needed, place a small towel roll under the curve of your neck (see diagram below).

Lumbar Surgeries Precautions:

DO NOT twist, bend or lift without getting clearance from your doctor. If you must bend down to pick up an object, use a grabber instead. Tighten your core muscles and keep your back straight before you bend forward at your hips. Then bend forward at your hips. To lift an item, contract your core muscles, keep your back straight and bend at the knee. Hold the item close to your body, and then lift up by straightening your knees. Bed Positioning

Lying on Your Back

Lie on a firm mattress with a pillow behind your head and a pillow under your knees.

Exercises to perform while lying on your back:

Deep breathing

Ankle pumps for edema control

Isometric contractions of your lower extremities to decrease soreness

Abdominal strengthening:

Put your hands on the lower part of your stomach

Gently tighten your abdominal muscles by pulling in your stomach

Breathe normally without relaxing your abdomen

Heel slides

Seated knee extensions with back supported

Lying on Your Side

Have a pillow under your head, a pillow under your waist and a pillow between your knees.

Self-Care: How to Deep Breathe After your surgery, you will need to deep breathe several times an hour to keep your lungs fully expanded. By deep breathing, you will speed your recovery and reduce the risk of developing breathing problems as you get well. Deep Breathing for Relaxation and Reducing Risk of Infection:

To deep breathe correctly, you must use your diaphragm and abdominal muscles – not just your chest muscles. This exercise will teach you how to deep breathe. Practice it two or three times a day before surgery. That way, you will be able to do it more easily after surgery.

1. Lie on your back in a comfortable position. Place one hand on your chest and the other over your upper abdomen. Flex your knees slightly. Relax.

2. Exhale normally. Then, close your mouth and inhale deeply through your nose. As you do, concentrate on feeling your abdomen rising without expanding your chest. If the hand on your abdomen rises as you inhale, you’re breathing correctly.

3. Hold your breath and slowly count to five.

4. Purse your lips, as though you are about to whistle, and exhale completely through your mouth (don’t let your cheeks puff out). Using your abdominal muscles, squeeze all the air out. Your ribs should sink downward and inward.

5. Rest several seconds, and then continue the exercise until you have done it five to ten times.

6. If you have an abdominal incision, you may be more comfortable if you hold a pillow over your incision. Lace your fingers together across the pillow to hold it in place. Then perform the deep breathing exercise as described above.

Note: You may also perform this exercise while lying on your side, sitting, standing, or as you are turning in bed.

SELF-CARE: How to Cough Effectively After your surgery the nurse will ask you to do coughing exercises at least every 2 hours. Coughing helps keep your lungs free of secretions. You should practice coughing before your surgery so you can do it easily afterwards. Follow these instructions: Coughing for Airway Clearance:

1. Sit on the edge of your bed. If your feet do not touch the floor, the nurse will give you a stool to rest them on. Bend your body slightly forward. (After surgery you may also perform this exercise while lying in a comfortable position, instead of sitting on the edge of the bed.)

2. If you have an abdominal incision, splint your incision by placing one hand above the incision, and one hand below it.

3. If you are lying down, you can splint or incision by putting a pillow over it and lacing your fingers together over the pillow. Immediately after surgery, you may feel too weak to firmly splint your incision. Don’t worry, the nurse will help you.

4. To help stimulate your cough reflex, take a slow deep breath. Breathe in through your nose and concentrate on fully expanding your chest. Breathe out through your mouth and concentrate on feeling your chest sink downward and inward. Then take a second breath in the same manner.

5. Now take a third deep breath. This time, hold your breath, and then cough vigorously. As you do, concentrate on feeling your diaphragm force out all the air in your chest.

6. Repeat this exercise one more time.

Equipment You may be given a brace by your doctor to provide extra support to your spine. You may also be given a walker or crutches to assist you in getting around. If you require other assistive devices such as a raised toilet seat, information will be provided as to where items can be purchased.

Practice Getting Out of Bed & Walking Supine to Sit

Use the “log roll” technique to get in and out of bed.

1. While on your back, bend your knees, and then roll onto your side in one motion. Roll your body as a whole unit, or as a “log.”

2. Keep your spine straight as you push up to sit upright. First, place your bottom hand under your shoulder. Place your top hand in front of you at chest level. Slowly raise yourself up by pushing up with your hands and swinging your leg off the edge of the bed.

3. Stay seated for a few seconds prior to standing due to a drop in blood pressure as you

moved from a supine to a seated position.

4. When sitting, keep your back straight. Try to sit in chairs with back support and avoid soft couches or chairs. You may place a small pillow or towel roll behind your back for support.

Sit to Stand (for Cervical and Lumbar surgeries)

1. Scoot to the edge of the chair.

2. Place your feet hip-width apart and slightly towards the back of the chair.

3. Keep your spine straight, lean forward at the hip then stand up by using your legs only. You may use the arm supports of the chair if needed. DO NOT pull yourself up by using your assistive device.

Walking

Walking is the best exercise for you after spine surgery. It strengthens your back and leg muscles, increases your endurance, and relieves stress. Begin with short frequent walks on level ground. You may find it helpful to set a goal. Talk to your doctor or Physical Therapist about setting a safe, realistic goal for yourself. 1. Maintain a neutral spine when walking by standing up tall and keeping your hips forward.

Stop immediately if you feel a sharp pain.

Gait Training: Walker

1. Stand in the middle of the walker.

2. Grasp the wheeled walker grips with your hands. Then push the walker forward at an arm’s length that feels comfortable. The back legs of the walker should be even with your toes.

3. Step forward into the middle of the

wheeled walker with one foot. If you have one leg weaker than the other, step forward with your affected (weaker) leg first. Continue to grasp the walker grips with your hands.

4. Then step forward with your other leg. As you do so, keep weight off your weaker leg by supporting some weight with your arms.

Gait Training: Crutches

1. Place the crutches under your arms. Squeeze them to the sides of your body.

2. Move the crutches 6 to 12 inches ahead with one of your legs. If one leg is weaker than the other, move the weaker side with the crutch first.

3. Push down on the hand grips. Step past the crutches with your other leg.

Returning Home Prior to returning home, have a friend or family member remove any items that can cause you to trip, slip or fall. You may need to prepare your bathroom for your return by:

Prevent slips and falls by using non-slip surfaces in your bathroom

Consider putting in grab bars and railings for support

Watch out for hazards, such as wet floors or items on the floor

Talk with your occupational therapist if you need more instructions in using bath aids

Install a hand-held shower hose

Use a long-handled sponge to wash hard-to-reach areas

Use a non-slip bath mat to help keep the floor dry

Use grab bars in your shower or tub for support as you get in and out

Sit on a bath bench or shower chair while you bathe

Install a toilet riser Other Preparation

Place common items within easy reach

Wear slip on shoes to avoid bending when wearing shoes with ties.

Outpatient Physical Therapy Your doctor may or may not prescribe Physical Therapy after your surgery. Your therapy program may or may not consist of the following exercises below, depending on the type of your surgery. Always clarify with your doctor prior to starting an exercise program. Ankle Pumps

Pump your foot back and forth slowly

Gluteal Sets

Squeeze your buttocks together.

Do not hold your breath.

Hold for a count of 3.

Quad Sets

Tighten muscles on top of thigh by pushing back of knee down against the table or bed.

Hold for a count of 3.

Short Arc Quads

Lie on back, towel roll under knee.

Lift foot and straighten knee.

Do not raise thigh off roll.

Hold for a count of 3.

Heel Slides

Lie on back.

Slide heel to bottom, bending your knee.

Hip Abduction

Slide leg out to the side

Keep toes pointed up and knee straight.

Pain Relief Ice

Ice will help with inflammation, muscle spasms and pain. It is generally used within the first few weeks of surgery. Heat

Heat will help with muscle spasms, stiffness and pain. It is used when swelling and inflammation is gone. Relaxation

Relaxation techniques can be used to decrease pain and anxiety. Deep breathing can be instructed for both pain management and clearance of your airways.

Questions to Ask Your Doctor 1. When may you shower, take a bath, or get your incision wet?

2. How long should you wear your elastic stockings (if applicable)?

3. When can you bend your back?

4. How much weight can you lift?

5. When can you progress to a crutch, cane, or no device?

6. When can you drive?

When to Call Your Doctor

If you notice any of the following signs of infection, call your doctor or nurse immediately:

Increased redness at the incision site

Increased pain at the site

Increased swelling at the site

Pus like drainage from the site

Black tissue around the site

Fever of 101°F (38.3°C) or above for more than 24 hours

Chills Use common sense in judging what you can and cannot do. If you have any questions or concerns, please feel free to call your doctor or nurse.

Final Thoughts & References

The information provided is an excellent resource. However, the opinions given may differ from your physician. Please contact your doctor before following any suggestions from this reading.

References

http://www.allaboutbackandneckpain.com/recovery/help-yourself-get-better.asp

http://patienteducation.upmc.com/Pdf/BedTransferLogRoll.pdf

http://www.spineuniverse.com

After Your Surgery

If you have any questions regarding the areas listed below or any other concerns, please feel free to call the Evergreen Care Network at 425.899.3200. Our knowledgeable social workers can help answer questions, provide information about community resources, make referrals and assist in accessing services.

Financial & Insurance Issues

No Insurance Coverage

Unable To Pay Rent, Utilities, Expenses, Etc.

Medicare Benefits

Medicaid Benefits

Unable To Pay For Medications

Billing Issues

General Assistance

Transportation

Bathing, Dressing, Getting Around

Chores (e.g. shopping, cleaning, meals)

Respite Care (help for your caregiver)

Assistance Obtaining & Installing Adaptive Equipment (e.g. grab bars, raised toilet seat, bath bench)

Rehabilitation, Nursing Home or Home Health Care

Feelings & Emotions

Depression, Sadness

Nervousness, Anxiety

Worry