The influence of specialist kinesitherapy on the spinal function after fenestration surgeries
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Department of Rehabilitation, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Department of Physiotherapy, Faculty of Health Science University in Kielce, Poland
Submission date: 2010-04-19
Acceptance date: 2010-06-23
Online publication date: 2012-12-04
Publication date: 2023-03-13
Corresponding author
Halina Protasiewicz-Fałdowska
Katedra i Klinika Rehabilitacji w Ameryce, Ameryka 21, 11-015 Olsztynek, Poland; phone: +48 89 519 48 44, fax: +48 89 519 48 44, e-mail: prohalina@wp
Pol. Ann. Med. 2010;17(1):36–43
Introduction. Back pain is a significant social problem. Etiology of back pain is multifactor. The majority of pathologies resulting in neurological symptoms lead to a surgical procedure. One of the most frequently used surgical procedures for the lumbar region of the spine is fenestration. A surgery resolves a mechanical problem, but often does not improve the functional one. A large group of patients, if not treated with specialist rehabilitation, continue to feel pain in the lumbar region or in the lower extremity. Aim. The aim of this work was to point to the necessity of applying modern kinesitherapy for relieving pain after fenestration surgeries performed on the spine. Materials and methods. Group of 18 patients, including 15 women and 3 men, within ages ranging from 25–59 (mean age 39.1) were qualified for individual therapies. The patients came to the Rehabilitation Outpatient Clinic complaining of pain after fenestration surgeries performed at the University Hospital in Olsztyn. All patients underwent spine surgery and the interval period between the procedure and coming to the Clinic was from 0.5 to 1 year. The procedure was performed at L4–L5 level in 13 patients, and at L5–S1 level in 5 cases. Lasègue’s sign, numerical pain rating scale (NRS), finger-to-floor test (spinal flexion) were analyzed. Discussion. Our study indicates that surgery should be followed by specialist therapy focused on regaining stability of the lumbar region via involving deep muscles: transversus abdominis muscle and multifidus muscle and stimulating nerve and muscle fibers to be mobilized in the ailing extremity in order to improve motor control of the lower back. Results. On release from hospital, in terms of neurosurgical and orthopedic recommendations, the patients were advised to exercise in the gym and go to the swimming pool 2–3 times a week, whereas no specialist rehabilitation was recommended. As a result, 3 months following their surgeries, all studied patients reported lower extremity weakness, pain when walking down stairs, numb sensation in toes, pain in the L–S area when seated longer than one hour. The performed examinations revealed that before the therapy, Lasègue’s sign was 30–60° (mean 51.9°), whereas after a 3-month long therapy, the range of motion was about 45–90° (mean 68.6°). According to the NRS, patients evaluated their pain levels before the therapy as 4–8 points (mean 6.11 points), whereas after therapy as 2–6 (mean 3.44). Before the therapy, a finger-to-floor test yielded the floor distance of 26–54 cm (mean 37.8 cm), after therapy the distance decreased to 17–48 cm (mean 28.6 cm). Due to the employed specialist therapy, in 17 patients pain ailments relief was observed. The patients did not report problems when moving about on uneven ground. They observed a functional improvement concerning everyday life activities. Functioning at work was easier in a sitting position and the efficiency of performed activities less burdensome than before specialist kinesitherapy. Conclusions. The 3-month long specialist kinesitherapy relieves pain and improves the range of motion in the lower extremity. The suggested program of kinesitherapy improves spinal flexion and static efficiency in a sitting position. Recommending specialist rehabilitation after neurosurgical procedures is essential.