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Lumbar Fusion by Thomas Andrews (Physiotherapist)

lumbar fusion diagram
lumbar fusion diagram

What is it?

In people with severe back pain or nerve referral down the leg, a lumbar fusion may be recommended. A lumbar fusion is a surgery that permanently connects two or more vertebrae of your spine together.  This is done with metal plates, screws and rods in the vertebrae. This technique holds the two vertebrae still and stops any movement at this area of the spine. Often during this surgery, the surgeon may release or trim areas that are compressing nerve structures to relieve pain.

When is it indicated?

Lumbar fusions are usually indicated for those people who have persistent high levels of pain despite trialling conservative treatment. For example; Physiotherapy, medication and injection therapies. Usually this occurs in people who have the following conditions:

    • disc herniations (disc bulge)
    • spinal scoliosis (irregular curves in the spine)
    • sciatica or nerve irritation
    • severe arthritis of the back (stenosis)
log roll
log roll

What to expect in the hospital:

After the surgery, you will be in hospital for at least the next 4 days to allow time to recover. During this period, physiotherapists and nursing staff in the hospital will assist you getting out of bed, walking and completing daily tasks.  Your surgeon will likely recommend that you do not to bend or twist following surgery for a number of weeks.

Getting out of bed after lumbar fusion or with severe back pain can be difficult. It is recommended that you use the log roll manoeuvre as shown in the diagram.  This reduces movement at the spine, which may help reduce pain and protect the area.

What to expect once your home:

After discharge from hospital, the first six weeks post surgery includes basic exercise, walking, and other light activities. It is not recommended that you avoid heavy house-hold duties during this time. After surgical review at 6 weeks, your surgeon may recommend Physiotherapy. Due to the screws and plates and the pain in your back, you are likely be stiffer in that region, making simple tasks such as putting on shoes and socks difficult. Physiotherapy following a lumbar fusion is recommended to assist in activating muscles in the back, core and legs and to support the injury area.  Treatment may also include nerve stretching, Clinical Pilates and manual therapies.

How can we help you:

Physiotherapists can use hands-on techniques to help improve movement of your back, reduce pain and facilitate muscle activation. Physios can also develop a tailored exercise program dedicated to your needs, to assist you in getting back to activities that you want to do.

Below are some exercises that we often give patients immediately after lumbar fusion to help get you started.

Transversus abdominus muscle activation.

The transversus abdominus is a deep core muscle that helps support the both the abdomen and the spine. After lumbar fusion surgery, this muscle has some difficulty working and supporting the spine. This exercise is aiming to jump start this muscle again to get it working. This may help to decrease pain after lumbar fusion and help to ensure the spine is supported.

To complete this exercise, you slowly draw your lower abdomen in, hold it for 3-5 seconds and then release.

Hip abduction

This exercise aims to build up the strength in the hip muscles to create a stable and strong foundation for the back.

To complete this, bring one leg to the side whilst standing upright. Hold this position for up to 3 seconds and then bring it back in.

Chair squats

This exercise is aimed at improving leg and hip strength. It also works on coordination of the lower back muscles.

To complete this, stand whilst holding onto a back of a sturdy chair or kitchen bench, keeping your back straight, bend your knees making sure they don’t go past your toes. Make sure you don’t squat down too low and return back. You can progress this exercise by removing the chair and completing a squat to the same height.

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Shoulder Dislocation & Stabilisation

The shoulder joint (also known as the glenohumeral joint) is the most commonly dislocated joint in the human body. This joint is the most mobile joint in the body with an extended range of motion which allows the arm to move in many different directions. Shoulder dislocation occurs when the head of the upper arm (humerus) is forced completely out of its socket (glenoid labrum). The humerus needs to be relocated as soon as possible in order to achieve the best possible outcome in the future. The most common form of dislocation is anterior dislocation where the humerus is forced forwards out of the joint. This injury is commonly seen in young adult men who have sustained high energy injuries to the shoulder joint. Most commonly these injuries occur in contact sports including basketball, football and wrestling.


Management after a dislocation differs and is dependent on a range of factors including age and participation in sports. People under the age of 20 are 68% more likely to experience a future dislocations and therefore this needs to be taken into consideration when determining the appropriate course of treatment.

Best current evidence demonstrates that immobilisation of the injured shoulder in a sling after relocation for 2-6 weeks combined with physiotherapy is the best course of treatment following a first time dislocation. Physiotherapy treatment can be commenced immediately after the injury and involves:

  • Postural retraining
  • Strengthening of the shoulder muscles
  • Range of motion exercises (reducing stiffness)
  • Taping
  • Facilitating return to sport/ function

Surgery is an option and recommended only in cases where the ligaments or bones within the shoulder joint are damaged. Common associated injuries within the shoulder include:

  • Bankart lesions: a tear in the ligaments in the front of the shouldershd2
  • Bony Bankart lesions: fracture of the front of the shoulder socket
  • Hill Sach’s lesion: fracture of the top of the humerus (arm bone)

Surgery can also be performed for patients who experience recurrent dislocations. In these cases surgeons will perform key hole surgery to tighten the ligaments in the shoulder in the aim of increasing the stability of the shoulder.

  • Capsular plication: tightening of the capsule to bring the humerus closer to the socket
  • Capsular shift: tightening of the capsule
  • Bankart lesion repair: repair of the torn ligaments in the front of the shoulder joint
  • Hill Sach’s lesion repair: fracture in the humerus is filled in with ligaments, bone or metal implants

There are different post-operative protocols after the above surgeries and all involve intensive physiotherapy management following the procedures. At Total Physiocare we can assist you in your recovery and rehabilitation following shoulder dislocation and these associated surgeries.

Post compiled by Alice Smith.