Joined: January 3, 2003
From: The Netherlands
FLAOrthoPT is right: indiscriminately applying SLR techniques postoperatively will do no good, as [URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11740347]Scrimshaw & Maher[/URL] found. (The authors applied the SLR technique.)
This means that an adaptation of the technique and/or a further identification of the cases in which the technique/neural mobilization would be useful, is necessary.
The McKenzie method (of all methods, I have by far the best results with that method) has a way of determining whether neural mobilization/SLR techniques should be applied postoperatively, but that it is too complicated to describe here.
Regards, and good luck, Frank J.J. Conijn, PT Editor, Physical Therapist's Literature Update The Internet Journal of Scientific-Literature Updates on Orthopaedic Medicine & Rehabilitation and Manual Therapy Visit our [URL=http://www.ptlitup.nl]home page[/URL] or [URL=http://www.ptlitup.nl/dlinks/p=subscribe.html]subscribe directly[/URL] to our free monthly issues
Joined: January 4, 2005
From: Adelaide, South Australiia
Participants in this chat line might be interested in the point that, in Scrimshaw and Maher's study, the mean SLR for the patients who were treated with SLR post-op fell within the normal range for an asymptomatic population, prior to the surgery. The study therefore showed that mobilization of the SLR of normal ROM is not likely to produce an improvement! Also, they did not separate adequately those with normal and abnormal SLR prior to surgery (or after for that matter) in terms of symptom response (ie. overt abnormal, covert abnormal etc).
Michael Shacklock MAppSc, DipPhysio Director Neurodynamic Solutions (NDS) 6th floor,, 118 King William Street Adelaide 5000, AUSTRALIA
Joined: November 15, 2003
I worked with post-surgical lamis and discectomies and fusions and whatever for 11 years-and consider the ordinary SLR manouvre of no real value. What are the aims of doing this?
Can you explain auto-assist, Yahyai Ma? Neural mobilisation can be useful, but not as an active SLR - until stabilisation of the pelvis can be guaranteed. A seated SLR may be helpful, once it is established that it is done correctly. Most patients will not extend the knee fully unless supervised well, and all that works is psoas with the pelvis flapping around.
I found McKenzie very useful, for those in ongoing pain, even if all they did was prone lying with some PKB, again with pelvic control taught. Also TransAb training, although that is a bit controversial.
Joined: November 15, 2003
We developed our own protocols, waved them past the surgeons and they OKd them - mostly, except for one who believed physical therapy was of no benefit. Unfortunately, I saw these patients only in the acute setting, and they were sometimes referred to physio in the hospital; but there were so many the dept could not handle all of them. I am now out of date with the precise protocols used now (and have been updated a lot) as I left the area over 3 years ago. But McKenzie seemed to work well, often diminishing post-op pain (or unaltered pain from pre-op, which was common). Also TA education, although in the four or five days they were in hospital were never enough to properly train TA. Mobilisation was encouraged within 24 hours, with independence in basic functions. I never allowed any sort of walking aid, unless the patient was elderly and/or had motor deficits.
I think mobility facilitation is the most important; many patients feel they will fall apart if they walk too much. There is very little written on post-op protocols; each hospital seems to develop their own. Sitting for more than 20-30 mins should be avoided. Breathing control is also very useful as breath holding and hyperventilation often occured. The worst ones were the young males - they had a habit of passing out once vertical.
Think of mobilising the spine (not passively), reduce fear with education, and they mostly look after themselves. Of course, check with the surgeon's op notes if they have special requests - eg rest in bed 36-48 hours post-dural nicking.
Sorry I can't help much with rehab down the line, as I am not familiar enough with ongoing rehab processes.
Joined: December 2, 2004
Yahyai ma, Years ago we had a neurosurgeon that sent post surgery (laminectomy) patients home with a pulley system to allow them to do frequent self passive SLR to avoid nerve root adhesions. I thought it was a great idea. Of course I think some thoughtfulness and evaluation of the response and appropriateness for each patient would be indicated.