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Swimming in post-spinal surgery rehabilitation

Management of vertebral problems neither begins nor ends with any surgical procedure. The likelihood of it success is determined in the pre-operative design. Post-surgical management also requires careful design and execution. At times apparently unimportant or inconsequential actions have a major bearing on outcome, and it is the responsibility of the surgeon to correctly emphasise and arrange these.

One of the objects of this web-site is to disseminate information which I have found helpful in the past, to a wider audience. The following is an extract from a letter written to someone who felt that she was recovering “too slowly” after a decompression for a narrowing of the vertebral canal which was threatening her with paraplegia.   

One recommendation is that you spend time in a swimming pool. This does not mean swimming initially. To begin it means simply getting into a pool, to the level of mid chest and walking about the pool, perhaps using your hands as in breast stroke. What this does is to make you “weightless” on your low back, and gently allows a rhythm and harmony of movement to return. Ideally this should be twice a day.

Developing the anterior abdominal wall (tummy muscles) is an important aspect of spinal rehabilitation. Traditionally “crunches” and “sit-ups” have been used. These are not recommended as they produce a significant compressive effect on the vertebrae. Instead backstroke is excellent. This can be varied to kicking the legs alone whilst floating on the back, or (where the edge of the pool coincides with the water level) resting the head on the side of the pool and kicking the legs, as in back-stroke.

After three or five days begin gentle hoola-hoop movements with the pelvis. This should be slow with as large a circle described by the pelvis as possible. Very slowly! After another week begin treading water. To begin with you will have difficult in doing this for more than a few minutes, but with persistence over three or four weeks you should manage up to twenty minutes. This will be excellent general cardiovascular exercise, but in particular will strengthen the anterior abdominal wall and the para-vertebral muscles markedly. Ultimately aim for swimming as an on going, life-long “maintenance”. The best strokes to begin are side-stroke, then a gentle crawl plus or minus backstroke. At that stage, if possible, you should get a swimming coach, Sounds dramatic? Not really, swimming should become a big part of your life, a regular recreation. Like learning a language or musical instrument one needs professional help to get optimum expertise. The aim is to be able to slide through the water effortlessly (really!) for forty or sixty minutes twice a week (at least), as an ongoing therapy.

Physiotherapists who use water in their therapy are excellent, but at times difficult to find.

Swimming in the ocean is not recommended. Walking through (even small) waves produces considerable buffeting, which recruits rapid (and undesirable) vertebral movements to balance. The slope of the beach, both inside and outside the water can load the vertebrae excessively. Walking on sand will load the back more, and aggravate most back pains. [The same applies to foot pain, which some find paradoxical as they feel the “softness” of the sand should be beneficial. It is not]
Many accidents are waiting to happen in the ocean, from stepping on unpleasant objects to dropping into holes in the sand, all of which will jerk the back.
Stick to the controlled environment of the swimming pool, and always be accompanied in the pool if you are post surgical.

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