A Guide to Working With Post Spinal Surgery Folks - Spinal Surgeries, Part 1
/Let’s talk about working with folks after a spinal surgery. This is a deeper dive into a topic I wrote about in a newsletter about “dose” - when it comes to bodywork. We will see that dose, not just in one session but over the arc of treatment is important in these cases. We want to have our eye on the long game for our people.
Intake
Gray’s anatomy
This is actually a super important part of my process with these folks. Let’s assume someone has been referred for care with pain patterns that may be related to a previous surgery. I think this is a pretty common scenario for a lot of us. The healthcare system doesn’t have a lot of options for these folks - we know the pitfalls of pain meds and so these folks often seek out our care.
I like to break intake up into two categories.
I really want to know about their current pain pattern. When these folks come in for care sometimes they can share a blended story that combines what led to the surgery and what they are currently experiencing. Both of these are super important AND it is really helpful if we can get a clear picture of what they are currently experiencing. I make sure to tell them that I am interested in all of it but I want to get oriented in their current symptom experience before learning more about them.
They may not even relate their current pain pattern to a spinal surgery. Case Study: a patient came in for headaches and we found that as we worked on L4-5 fusion the headaches dissipated.
As they are sharing their symptoms I am asking myself how they might map to the surgery they had. I build pictures in my mind of what might be happening in their system based on what I’m learning. These are very loose and just beginning points for my curiosity, not diagnoses.I want to know what led to them electing to have surgery. I want to know about:
Signs and symptoms, again, what were they experiencing? As much detail as possible, sometimes seeming small details can be helpful.
Was there a specific injury? What activities, habits etc… were they doing? Were there habitual movements or postures whether from work or hobbies?
Is there any significant accident history?
Is there anything mental-emotional-stress related that they identify as being a part of this experience?
Now we have two clearly identified pictures of this person’s experience - of course with some very likely overlap.
Pre-surgery dynamics: These most likely still exist in the person’s system. The surgery likely addressed a consequence of these tissue dynamics but did not change them. The patterns are likely still present. Prioritizing them in care will be very useful (see below).
Post-surgery body response: Hopefully, the surgery was helpful in addressing some of the most significant pain patterns. And, surgery is its own type of injury to the system and needs to be treated. The scar tissue is one of the aspects we need to work with and also these surgeries involve some radical adjustments to the body’s natural form, i.e. discectomy or fusion (we will discuss all these in a future post). The current symptoms are how we are going to know if our assessments and treatments are helping.
We want to be super careful here to not vilify the surgeon or surgeries. Sometimes they are absolutely needed and we want to help the system integrate what has happened.
Three Factors to Consider When Making Your Treatment Plan
That’s a lot of info before even treating! I really have learned that how we think about our work plays a big role in how that work is received by the body. I very much advocate for a thoughtful approach to our work with people. I like to think about having processes like what I am breaking down in this post and a lot of curiosity when I am working.
Factor 1: Mental-emotional state/s. This is relevant for both aspects of the case; what led to the surgery and how they have been doing after the surgery. You may be seeing someone years later and a recent stressor has stimulated a pain pattern. Aybe, it echoes something that is in some way, for that system, similar to something happening that led to the surgery?
It is very common for folks to carry a lot of fear that their pain is going to come back. So, their system has a strong response to the normal pains of daily living. This is an example of where it is helpful to have gone through both scenarios with them, if the pain is different than what led to the surgery we can remind them of that. I also like to refer folks to an app called curable. It is a fantastic resource for folks dealing with chronic pain.
Factor 2: Tissue Dynamics Before Surgery. When you start treating, begin with exploring tissue dynamics that you imagine might be related to what was happening in their system prior to the surgery. This can be a bit of a therapeutic gold mine, there can be a lot of information in these areas! This is where curiosity comes in, following where the tissues lead. It’s very likely that both you and your person will learn something from this. I love when me and the person I’m working with learn things together - it’s fun and often can help create some good reframes.
Regardless of where the surgery was — most likely, L4-5, L5-S1 or C4-5-6 — this exploration will likely lead you to working around the thoracolumbar junction. One of my favorite places to work! See this blog post for more.
I generally make this aspect most of my treatment focus, especially in the first handful of visits.
Factor 3: Tissue Dynamics Post Surgery. I work towards the surgery site rather than going right to it. Imagine a series of concentric circles around the surgery, start in the outer circles and slowly work your way towards the innermost circles.
Use whatever techniques you are good at - and think about dose - use less force than you might think, especially at first. Remember, the person likely has conscious or unconscious physical and emotional reactivity here. Going too fast or working too deep can overload the system. Integrate this care with what you learned from addressing the before surgery dynamics.
In the first few visits I often spend the least amount of time on work directly related to the surgery. Remember, it took a long time for the person’s system to end up on your table. You have time - of course we want them to feel some bit better pretty soon but we often get there by playing the long game. Working slowly, with a nice combo of being methodical and curious, listening to the tissues.
In summary:
Get a really good sense of pre and post surgery symptom pictures and anything else that might be related. Details can be super helpful!
First explore and treat anything that might seem related to tissue dynamics that may have led to the surgery.
Second, imagine concentric circles around the surgery site and work towards the inner circles from the outer. Go slow and be gentle.
Third, and always overarching, take into account the many layered ways the nervous system may be involved in your person’s experience.
