Spinal Precautions

March 5, 2008 at 12:16 pm 14 comments

I have previously blogged specifically about sternal and hip precautions but only briefly mentioned spinal precautions.  Every day, I get visitors to this blog looking for information regarding spinal precautions, so here they are:

  • No Bending
  • No Lifting
  • No Twisting

The precautions, also known as BLT’s (for Bending, Lifting, Twisting) are usually in effect from anywhere between two and three months.

The bending will depend on where in the spine the surgery took place.  If it was in the cervical spine, don’t bend your neck.  If it was in your back, don’t bend your back.

One should not lift anything more than 5-10 lbs. after a spinal surgery.  A gallon of milk is about 8 pounds (or 8.35 according to a patient of mine who was a firefighter), and is usually a good reference point as to the maximum you can lift.

Twisting is pretty straightforward.  Don’t twist your back (or neck).  The two areas people have trouble with this is when sitting down, one tends to twist and look to see where they are about to sit; and when wiping themselves after a bowel movement.  Be careful!

These precautions apply to most spinal procedures, whether it is just a spinal cord stimulator placement, a laminectomy, ACDF, ALIF, etc.


Entry filed under: occupational therapy, OT, precautions. Tags: , , , , , , , .

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14 Comments Add your own

  • 1. Cherie  |  June 20, 2008 at 10:35 pm

    I have a lot of patients post surgical intervention. I had the privilege of the cold room during open heart surgery…I also couldn’t sit down ( no seat in the surgery room) so when the sternal clamp held the ribs apart and I saw pink, I couldn’t sit to ease the dizziness. I am sure it;ll be different for you. However, you truly appreciate the precautions. I’d love to hear about cardiac precautions, as basic as they are…I worked on a cardiac unit and we began exercise including shoulders to 90 1-2 days after surgery….but I thought we went higher just without resistance, pulling/pushing or isometrics….the trend at the facility I work at now is for pacers and cardiac sx; nothing above chest level. I’d love to hear more.


    Cherie, FL

  • 2. aishel  |  June 21, 2008 at 8:58 pm

    Cherie, thanks for your comment. See the following link for where I discuss sternal precautions:

  • 3. debby gilliam  |  October 3, 2008 at 5:44 pm

    I would like some specific guidelines for upper extremity functional activities and ther ex after cervical spinal sx. In the clinic we always restricted any resistive ther ex. But allowed functioinal activity like comb hair, shave, get glass from upper cabinet etc. Any feedback? or place where I can get details?

  • 4. aishel  |  October 4, 2008 at 6:48 pm

    I’ve also heard that with cervical spines, any resistive exercise should be avoided. Beyond that, I don’t have much information.

  • 5. Rashmi Bhatia  |  March 4, 2009 at 3:02 pm

    I am wondering if you prevent patients from crossing their legs (hip ER to get foot on opp knee) to manage LB dressing following spinal surgery??

    • 6. cindy schell  |  August 24, 2009 at 4:32 pm

      No you do not have to prevent back surgery patients from crossing their legs. That is the preferred method to useso they don’t bend or twist.

      • 7. Garry Clifton, OTR/L  |  October 1, 2014 at 1:54 am

        I disagree with this response. Lifting the leg causes abdominal strain and torsion on the spine. Unless you have extremely long arms, you will be bending and twisting to put on your shoes and shocks. Most rehabilitation therapist recommend using adaptive equipment such as a dressing stick to remove the socks and put on pants a sock aid to put on the socks, and reacher to pick things up from the floor.

  • 8. jim  |  April 30, 2009 at 7:43 am

    What medicine is linked to cancer for spine treatment

  • 9. jim  |  April 30, 2009 at 7:45 am

    What medicine is linked to cancer for spine treatment that surgions still use

  • 10. Gabriela  |  September 24, 2010 at 12:17 pm

    Hi, I am wondering if anyone has any suggestions for therapeutic activities for patients with newly acquired SCI or progressive MS

  • 11. Laurie  |  January 28, 2012 at 4:58 pm

    I am considering surgery for scoliosis. What is the prognosis? and the exercise considerations. Currently I am in a wheelchair but I am working my way out of it (Goal is April). Your thoughts?

  • 12. DWhite  |  April 7, 2012 at 10:47 am

    Are there lifting restrictions? not past 90 degrees??

  • 13. kflo  |  May 4, 2013 at 7:59 pm

    is there any circumstances in which therex, light resistive exercise is appropriate?

  • 14. Occupational Therapy Spine Surgery  |  January 22, 2015 at 3:31 pm

    […] Spinal Precautions | Occupational Therapy – A Blog … – Mar 05, 2008 · Spinal Precautions. March 5, 2008 at 12:16 pm 13 comments. I have previously blogged specifically about sternal and hip precautions but only briefly …… […]


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