Getting Patients Moving: Dr. Larry Davidson Discusses Best Practices for Early Mobilization After Spinal Procedures

Recovering from spinal surgery involves more than wound healing; it also requires regaining strength, flexibility and functional independence. Dr. Larry Davidson, an expert in minimally invasive spine surgery, recognizes that early mobilization protocols are essential for reducing complications, improving outcomes and enhancing long-term recovery. With the right approach, patients can start moving safely just hours or days after surgery, helping to accelerate healing and reduce the risk of setbacks.

Early mobilization is now a cornerstone of Enhanced Recovery After Surgery (ERAS) protocols, and ongoing research continues to define what works best for different types of spinal procedures.

Why Early Mobilization Is Critical

Postoperative immobility increases the risk of complications such as blood clots, pulmonary issues, constipation and muscle atrophy. In spinal surgery patients, delayed movement can also lead to joint stiffness, poor circulation and chronic pain. Early mobilization helps prevent these issues by stimulating blood flow, activating muscles and maintaining proper spinal alignment.

Patients also tend to benefit psychologically from early movement. Regaining basic mobility soon after surgery restores a sense of control, reduces anxiety and improves motivation, which are critical factors in achieving better recovery outcomes.

Building a Safe and Structured Protocol

The most effective mobilization plans are structured, goal-oriented and customized to the individual’s needs. These protocols typically begin with simple movements such as bed mobility, rolling, sitting up and shifting positions. Progress then moves to standing and assisted walking, with an emphasis on proper posture and mechanics.

Therapists often guide breathing exercises and muscle engagement techniques, including ankle pumps, glute squeezes and gentle leg lifts to maintain circulation and prevent deconditioning. Each step is carefully supervised and adjusted according to the patient’s pain level, endurance and overall response.

Tailoring Mobilization to the Surgical Procedure

Not all spinal procedures allow for the same mobilization timeline. Patients who undergo microdiscectomy or laminectomy are often encouraged to begin walking within hours after surgery. In contrast, those recovering from spinal fusion may require more time due to hardware placement and increased tissue trauma.

Complex surgeries like multilevel fusions or deformity corrections often require a more cautious, staged approach. Pain control, stability and the presence of drains or catheters must all be considered before mobilization begins. Collaboration between surgeons, physical therapists and nurses ensures that mobilization timing is both safe and effective for the type of procedure performed.

The Role of Physical Therapy in Early Recovery

Physical therapists are instrumental in the success of early mobilization. From the first postoperative day, they assess patient readiness and guide essential tasks such as transferring from bed to chair, standing with support and beginning ambulation with assistive devices.

Early sessions focus on safety and technique. Therapists teach patients how to log-roll, engage their core and move without twisting the spine. For patients using walkers or braces, therapists provide instructions on proper use to ensure stability while protecting the surgical site. Education is ongoing and includes strategies for safe movement at home, such as bending the hips, using grab bars and avoiding high-impact motions.

Dr. Larry Davidson notes, “Emerging minimally spinal surgical techniques have certainly changed the way that we are able to perform various types of spinal fusions. All of these innovations are aimed at allowing for an improved patient outcome and overall experience.” These surgical improvements, when combined with guided physical therapy, create a comprehensive recovery framework that emphasizes early mobility without compromising safety.

Evaluating Progress and Adjusting Plans

Successful early mobilization requires continuous evaluation. Clinical teams monitor how the patient responds to activity by tracking vital signs, pain scores, energy levels and tolerance to physical tasks. If discomfort increases or mobility stalls, adjustments are made to avoid setbacks or injury.

Some red flags that indicate a need to pause or modify the plan include lingering pain beyond expected levels, dizziness during standing, new neurological symptoms or issues with balance and coordination. When identified early, these concerns can be addressed before they lead to greater complications.

Tools and Technology That Support Early Movement

A variety of devices can support and enhance early mobilization efforts. Braces provide structural support to protect healing tissues, especially in fusion patients. Walkers and canes offer assistance for balance and confidence. Adjustable hospital beds and sliding boards can ease transitions in and out of bed.

In addition, wearable fitness trackers are now being used to monitor step count, heart rate and motion, providing both patients and providers with a measurable way to assess activity and recovery progress.

Educating and Empowering Patients

Education plays a central role in successful mobilization. Patients are introduced to movement protocols before surgery through preoperative classes or individualized sessions. Understanding the importance of early movement helps reduce fear, increase participation and prepare patients mentally for what to expect post-surgery.

Postoperative instruction is reinforced at the bedside. Patients receive guidance on how to sit, stand and walk properly, how to use devices safely and what warning signs to look for. Involving caregivers in this process further improves compliance and continuity of care at home.

Patients who feel informed are more likely to engage in their recovery and less likely to develop anxiety or avoidance behaviors that slow progress.

Pain Management as a Key Enabler

A successful mobilization program relies heavily on effective pain control. Multimodal pain strategies, including the use of acetaminophen, NSAIDs, nerve blocks, gabapentinoids and limited opioids, enable patients to move without excessive discomfort.

Cryotherapy, muscle relaxants and Transcutaneous Electrical Nerve Stimulation (TENS) may also be incorporated to manage soreness and enhance comfort. With good pain control, patients are more likely to meet their movement goals and avoid the complications associated with immobility.

Integrating Mobilization into Overall Recovery Plans

Early mobilization is not a stand-alone intervention; it works best when integrated into a comprehensive recovery plan. ERAS protocols include goals for pain control, nutrition, sleep hygiene and gradual activity increases. Setting clear benchmarks, such as walking a certain distance by day three or climbing stairs by week two, helps keep recovery on track.

Ongoing collaboration between surgeons, therapists, nurses and patients ensures that these benchmarks are realistic and achievable. Adjustments are made as needed based on performance, comfort and healing progress.