The Role of Physiotherapy in Recovering from Cervical Fusion

Cervical fusion, also known as Anterior Cervical Discectomy and Fusion (ACDF) surgery is a procedure used to relieve chronic pain, nerve compression, or spinal instability, however, the procedure itself is only a first step; physiotherapy is needed to make a complete recovery.

Research (Vonck et al., 2018) shows that early, controlled physiotherapy leads to better post-surgical outcomes. Following any type of orthopedic surgery, physiotherapy is part of the recovery process. No matter the procedure, the short and long-term goals are to reduce pain, improve range of motion, and restore muscle balance. For cervical fusion patients, physical therapy helps patients overcome stiffness, improve posture, and rebuild strength—key factors in preventing excessive stress on nearby vertebrae, which can cause further problems down the line. 

Let's take a closer look at its impact and practice.

Cervical Fusion, Movement & Strength

Cervical fusion stabilizes the spine by fusing two or more vertebrae. While this prevents painful motion, it also alters muscle dynamics in the neck, shoulders, and upper back. Cervical spine surgery patients often experience:

• Reduced neck mobility due to the fused vertebrae.
• Weakness in the shoulder and arm muscles from post-surgical nerve irritation.
• Postural imbalances that strain surrounding muscles.
• Stiffness and discomfort, particularly when turning the head or lifting the arms.

Without proper rehabilitation, these changes can lead to chronic pain, limited function, and compensatory movement patterns that create new problems over time.

Why Physiotherapy After Cervical Fusion?

Postoperative physiotherapy is designed to restore mobility in a controlled manner. While there may be limitations on certain movements during the initial recovery, gentle motion is essential for preventing joint stiffness and muscular atrophy. Early-stage therapy involves passive range-of-motion exercises, along with a gentle stretch of the neck and shoulder muscles.

Building muscle strength around the fused segment is equally important. Targeted exercises focus on the scapular region, where strengthening the rhomboids, trapezius, and other supporting musculature for arm and shoulder retraction helps promote stability and reduce strain on the cervical spine. Controlled scapular retraction drills and gradual arm elevation activities are frequently prescribed to fortify the upper back, improve postural alignment, and enhance overall function.

Achieving and maintaining good posture plays a critical role in safeguarding the cervical spine over time, as many people inadvertently adopt slouched positions as a protective response after surgery. 

Cervical Fusion Rehabilitation Exercises

Cervical fusion rehabilitation involves a careful progression that begins with pain management and controlled range-of-motion activities before advancing to more dynamic exercises. The following exercises are examples of movements that are routinely incorporated into post-operative cervical fusion protocols:

• Shoulder Blade Squeeze (Scapular Retraction): Sit with the spine in a neutral position, and focus on gently drawing the scapulae (shoulder blades) toward the midline of the thoracic spine. This shoulder retraction activates the trapezius and rhomboid muscles to stabilize the cervical region. Maintain the contraction momentarily before releasing.

• Arm Raises (Glenohumeral Elevation): The starting position is to have the arms at the sides with thumbs pointing upward. Slowly elevate the arms until they reach shoulder level, then slowly lower them in a controlled manner. This movement targets the deltoid and rotator cuff muscles without overloading the cervical spine. 

• Chin Tucks (Cervical Retraction): Gently pull the chin backward while keeping the head aligned over the shoulders—this helps strengthen the deep cervical flexors and reinforce proper cervical posture. Hold for several seconds.

• Gentle Neck Stretches (Lateral Flexion): Tilt the head laterally, ear toward the shoulder, pausing when a comfortable stretch is felt along the contralateral side of the neck. This gentle movement helps address tightness in the sternocleidomastoid and upper trapezius muscles. Avoid pushing beyond a mild to moderate stretch.

The Ortho Westmount Difference

At Ortho Westmount, we specialize in complex spinal procedures, including Anterior Cervical Discectomy and Fusion. Our experienced surgeons work closely with physiotherapists to develop customized rehabilitation plans that maximize recovery.

Don’t let post-surgical stiffness or weakness hold you back. If you’ve had cervical fusion surgery or are considering it, schedule a consultation today and take the first step toward a stronger, pain-free future.

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References:

• Royal Devon & Exeter NHS Foundation Trust. (n.d.). Cervical fusion: Post-operative physiotherapy advice (Patient information leaflet: RDE-22-039-001). Royal Devon & Exeter NHS Foundation Trust. Retrieved February 12, 2025, from https://www.royaldevon.nhs.uk/media/hallzybj/patient-information-leaflet-cervical-fusion-post-operative-physiotherapy-advice-rde-22-039-001.pdf
• Lorenz, N. A., Galetta, M. S., Zabat, M. A., Raman, T., Protopsaltis, T. S., & Fischer, C. R. (2023). Post-operative physical therapy following cervical spine surgery: Analysis of patient-reported outcomes. Global Spine Journal, 13(1), 8–15. https://doi.org/10.1177/21925682221133884
• Government of Alberta Health Services. (n.d.). Cervical spinal fusion: What to expect at home. MyHealth Alberta. Retrieved February 12, 2025, from https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zx4109‍
• Vonck, C. E., Mann, C. J., Lubelski, D., Grauer, J. N., & Mroz, T. E. (2018). National trends in demographics and outcomes following cervical fusion for cervical spondylotic myelopathy in the United States. Global Spine Journal, 8(4), 317–323. https://doi.org/10.1177/2192568217722562