Spinal Fusion is the surgical immobilization of adjacent vertebrae. This procedure maybe done for several conditions, including herniated disks. It is typically used to stop the movement at a painful vertebral segment.
The vertebrae are some of the toughest, most dense bones in your body. In order to have the Range of Motion (ROM) you enjoy from your spine, you have a relatively softer, more flexible, vertebral disc between your vertebrae. The vertebral disc is still tough, having the texture of a hockey puck. The discs are made up of fibrous cartilage enclosing a central mass, the nucleus pulposus (think of it as a gelatinous mass). The vertebrae are held in place by several ligaments. If there is damage to these ligaments, Spinal Fusion will not reduce the pain completely. Spinal Fusion will limit the stress on the ligament, but cannot repair the damage to the ligaments.
Surgeons use a variety of approaches to Spinal Fusion Surgery.
(1) Adding bone grafts: typically, the surgeon will cut away a piece of bone from the pelvic bone and graft it to the site of the herniated disc, which will immobilize the spine at that point. Many patients will report the complete absence of pain at the site of the targeted disc, but have excruciating pain at the site of the pelvic bone where the graft was taken. The pain will become less and less as this site heals.
(2) Creating a biological response to cause the bone graft at the site of the injured vertebral disc, to grow between vertebral elements, to grow a bone fusion.
(3) Using a bony fusion to grow a single fixed bone to replace a moving joint to stop ROM at the injured joint segment.
The doctors may suggest any of the above surgical procedures if you have degenerative disc disease, herniated or ruptured discs (herniated discs are often described as “Bulging Discs”), thinning discs, Scoliosis, vertebrae fractures, Spondylolisthesis, and/or Spine Tumors.
Most of the above are chronic diseases, meaning they can occur slowly over time as result of poor or inadequate: exercise, physical activity, nutrition or life style habits. Acute injuries can occur, such as an auto accident or fall that can cause a herniated, ruptured disc or vertebrae fracture. Weight lifters who continuously use poor form can cause any of the above. Think of the Weight-Lifters who lifts their hips off the bench while doing heavy Chest Presses or use poor form in the Squat or Deadlifts, or rolls his hips under while they perform heavy Leg Presses. Even the classic Straight Legged Sit-Up (SLS-Up) has caused innumerable damage to the lower spine.
Remember, you learned in the IFPA Personal Trainer Certification Course that SLS-Ups were both ineffective and unsafe. Therefore, they are listed as a high risk, contra-indicated exercise.
You will not be able to return to activities as quickly after Spinal Fusion Surgery. Typically, you can expect at least 3-4 months’ post-surgery for the vertebrae to heal effectively. Healing will continue for at least one year.
You can expect to be off work, be severely restricted on the activities you can do and be limited to lifting nothing heavier than a gallon of milk for 4-6 weeks. Even these limits are predicated on you being healthy and the work you perform (not strenuous), i.e.: clerical/office type work. Even sitting for long periods of time is contraindicated. For instance, if you are a truck driver, you will be out of work for a longer period of time. If you are older or not physically active and healthy prior to surgery, you will be out of work for a longer period of time.
Recovery from Spinal Fusion or any Back Surgery is an ongoing process. How fast you can recover is dependent on your previous activity level, exercise history, nutrition and lifestyle, age, the precise type of surgery you had, your ability to take instructions from and listen to the advice of your doctors, your commitment to your recovery plan and moving and exercising correctly.
If you carefully follow the Physical Therapy Program to completion, you should be able to return to normal activities. Always listen to your doctor and therapist and get their advice on exercise and contraindicated activities. Once you are cleared by your doctor for normal activity, double check with the doctor to make sure you can begin a weight training program. If you receive clearance, make sure you learn every exercise movement PERFECTLY while Unloaded before you begin to add weight to each exercise. Weight Training can be your best friend at preventing additional back pain and muscle-skeletal pains and injuries…OR… it can be your worst enemy if you do an exercise with poor form. Check your IFPA Personal Training Text for ideal form and technique.
The Typical Exercise Prescription following Spinal Fusion
1) Aerobic Training: initially Non-Impact: Swimming, biking eventually moving to weight bearing: Walking, Tai Chi, Pilates, Elliptical, etc. at moderate intensity Borg Scale: 12-16; most days of the week building up to 45 mins/session. NOTE: sessions lasting more than 45 mins can cause an inflammatory response!
2) Strength Training: Start on Machines with the basic exercises: 1 Set of 15-20 Reps NOT TO FAILURE; 2-3 non-consecutive days/week. The Beginner programs outlined in the IFPA Personal Trainer Text are ideal.
3) Flexibility Training: Static Stretches or PNF with an IFPA Certified Flexibility Specialist or Physical Therapist. Comfortable ROM, most or all days of the week. Follow the guidelines in the IFPA Personal Training Manual.
4) Low intensity Balance and Functional Training recommended.
Care and Prevention of Back Pain
Benjamin Franklin once said, “an ounce of prevention is worth a pound of cure.” It is very unfortunate that most people do not take the personal responsibility for their own health and Wellness, for if they did, the incidence of all back pain episodes and other joint and musculoskeletal disorders, would greatly diminish. Current studies indicate that over 80% of the population experiences at least one debilitating back pain episodes in their lifetime. If you consider that only 8% of the population exercises with the required Frequency, Intensity, Time and Type to gain health benefits, you can expect those numbers to rise. You must also consider that the same exercise prescriptions you use to prevent musculoskeletal disorders are the same as needed to prevent almost all chronic disorders.
The Exercise Prescription for the Care and Prevention of Back Pain Syndrome is to focus on the following 7 of the 12 IFPA Components of Fitness:
1) Strength Training: 3 Days a week on alternative days
2) Flexibility Training: Daily
3) Aerobic Training: 5-7 times/week
4) Balance Training: Most days can be incorporated with other components of fitness
5) Body Composition: Make it a goal to build muscle mass and reduce fat mass to a healthy level. A “Fit Body Fat” is between 14%-17% for a male, with 25% considered obese. A “Fit Body Fat” is between 21%-24% for a female, with 32% considered obese.
6) Symmetry: Develop all muscle groups in balance.
7) Biochemical Balance: Healthy nutrition, hydration, sleep, stress management, etc.
While some may look at the Exercise Prescriptions above as “Too Much WORK!” You cannot imagine how debilitating a Back Pain Episode can be! Imagine lying in bed in so much pain that every time you take a deep breath, it feels like a US Army Ranger just shoved his Commando knife into your back and twisted it with malice! Trust me on this, you will be wishing and praying that you had heeded this advice and done the “Too Much WORK!” Besides saving you from agony, multiple studies show that for every hour you exercise, you gain at least TWO Hours on your Life Span and many studies show more than that! You have a choice to gain pain-free Health, Functionality and vital years of your life and not just adding years, but adding quality to your years!
Please take personal responsibility for your life for there is no medical treatment that can do for you, what you can do for yourself.
Dr. Jim Bell