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Exercise Rehabilitation Following a Spinal Fusion

Feb 10, 2022

The human spine plays an integral part in allowing the body to move freely and bend with flexibility, while also acting as the body’s central support structure (Oxland, 2015). Patients that present with symptomatic instability, structural deformities, or elevated pain, may be treated with an interbody spinal fusion (Enders & Coughlin et al, 2020). Common spinal deformities including scoliosis, kyphosis, and lordosis, which are commonly caused by degeneration, are typical precursors for spinal fusion surgery.


Spinal fusion surgery is a neurosurgical or orthopaedical surgical technique where a bone graft is added to a segment of the spine. Bone grafts are commonly taken from the patients’ hip, harvested from cadaver bone, or a manufactured synthetic bone substitute (Ullrich, 2013). This sets up a biological response in the body that causes the bone graft to grow between the two vertebral elements to create a bone fusion (Ullrich, 2013). Two vertebral segments are fused together to stop the motion at one segment. Cervical and Lumbar spinal fusions have provided a greater than 90% likelihood of relieving radicular symptoms and stabilisation, or improving myelopathy (Levin & Hale et al, 2007). Following spinal fusion surgery, stiffness and soreness are likely to occur, thus exercise rehabilitation has long been a common feature in the postoperative management of patients undergoing this procedure (Madera & Brady et al, 2017).

 

Rehabilitation following a Spinal Fusion:


Postoperatively, physical therapy and rehabilitation modalities are frequently used to improve patients’ activity levels, range of motion, and core strength (Madera & Brady et al, 2017). Immediately following surgery, short distance walks are recommended in conjunction with static lower limb musculature stretching, in line with specialist recommendations (Miller, 2016). Strengthening exercises have long been the cornerstone of physical therapy. Evidence states that motor control and strengthening exercises play a vital part in postoperative rehabilitation as neutral spine exercises are recommended to increase core strength and improve disability index scores (Madera & Brady et al, 2017). As trunk muscle function and health related fitness in patients with chronic back pain are often extensively impaired, comprehensive training programmes are required. Effectiveness of exercise interventions are partly adherence dependent, thus supervised rehabilitation assist in goal setting, as well as monitoring progression and motivation (Tarnanen & Neva, 2012)

When looking at the current literature, multiple studies support a multidisciplinary approach, using evidence-based guidelines, to deliver the best outcomes for individuals following spinal fusion surgery (Madera & Brady et al, 2017.)



James McNally

Workers Compensation Specialist ‑ Team Leader East (AEP, ESSAM)

Exercise Rehabilitation Services

     




References

Oxland, T. (2015). Fundamental biomechanics of the spine – What we have learned in the past 25 years and future direction. Journal of Biomechanics, 49(6), 817-832.

Enders, J., Coughlin, D., Mroz, T., Vira, S. (2020). Surface Technologies in Spinal Fusion. Neurological Clinics in North America, 31(1), 57-64.

Ullrich, P. (2013). Lumbar Spinal Fusion Surgery. Spine Health.

Levin, D., Hale, J., Bendo, J. (2007). Adjacent segment degeneration following spinal fusion for degenerative disease. Health and Medicine, 65(1).

Madera, M., Brady, J., Deily, S., McGinty, T., Moroz, L., Singh, D., Tipton, G., Truumees, E. (2017). The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review. Journal of Neurosurgery, 26(6), 694-704.

Miller, R. (2016). Guide to Physical Therapy After Spinal Fusion. Spine Health.

Tarnanen, S., Neva, M., Dekker, J., Hakkinen, K., Vihtonen, K., Pekkanen, L., Hakkinen, A. (2012). Randomised controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC Musculoskeletal Disorders, 13(1), 123.

By Alison Absolute Balance 24 Apr, 2024
The human body is designed to move in a three-dimensional plane divided into the following segments: Sagittal Plane: Cuts the body into left and right halves. Forward and backward movements. Frontal Plane: Cuts the body into front and back halves. Side to side movements. Transverse Plane: Cuts the body into top and bottom halves. Twisting/rotational movements. Too often we get caught training mostly in a sagittal plane, think running, squats, bicep curls etc. While these are all good exercises, in day-to-day life we don’t only move along a sagittal plane. What happens when you need to quickly get out of the way of the e-scooter flying towards you on the foot path or make a quick sidestep to avoid a pothole – these movements are along the frontal plane. While movements such as turning to check your blind spot while driving or turning to talk to the person next to us are in the transverse plane. When it comes to injury prevention and movement efficiency it is important to incorporate exercises from all planes of movement into training programs. Sagittal If a line ran down the middle of the body splitting it from left to right, movements parallel to this line are within the sagittal plane of movement. The sagittal plane is the most common plane of movement and is trained overwhelming more than the frontal and transverse planes of movement. Movements/exercises considered to be in the sagittal plane include running, squats, deadlifts and bicep curls. Now while all these exercises are good, with the way our lives having evolved into many desk sitting roles, driving from place to place etc, to then go to the gym and focus heavily on movements that are predominantly up – down, and forwards – backwards we can end up reinforcing these pathways and becoming somewhat robotic, heavily limiting our natural movements. Frontal If a line ran down the middle of the body splitting it into front and back, movements parallel to this line would be within the frontal plane of movement – essentially any movement that involves moving away from or towards the midline. Often neglected in strength programs, frontal plane exercises include Cossack squats, lateral lunges, and side raises. Transverse If a line split the body in half separating it into top and bottom with the pelvis being the point of division, any movement parallel to this line would be considered to be in the transverse plane of movement. Movement along/through a transverse plane is generally more rotational such as a Russian twist or trunk twist. By focussing largely on sagittal plane movements, we are risking developing muscle imbalances, limited mobility and uncoordinated movements in the neglected planes. Our body is designed to move on a 3-dimensional plane so make sure to train in a way that will allow it to move the way it’s supposed to. Katie McGrath Injury Prevention Specialist Injury Prevention Services
18 Apr, 2024
Stretching and mobility exercises are indispensable components of both injury prevention and recovery strategies. Incorporating dynamic stretches before physical activity can help prepare the body for movement by increasing blood flow to muscles and enhancing joint flexibility. This dynamic warm-up routine primes the muscles and connective tissues, reducing the risk of injury during subsequent activity. Furthermore, static stretches, performed after physical activity, helps alleviate muscle tension and improve flexibility, thereby minimizing the likelihood of strains and tears. In the realm of injury recovery, stretching and mobility exercises play a crucial role in rehabilitation protocols for individuals recuperating from various musculoskeletal injuries. Following an injury, muscles can become tight and weakened due to disuse or trauma. Gentle stretching exercises aid in maintaining or restoring flexibility, preventing muscle atrophy and contractures. Additionally, targeted mobility exercises assist in restoring range of motion and functional movement patterns, allowing individuals to gradually regain strength and flexibility while reducing the risk of re-injury. Moreover, stretching and mobility exercises promote tissue healing by improving circulation to the injured area. Increased blood flow delivers essential nutrients and oxygen to damaged tissues, facilitating the repair process and reducing inflammation. By incorporating a comprehensive stretching and mobility routine into their regimen, individuals not only safeguard themselves against future injuries but also expedite their recovery journey, enabling them to return to their activities with greater resilience and confidence. Mariah Adolphus Workers Compensation Specialist (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
05 Apr, 2024
Hey, my name is Blake, and I am an Exercise Physiologist, Workers Compensation Specialist and Clinical Team Leader at Absolute Balance. I graduated from Edith Cowan University in 2015 after completed my Bachelor of Science (Exercise Science and Rehabilitation). I grew up on a farm Northeast of Perth past Gingin with my parents and two brothers, both of which are back working on the farm, which has been in our family for generations. My love for sport and interest in the human body initially prompted me to complete my Bachelors in Exercise and Sports Science, and my initial thoughts on a career were either Physiotherapy or Phys Ed Teacher. However, this quickly changed when I commenced my first Exercise Physiology unit in my Sports Science degree as it opened my eyes to exercise rehabilitation, and how important it was to individuals with injuries. Having experienced multiple injuries personally playing football (AFL), basketball and tennis, I can fully empathise with how much injuries can impact your life. Being an EP and being in a role where I can make a positive and meaningful impact on individual’s lives who have sustained an injury is extremely important to me. This doesn’t only extend to the patients I see, but also the team members I lead within Absolute Balance. I guide a team of five in the Northeast region at Absolute Balance, assisting them with their own patients and leading them to grow as Exercise Physiologists and individuals. Although it has its challenges, leadership is extremely rewarding and has helped me grow both personally and professionally. Whilst I am not at work, I am spending my time at the gym, at football training and games during February-September (or in the car travelling to and from comes with the gig of country football), spending time with my wife and our dog Otis. I spend the other half of my weekend manicuring my lawn and watching good shows and sports. Blake Cocking Workers Compensation Specialist ‑ Team Leader North East (AEP, ESSAM) Exercise Rehabilitation Services ‑ WA
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