Spine Fusion & Hip Extension During Running

Spine Fusion & Hip Extension During Running

Throughout this blog, I speak of ways to improve efficiency of running.  Recently, I became acquainted with Jeff Gaudette of Runners Connect.  On his website he has a great tutorial about the importance of hip extension during running.  As with all aspects of running, there has to be purpose, intent, and proper execution behind it to maximize the benefit of this one aspect of running.  So, with this post, I've decided to cover a couple of different aspects of hip extension and running.  As usual, I want to provide information that is unavailable anywhere else with specifics to injury and running or sport in general. 

Proper hip extension is a key component with efficient running.  As with all aspects of running and its' mechanics, there needs to be intent and purpose behind a specific aspect of a specific phase of the running cycle.  With this post, I'd like to emphasize the importance of the incorporation of the abdominal muscles to check anterior pelvic tilting and it's effect on checking hyper extension of the hip during running.

As with anything used in excess or in a "too much" mode, bad things can happen.  Without the braking motion of the rectus abdominus muscle and psoas muscle during running and active hip extension, you increase your chance of overuse injuries in the form of lower back pain, psoas muscle tendonitis, and even greater trochanteric bursitis (hip bursitis).  Hip bursitis by itself can be extremely debilitating if treatment is not strictly adhered to.

For persons that have undergone lumbar spine fusion, the tension in the abdominal muscles is extremely important with regards to limiting anterior tilting of the pelvis and compression of the compromised spine segments.  Because of the attachment of the psoas muscle on the lumbar spine transverse process, the action of active hip extension is like using a chisel to break down the inter body fusion hardware.  For those that remember the mechanics of the spine, an anterior pelvic tilt is the same thing as bending backwards.  All of us that have had a lumbar spine fusion know that bending backwards is an action that you want to avoid at nearly all costs.

For Those Without Spine Pathology

Hip extension is an active motion that provides us with potential energy ready to be turned in to kinetic energy for the forward advancement of our thigh and leg.  The stored energy in the hip flexors via the hip extending is the potential or stored energy.  The resulting and forward motion of the thigh is the stored or potential energy turned in to kinetic energy.  It's basic physics.

Now, lets ad a support system to the hip extension.  To maximize the amount of energy being stored in the hip flexors there has to be a strong support system or base for the hip flexors to work from.  The act of hip extension is like cocking the trigger on a gun.  Another analogy is if you want to acquire height in a vertical jump, it would not be wise to jump off a soft cushy surface.  The force developed to propel you upward would be absorbed by the soft surface you are launching yourself from. You would want to jump up from a hard firm surface to provide as much propulsion upward as possible.  This law or rule of physics is based on Newton's Third Law of Motion:

Third law: When one body exerts a force on a second body, the second body simultaneously exerts a force equal in magnitude and opposite in direction to that of the first body.

Given this information, it would make sense to provide a strong base in which stored or potential energy can be maximized.  So, to provide a strong base of support, an antagonistic muscle body would have to be employed to maximize the energy return of good hip extension during running.

The Anatomy & Physiology of Good Hip Extension

Image I shows a side view or sagittal plane view of a torso.  The bony structure of the pelvis and lumbar spinous process' are visible too.  Also visible are the rectus abdominus muscle and transverse oblique muscle.  For our purpose, I'm going to be focusing on the rectus abdominus muscle.  In the case of hip extension and the actual elongation of the hip flexors, the rectus abdominus is the antagonist of the hip extension muscles.  When the hip is at full extension, it's the contracting or shortening of the rectus abdominus that provides the base structure or launch pad for maximum kinetic energy from passive hip extension to active hip flexion.  It gets a little confusing huh?  No worries, we'll fix any confusion.  If the abdominal muscles do not contract and engage, then the slowing and reversing of the hip extension motion is left up to maximum congruence of smashing together of bony surfaces and maximum elongation and tension on the supporting ligaments and tendons.  Over very high repetition, this can cause over use injuries in several areas of the torso, lower back, and hip. 

So, when the hip or thigh goes backwards (extends) there has to be a brake to stop it's backward motion.  This brake is the psoas muscle and the supporting contractile structure is the rectus abdominus muscle.  Let's look at Image 2.  

                                                                                Image 1 

Side View of Torso, Lumbar Spine, & Pelvis

Image 2

Overview of the Mechanics of the Torso, 
Lumbar Spine, & Pelvis During
Running and Hip Extension

The gluteus maximus, medius, minimus, and hamstring muscles are the major hip extension muscles.  If the action of these muscles are left unchecked, the pelvis tilts forward very hard.  Subsequently the small joints in the back become compressed in a very harsh and violent manner.  This is indicated by the black arrows.  The hard forward tilting of the pelvis is indicated by the blue arrows.  When the top of the pelvis tilts forward, this is referred to as a anterior pelvic tilt.  The green arrows indicate the elongation of the abdominal muscles when the pelvis tilts forward.  Basically, with an unchecked and strong hip extension moment we are literally bending ourselves backwards.  

Now, if we reverse the direction of the green arrows and contract the abdominal muscles to just the right amount, then this reduces the amount of extension in our spine and reduces the amount of passive anterior tilting of the pelvis.  This accomplishes three major events.

1. This increases the amount of stored energy in the hip flexors for a much quicker hip flexion moment and forward advancement of the thigh and leg.  This is done by the abdominal muscles providing a solid base of support to turn this stored energy into kinetic energy.

2. This significantly decreases the amount of joint compression in the spine and tensile forces on the passive stabilizers of our hip and lumbar spine.  These passive stabilizers are our ligaments and joint capsules.

3. This reduces the amount of unwanted anatomical events such as compression in the lumbar spine segments, unwanted "yanking" of the psoas muscle on the lesser trochanter of the femur, and unwanted yanking motion of the psoas muscle on the transverse process in the lumbar spine.

By checking active hip extension with the right amount of contraction in the abdominal and psoas muscles, the stored muscle energy used for efficient hip flexion will be significantly increased.

All of this translates into more efficient running and enjoyable running.

As usual, I can be reached at:

bradsenska@yahoo.com

Happy Bipeding!

The Difference Between "Strength", "Power", & "Endurance"

So, what makes people different with specifics to strength, power, and endurance?  To make this answer not so complicated, it comes down to the make up of muscle fiber type, fuel supply, and the size of the spark plug you have in your body.  Spark plug?  What the...?  When I say spark plug, I'm referring to your nervous system.  In the previous post, I put a chart up that gave guidelines of how to specifically train for your goals.  Muscle fiber type and fuel source are also extremely important and I will get to this in a moment.

How The Nervous System Plays A Role In Training and Performance

Each muscle cell or fiber contains nerve innervation.  It has to right, in order to contract?  Some muscle fibers contain more motor nerves than others.  If a muscle fiber contains more nerve innervation, then this increases the muscles ability to fire, explode, contract, put out power!  You get what I'm saying.  A good example of someone with this type of nervous system would be an offensive or defensive lineman on a football team.  There are many other examples, but I think most of us can relate to the football linesman.

How Different Fuels Play A Role In Training and Performance

What you eat is extremely important for training and acquiring your fitness goals or for a specific sport or competition.  The following are different analogies regarding the various fuels available to us in our bodies.

If you go to a gas station, you get to choose what kind of fuel your car runs on.  You typically have 3 choices of octane fuel.

1.  High Octane Fuel - Many of the turbocharged and performance sports cars run on high octane fuel.  A good analogy would be the same as direct fuel injection into the cylinders of a car.  The muscles are taking a fuel from the immediate available blood supply at the very moment it is called upon.  This fuel source is ATP (adenosine triphosphate).  ATP is an instant source of energy but is exhausted very quickly.  

An example of someone using ATP as their main fuel supply for their activity or sport would be a 100m or 200m sprinter.  Another example is an Olympic Power Lifter.  These people perform at maximum capacity but are only able to attain this level of exertion due to the quick depletion of ATP and a very rapid build up of waste product or lactic acid.

2.  Mid Octane Fuel - When referencing fuel for the muscle in the mid-octane range, this would be a combination of immediate blood glucose and conversion of stored glycogen in the liver of which then gets converted to blood glucose of which then gets converted to ATP.  The process for this to occur in our bodies requires a certain amount of time.  It's not an instant fuel source like ATP.

An example of someone using the "mid-octane fuel" would be a middle distance runner such as a 800m to a 10K runner.  Often, this fuel source can be available up to 1 - 1 1/2 hours of medium high physical exertion (i.e. exercising or working at 70 - 85% of maximum exertion).

3.  Low Octane Fuel -  Low octane fuel would be the 87 rated gasoline.  When applying this analogy to the body we are talking about using adipose or fat tissue for the fuel supply.  The process for fat or adipose tissue in our bodies to convert to useable energy takes a much longer time than ATP, blood glucose, or conversion of liver glycogen to ATP.

An example of someone using the "low octane fuel" would be someone running a marathon or cycling for a long period of time.

Fuel expenditures will vary from person to person.  The body can also be trained to a certain extent to utilize various fuel sources.  But, given our genetic makeup, not all of us can be elite class athletes no matter how hard you try or what supplements you take.  The genetic makeup in our bodies are key to how each of us perform individually.

But Hold On Just A Second!!  What About Oxygen?

Oxygen is key to "Converting" these fuel sources into useable ATP.  This is done during the Kreb's cycle.  Ask any high school or college student taking biology based classes about the Kreb's cycle and they'll tell you all about it!  Yes, the more oxygen that is available, then there's more potential for creating useable ATP for muscle contraction.

Then There Is The Muscle Fiber Type

Most likely you've heard the terms "fast twitch", "slow twitch", and then a combination of "fast & slow twitch" muscle fibers.  These muscle fibers are then classified even further into sub-categories that have  various combinations of fast and slow twitch muscle fibers.

A fast twitch muscle fiber typically uses ATP for fuel and is heavily innervated with motor nerves (e.g.. an olympic lifter or sprinter)

A slow twitch muscle fiber uses fat stores or adipose tissue for fuel.  Typically, the slow twitch muscle fiber has less motor nerve innervation (e.g. a long distance swimmer or runner).

And finally, the combination of fast & slow twitch muscle fiber.  This muscle fiber has a mixed amount of motor nerve innervation.  Meaning, it doesn't have as much motor nerve innervation as the fast twitch but it also doesn't have as few motor nerves as a slow twitch muscle fiber (e.g. a middle distance runner or swimmer) 

In Summary We Have:

1. The type of muscle or motor
2. The nervous system or spark plug that innervates the muscle
3. The various fuels:

• ATP (adenosine triphosphate)
• Glucose in the muscle cell and circulating blood
• Glycogen stored in the liver which then gets converted to glucose and then is available in the circulating blood
• The break down of fat stores which is then used for available fuel in the blood  

Here's a little trivia.  In the last post regarding Sets & Repetitions there was a mention of lactic acid.  Lactic acid is sometimes used as a fuel too.  The myocardium or heart muscle is able to use lactic acid as a fuel source.  Cool huh?

We Can Now Define "Strength", "Power", & "Endurance"

Not to draw this out, and relying on the information given previously in this post, a person who is:

"Strength" or when considering when someone is strong is when this person has heavily innervated muscle fibers of which allows a very large recruitment of muscle while performing work against a maximum amount of resistance for a very short period of time or for just one movement.  This would be like shot putting, javelin throwing, Olympic lifting, etc.

"Power" is when someone is able to perform a maximum amount of work over a specific period of time.  Someone that would be considered powerful would be a elite cycling time trialist.  This person has a specific amount of distance to cover in the least amount of time.  Maybe a better analogy would be a drag racer.  These cars have to be extremely powerful in order to be the fastest in a 1/4 mile run.  Savvy? 

Here's a little trivia again.  Many people are familiar with "Olympic Power Lifting".  To me this is an oxymoronic term.  It should be just "Olympic Lifting" or "Olympic Strength Lifting" or something along those lines.  The athlete is performing work against a maximum amount of resistance for just one lift.  This is for the most part the definition of strength.

"Endurance"is simply the ability to endure or last.  No matter the work load or resistance, eventually a person or the part of a machine will wear out given the work being performed over time.  An elite marathon runner is performing an endurance sport.  But because this person has trained for this and has developed a specific skill to complete the marathon in a much faster time than your average joe, they are still enduring a given workload over a period of time.  Yes, a marathon runner could be considered powerful, but given the work done over time, this person has more endurance than power.  Other examples would be Olympic distance triathlons, open water swimming competitions, basketball players, boxers, soccer players, etc.  A lot of work is being performed over a long period of time.

I hope this post gives you a better understanding of strength, power, and endurance.  If so, you are now better informed and will be able to plan your workouts and acquire your goals with greater ease and less confusion with just how you should be training.

As usual, feel free to email me for any questions or advice!

Good Health To All,

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

The Meaning Behind Sets & Repetitions

Many moons ago I knew that I would eventually own either my own fitness facility or some kind of facility in which I would be able to do personal training and incorporate a well rounded body-mind-soul-work-play life style.  This was in 1983.  It was my first year in college at Scottsdale Community College.  The corporate wellness boom was in it's beginning years.  Health clubs were popping up such as Nautilus.  But I had something much more specific in mind.  It had to have just the right balance of education, promotion of fitness, prevention of injury...

Finally, in 2002 after receiving my Doctoral Degree I opened my very own clinic!  The name of my clinic was Specialized Exercise & Physical Therapy.  The Specialized Exercise designated that each person coming in is treated with a specific or special prescription just to suit their needs.  After all, physical therapy is specialized exercise mixed with other treatment modalities, manual therapy, etc.  

I began mentoring 1st & 3rd year physical therapy graduate students.  Many of the students did not have an undergraduate degree in healthcare, exercise science, or any other experience with human performance and rehab.  And then many of the graduate students did have exercise science degrees.  But with this one topic (sets & repetitions), there was a commonality with the non exercise science background and the students with business degree backgrounds.

Now, To My Point

Part of being an intern is to become competent with evaluating, assessing & problem solving, and diagnoses.  When it came time to prescribing a rehab protocol, I made it a point with every student to ask why they prescribed the number of repetitions and sets for this person with a specific exercise.  The most common reply was of course to strengthen the muscle, improve joint glide, decrease scarring and so on.

But what I was asking is "specifically, how did you come up with the number of repetitions and the specific number of repetitions?"  There was surely a reason behind it.  Never once did any of the students understand the science behind sets & repetitions.

Here's The Answer!  (Go To The Bottom For The Short Answer)

I'll use the example of performing and arm curl or flexing, pumping, working the biceps.  There is a massive amount of muscle fibers that "recruit" or work to perform this motion against resistance.  Each one of these muscle fibers has a certain amount of "fuel" (oxygen, blood glucose, stored glycogen converted to glucose, ATP, adipose, etc.).  The fuel source depends on the amount of resistance that is being applied and for how long the work is being done.  Again, for our purposes, we're going to be speaking of the blood glucose or ATP fuel source.

So far, we have:

Muscle fibers + Fuel source

Now, let's assume that every muscle fiber in the biceps muscle fired and spent it's fuel source on just one repetition.  If this were the case, there would be no fuel left in the muscle to perform a second repetition.  This raises the question of how is it then that more repetitions can be performed?

Let's go back to the muscle fibers and recruitment.  Out bodies will only use or recruit the amount of muscle fibers necessary to complete the movement against the resistance being used.  

Now we have:

Muscle fibers + Recruitment + Fuel source

Now there's one other component that needs to be added in.  How are repetitions figured in?  There is a very strong science background with regards to the amount of repetitions for developing specific properties of a muscle.

The equation now is: 

Muscle fibers + Recruitment + Fuel source + Repetitions =

Repetitions:      3             6              8             10              12              15              20               25

Per Set 

Weight:          Heavy                                  Moderate                                  Light

Intensity:       Hight Intensity                    Moderate Intensity                  Light Intensity

Results:         Strength                              Muscle Hypertrophy                Endurance                 

                                                                    Power/Strength
          

                                                                                                        

               Blood Glucose/ATP                Blood Glucose/Oxygen            Glycogen/Fat Stores

Deciphering The Above Table:

The above table is a general rule to follow when wanting to develop a the type of strength that repetitions indicate.  A very high resistance is going to recruit a much large amount of muscle fibers.  A more stronger motor is needed to move the weight.  When performing this type of repetition, the fuel that is being used is what is immediately available in the muscle fibers that are working.  The muscle needs instantaneous fuel.  There's no time to use oxygen as fuel.  Using oxygen takes time to process through the "Krebs Cycle" in order to convert it to ATP.  Therefore the repetitions that you'll be able to complete will be very low.  When working the muscle to develop raw strength, the rest time between sets will be much greater.  Often, an olympic power lifter will wait upwards of 8 - 12 minutes between sets of just 3 - 4 repetitions.  This time is needed in order for the muscle to evacuate lactic acid and replenish the muscle of fuel necessary for the next set.

As you can see, when moving to a lower resistance, more repetitions can be performed.  This is because fewer muscle fibers are being recruited per repetition.  So while one group of muscle fibers are working, a separate group is resting.  When the first group of muscle fibers have depleted their fuel and are unable to continue working against the resistance, then the resting fibers take over buy not until the subsequent set.

Sets are the last component of prescribing the sum of sets & repetitions.  

From the last paragraph above, only the necessary amount of muscle fibers will recruit or work depending on the resistance.  If the weight or resistance is light, then a large amount of repetitions will be able to be performed.  This is because the fuel source for the amount of resistance or work being done is plentiful.  Eventually though, the fuel will run out and the exhaust or waste product will takes it's place - Lactic Acid or plain overall fatigue.  The muscle fiber will fatigue, and you'll have to put the weight down and rest.  When this point is reached, you've just completed one set.

So, if you want to increase the size of a muscle (hypertrophy), then using a weight in which the muscle fatigues between 8 - 12 repetitions is perfect!  A rest of 40 seconds to 75 seconds is a good rest period between sets for this type of training.  The reason why you want to perform 2 - 5 more sets with this specific exercise is to recruit the total amount of muscle fibers in the biceps muscle.  Remember, during a set of repetitions, only a specifically determined amount of muscle fibers will be working.  The rest of the muscle fibers are resting.  On subsequent sets, the resting fibers work.  Multiple sets are performed to make sure all of the muscle fibers in that specific muscle belly are sufficiently worked in order to make the desired change.

Now Our Equation Reads:

Muscle fibers + Recruitment + Fuel source + Repetitions + Sets = Desired Outcome.  

Short Answer:

Weight lifting/strengthening is goal specific.  To improve the strength or power of a muscle there has to be a large enough force and workload applied to the muscle in order to make permanent change.  By performing multiple sets, this ensures that all of the muscle fibers in a targeted muscle belly are recruited and fatigued enough so that the desired change is made.  This means that by using, for example, a 20 lb. weight and you are only able to complete 10 repetitions, then this constitutes one set of 10 repetitions.  By repeating a set consisting of 10 repetitions even if you have to vary the weight to do so, you are still sufficiently working the muscle to cause an increase in strength and size (muscle hypertrophy).

As usual, email with any questions or concerns!

Good Health To All,

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com

Swimming and Bilateral Breathing

Many seasoned and experienced open water swimmers, triathletes, and adventure racers may already know the importance of bilateral breathing when swimming.  There are several very good reasons for practicing this breathing pattern during swim practice and especially during swim competitions.  Here is a summary of these reasons:

1. You swim a straighter line in open water when breathing bilaterally

2. You are able to see where your competition is on both sides of you

3. Bilateral breathing improves your bodies ability to use available oxygen more efficiently

4. Most important, if you have a long swim and the swim is the first event, then getting out of the water, running to the transition area, and then donning your running or cycling gear will be more fluid, coordinated, and will save you what could be enough time to put you on the podium.

Let me explain each point.  

Number 1:  

I'll use the analogy of driving a car, walking, or riding a bike.  When you look to your right, the normal response when looking to your right or to your left is to head in that direction as well.  The key to performing acrobatics, diving, or other stunts like free style ski jumping is to always look where you want your body to follow.  When I was first learning backflips and double back layouts on a trampoline when practicing for our acrobatics team, the first thing you learn is to lead with your head and eyes.  Our bodies are programmed to follow our line of sight, to follow where our head leads.  In other situations in life, this can be bad news and trouble, but in this context, it's necessary for improving your performance in open water swimming of which a transition to another sport discipline immediately follows.

In summary, if you employ bilateral breathing when open water swimming, you will swim a straighter line and not drift off course as many rookie open water swimmers do.  

Number 2:

You'll know where your competition is on both sides of you.  Knowing where other competitors are is essential especially if you're eyeing someone you've targeted to beat.

You also want to avoid getting too close to someone that may decide to take advantage of your slipstream.  Just as with cycling, speed skating, running, etc., a swimmer can slide in behind you and significantly reduce their energy expenditure in the swim leg.  Once someone does get in to your slipstream, it's very hard to shake them.  You certainly can't zig-zag around.  This would be detrimental to your race.  So, if you know that this person is someone that you are competing directly against for a podium spot, then it just may be that you've given your podium spot away.

Email me and I'll tell you how to shake someone out of your slipstream without putting yourself in the anaerobic red zone.  I'll also tell you how to maneuver around the turn buoys faster and more efficient than your competition. 

Number 3:

Bilateral breathing can have a profound effect on your bodies ability to utilize available blood oxygen more efficiently.  Because your breathing is in a controlled rhythm, this has a secondary effect on your bodies metabolism.  By practicing bilateral breathing, this causes a reduction in the uptake of oxygen.  Your body adapts to and overcomes this oxygen deficit by an increased ability of your body to grab on to un-utililized oxygen that is yet in the blood.

In addition to this, oxygen rich blood is delivered to the working muscles via increased capillary density through anastomosis.  When a muscle becomes short of oxygen and it's ability to perform work, this signals the body to produce more blood delivering capabilities to this area.  This is a process known as anastomosis.

Number 4:

Here is another analogy.  Have you ever played that game where you bend over with your forehead on the end of a bat with the other end of the bat on the ground.  Then for so many seconds or turns you spin in one direction then drop the bat, and attempt to run a straight line without falling or being penalized for going too far off course while getting from point A to point B?

The same thing happens after swimming a 1.5km swim while unilaterally breathing.  You reach the dock or shore, stand up, try to doff your wetsuit and swim cap, and all the while you're trying to run a straight line to the transition area.  But instead, your running into the aisle ropes and other people  Your vision is out of whack, and at times you're falling down because you're too dizzy.  It's extremely difficult, frustrating, and can be very time consuming when trying to focus on donning your running or cycling shoes, glasses, helmet, tuck in a goo packet, or whatever.   

This dizzy and spinning sensation can cause a significantly longer transition time than necessary.  The fluid in your inner ear has been spinning one way for the last who knows how long during the swim leg and is now mis-directing you on which way is up and which way is forward.

The way to fix this is, if you just can't get the hang of bilateral breathing over a long swim course, then switch to bilateral breathing for at least for the last 5 - 6 minutes of the swim leg.  This will normalize the inner ear fluid and straighten out your onboard GPS and guidance center.  You will save you a whole mess of time,  you'll remain upright, oriented, focused, and even at times keep you from tossing your cookies.

So, if you haven't tried bilateral breathing, give it a try in practice.  Take note the line that you swim, the tempo in breathing, the difference in coordination of your swim stroke, and then hop out of the pool and go for a jog around the block just to see how you do.  I think you'll be pleased with the result.

In Good Health & Until Next Time...

Brad Senska, PT, DPT, BS, ASTYM.

bradsenska@yahoo.com 

Cycling Following A Spine Fusion

It is my opinion that "Yes" you can cycle following a spine fusion as long as it doesn't exacerbate the underlying spine pathology and if there are no other complicating factors.  However, whether road cycling or mountain biking, there will be variables to consider following a spine fusion.  These considerations are prudent whether you are returning to cycling or just beginning cycling.  There are "Three" main issues that need to be considered.  

These are:

1.  The location of the spine fusion.

2.  The type of the spine fusion.

3.  What are your expectations of cycling following a spine fusion?

Sorry about not having a straight forward answer for you.  But when you have construction performed on a structure in your body that is central to any kind of movement, it's important to get you the proper information!

So, I'll briefly go over each of the considerations mentioned above so that you will be able to at least make an informed decision regarding your cycling goals:

1.  What Type Of Spine Fusion Was Performed?  

Spine fusions come in many forms.  They can be a single level to a multi-level fusion.  A single level fusion will consist of stabilizing a vertebra above a nerve/disc, and then stabilizing a vertebra below that same nerve/disc.  A single level fusion is typically the easiest fusion to undergo and one that doesn't significantly limit your activities once you have recovered and are given the ok to resume your usual work and recreational activities.  

Ill. 1

A multi-level fusion (Ill. 1) will consist of stabilizing multiple vertebrae.  Just a reminder, the vertebrae are the bony segments in a spine.  This type of fusion usually takes longer to recover from and requires more caution with activities even after you have healed and resumed normal activities.  The reason for the extra caution is that instead of losing just one "shock" absorber and "hinge" for multi-plane movement, you have now lost two or more shock absorbers and hinges for movement.  This means that if you are too aggressive with movement, ballistic motion, or pounding through your legs or upper body, then the remaining spine segments (vertebrae & discs) will be required to do much more than their usual work.  This subsequently causes a rapid and early degeneration of the remaining healthy segments.

Ill. 2 

Spine Fusion Screws, Set Screws, & Rods

These are the actual screws & rods that were removed from
my lumbar spine (L5 - S1) in February 2006.

One last consideration regarding the type of fusion; was the fusion an anterior approach or a posterior approach?  Meaning, for a lumbar spine anterior fusion, did the surgeon go in through your abdominal wall?  For a lumbar spine posterior fusion, did the surgeon go through the muscle in your lower back?  The same can be asked for a cervical spine fusion.  And then there is the process used to perform the fusion.  Was a cage put in place around the vertebrae, or were screws, rods, & spacers (as seen in the above illustration) used?  In addition, did the fusion require bone grafts?  Was any kind of debridement performed around any of the involved segments?

A discussion will need to take place between you, your surgeon about the time frame in which the fusion will become mature and when you will be able to resume normal work and recreational activities with out risk.  There is one other person that can provide a significant amount of input regarding your progress.  This will be the physical therapist of whom you are working with.  

2.  Where Is The Location Of The Spine Fusion?                                                                     Ill. 3

 This is going to be a significant factor when cycling!  If the fusion is in the lumbar spine (lower back), then there are better chances that you will only be minimally affected by the fusion even if it's 2 or 3 segments.  If the spine fusion is in your cervical spine (neck region), then this will have a greater impact on your cycling.  This is especially true when road cycling or time trials/triathlons are your specialty.  With one or more segments of your cervical spine fused, the ability to look up and forward are going to be restricted (it is also strongly recommended that you not extend your neck excessively following any cervical spine fusion).  As previously stated, prolonged posturing when attempting to look up or "extend" your neck (Ill. 1) is going to cause more work on the segments above and below the fusion.  The muscles responsible for this posturing will become overworked and can cause painful symptoms caused by developing an "abnormal tissue length tension".  This can present in the form of very strong headaches, muscle spasms & trigger points in and around the scapulae, pain and soreness in the upper trapezius muscles, and even blurred vision from the amount of tension the muscles apply on the scalp.  They can be extremely painful and will often not respond to over the counter analgesics such as Tylenol or Advil.

3.  What Are Your Expectations Following A Spine Fusion?
                                                                                                                                                         Ill. 4

 By expectations, what type of cycling and at what intensity are you planning on going back to?  Are you resuming or starting mountain biking, road biking, cross, etc?  Following a spine fusion whether it be a lumbar spine fusion or cervical spine fusion (rarely are thoracic spine fusions performed.  These segments are very stable due to the ribs and the sternum stabilizing the thoracic spine segments), you will most likely have to make some adjustments on your bike to accommodate for the lost motion from the fused spine segments.  This change may be a very slight lowering of your seat, raising of your seat,  moving the seat fore or aft, or changing the length of the handlebar stem, etc.  Then you need to consider the cost of long hours in the saddle if you are riding competitively.  This will certainly take a toll on your spine especially when the intensity of your cycling increases.  When riding aggressively and pulling/pushing through your arms on the handlebars and then through your legs on the pedals and cranks, this adds stress to your spine in all three planes (sagittal - forward/backward, frontal - side to side movement, and transverse or axial - rotation/torque).  Don't think your clever if you believe that these forces won't affect the cervical spine!  Whenever your are pulling or pushing through your arms, the shoulder girdle has to stabilize the arms in order to apply force through them.  A majority of the shoulder girdle muscles are also the primary stabilizers of the cervical spine.  

You will then need to re-assess the type of terrain you are riding on.  This means if you are an avid mountain biker, you will have to assess the amount of impact your body is receiving if riding on rocky terrain.  A full suspension bike will help but will not be a substitute for what your spine "had been" able to do  *(Condition 3, Paragraph 3).  In addition to the type of cycling you are doing - road, mountain, or cross - assess the risk of cycling.  For example, if you are a competitive road cyclist (like myself), are you willing to take the chance that you may end up in a heap of crashed cyclists or having a freak accident with a car and subsequently dislodging a piece of hardware in your vertebra or even fracturing the vertebrae that have already been compromised.  If mountain biking, are you ready to take a header over your bars following a split second loss of concentration on a technical single track trail?   Granted though, it would still take a severe and violent accident to disrupt the fusion if you have given proper time to heal and have properly conditioned yourself following the spine fusion.  

The risk regarding your individual riding style needs to be considered.  Again though, with a single level lumbar spine fusion that has no other accompanying issues or risk factors, it would take quite a unique crash or force to disturb the fusion. 

AUTHORS NOTE:  Something that I've not ever mentioned in my blog entries is that I have had 6 levels of my spine fused.  Three levels in my lumbar spine and most recently 3 levels in my cervical spine on 3/26/2013.  Prior life events (not just one event but several over the years) was the start of my spine pathology.  I had my first lumbar spine fusion in February 2005.  I had just one level fused - the 5th lumbar vertebra to the sacrum (L5 - S1).  I had to wait one year for this fusion to mature.  My second spine surgery was in February 2006.  I had the hardware removed and a debridement of bony overgrowth from the "bone morphogenic protein" that's used to speed the fusion.  Since this fusion was only one level, I returned to competitive cycling in 2007.  It was a hit and miss year.  However, in 2008, I won two Arizona State Championships in the Cat. 3 division at age 44.

Part Two:  In late 2007, I was descending a narrow mountain road on Mingus Mountain near where my office was located.  As I was descending at my usual aggressive pace, I rounded a corner and in the apex of the corner was a section of road that had been disturbed by road work machinery a couple days prior.  Needles to say, I was not expecting road brail to be present in bold type font!  My rear wheel became stuck in a narrow rut that was approximately 2 inches deep.  To shorten this up, I slammed the asphalt extremely hard.  I weakened my fusion.  The result of this accident led to another fusion in November 2008 at the 3rd and 4th lumbar vertebra.  This fusion failed in less than a year.  It failed in spite of staying off the bike following this surgery.  Subsequently, in September of 2009, I underwent a multi-level spine fusion.  This fusion included lumbar segments 3, 4, 5, and the sacrum or S1 (L3 - S1 fusion).

I went back to riding but on my computrainer for several months.  Then I began riding on the road again for short distances in early 2011.  The only thing that I could put together that year was a 3rd place finish in the individual time trial state championships.  Since this time, I have only ridden recreationally with friends and for fitness.

*Summary:  My love of cycling, competing, the camaraderie, meeting new people, having that absolutely blissful and peaceful feeling of riding on vacant alpine type mountain roads where you can enjoy the smell of the pine trees and the sounds of nature combined with the fresh crisp clean air...this is medicine to my body and soul!  I opted to take the risk of "consideration number 3, paragraph 3".

The above is "my" story, not yours!  It's not that I'm being selfish or anything, it's just that well, you know, this doesn't mean it's going to happen to you, that's all.  You must do what feels right to you.  This was not written in order for it to be a generalization or a "bummer dude" soliloquy!  This is the consequence of my aggressive style of riding!  You need to consider your situation, how cycling fits in to your life, and how important this sport is to you.

I love running as much as cycling.  Cycling has the same mental and physical benefits that runners so frequently write about and verbalize.  There is a zen just as powerful if not more powerful in cycling as there is with running.  We cyclists I guess just aren't the romantics or at least don't profess our romance for cycling like runners do so frequently with running.

There is one last very important issue to address.  YOU are accountable for your body following an invasive procedure like a spine fusion.  Prior to returning or taking up any kind of sport, you need to make sure you have done all of the prerequisite work such as allowing the proper amount of time to heal, completing a proper conditioning program, and to restore strength and function to the injured structures.  You would be surprised at how much a "simple little one level spine fusion" (as a surgeon would say of whom has never experienced any type of fusion) can take out of you.  Just like anything else, make sure you don't rush your healing or take shortcuts!

Until next time...

Happy Cycling!

Brad Senska, PT, DPT, BS, ASTYM.
bradsenska@yahoo.com