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Saturday, March 9, 2013

Getting Back To Running Following A Spine Fusion

Since I left this blog more or less wide open for discussing nearly any aspect of sports injury and non-related sports injury but are trying to get back your prior level of physical fitness and or activity, I’ve a topic I believe that may be relevant to many of you and is absolutely relevant to myself.

I’ve never mentioned in any of my posts the injuries that I have sustained through sport and injuries that were not related to sports.  With regards to dynamic activities such as running, jumping, team sports etc. following a spinal fusion, you will hear a very broad spectrum of opinions whether it is a smart or good idea to resume your usual fitness activities following a fusion.  There is a lot to be taken in to consideration after a fusion.  The following are several aspects to consider and then I’ll talk about how to make an informed decision as to whether or not it’s a good idea with regards to you:

·      Consider the trauma of which was sustained that led you to having a fusion.  Was the need of your fusion due to hereditary traits and age, were you involved in a severe traumatic accident, OR, was the fusion a product of repetitive use or an overuse injury?

·      How many levels were fused and in which part of your spine?  For example, did you have a fusion in your lumbar spine, thoracic spine (which is not very common), or in your cervical spine?

·      Was or is there any permanent nerve damage resulting in muscle wasting or atrophy?

·      Are your pain symptoms currently managed or do you still have acute pain?

·      And, what are your expectations regarding the level of fitness you want to acquire or re-acquire?

Since January 2005, I have had 5 surgeries on my lower back.  My lumbar spine is fused from the 3rd lumbar vertebra to the sacrum.  Three of these surgeries were to perform fusions in order to stabilize my lumbar spine, take pressure off of nerves, restore strength, and to resolve acute pain symptoms.  Two of the surgeries were to remove bothersome hardware and for debridement of scar tissue.  The injuries I sustained in my back were from two specific issues.  The first reason leading to surgery was trauma from cycling accidents and acrobatics, the second and what I believe caused the damage to my spine worse than the damage that should have been done is due to genetics or hereditary issues.  Yes, my family has a history of spine degeneration.  I believe I was spared a much worse outcome from the hereditary issues due to staying fit through my sports and strength training as well as strict adherence to using the best biomechanics possible on the bike and when running as well as with work activities.

So, to answer the question, can you go back to running following a spine fusion?  Absolutely!  I also resumed cycling and in 2008 won 2 Arizona state championships in the Cat. 3 division.  These were in the 40km individual time trial and the hill climb road race. 

Introduction back into cycling and running were done methodically.  Here is where my advice to everyone begins.

First, you need to make sure that your fusion has matured.  Like healing of the plantar fascia, beginning ballistic and dynamic type of activity cannot be rushed!  You also need to make sure that no other parts of your body will suffer injury or insult if you do resume running.  And something that is extremely important, make this decision with your doctor.  But here’s the catch.  Do not let your doctor make the decision for you!  I’m not saying this to undermine your doctor.  I’m saying this because you know your body the best.  You are the best advocator for yourself!  Also, your doctor may not have any kind of sports, biomechanical, kinesiology, or athletic background and not have a clue about the forces caused or not caused through running.  Yes, he may be a surgeon, but this only means he knows how to do surgery and does not know how to help the patient recover from the surgery!  That’s why there are physical therapists!  

Most information about getting back to running following a lumbar spinal fusion says to not go back to running.  Most of the information that this is based on is nothing but myth, old wives tales, and is based on hypothetical information.  I know many weekend warrior types, amateurs, and professional triathletes that have undergone lumbar spine fusion at one and two levels.  Right around 6 - 10 months later, they’re racing at their prior level and are symptom free.

When doctors and healthcare providers think of running, the first thing that comes to mind is IMPACT!! (Notice how I used the “impact font”.  Clever huh?).  If your mechanics of running are proper, then impact is not an issue.  Running is a forward motion and not an up and down motion.  To really see this in action, view a video of sprinters or marathoners.  You’ll notice that there is virtually no up or down motion.  Up and down motion when running indicates an inefficient and harsh running gait!  This is precisely why using a good mid-foot strike is so important (as should be used when running).  The midfoot strike takes away the axial pounding through your lower extremity and hips and in return minimizes the axial pressure through your spine.

There is a very large population of physical therapists and other healthcare providers that will tell you to absolutely refrain from running following a spine fusion.  And, if you are going to cycle, then you’ll have to cycle on an upright bike.  Then there are the physical therapists and doctors that have an athletic and sports background with a much larger knowledge base in the mechanics of sport, the tolerance of forces, and the dispersion of these forces when the said activity is performed with in the proper manner.  These are the therapists that will put you back into your running shoes and back in to an aero position on your time trial bike or road bike without compromise to your body.

So, in summary, you can get back to running following a spine fusion.  You’ll have to be patient, start in a gradual and methodical manner, make sure there are no secondary complications or injuries occurring, and make sure you’re running in the most efficient manner.  I could go on for quite some time giving you a lot more information regarding this topic.  But I’m preparing for a cervical spine fusion on March 26, 2013 (a hereditary issue).  But you can count on me getting back to running at the right time and in the right manner.

Watch for Part Two of this post.  I’ll talk about specific aspects to focus on following a spine fusion and what to do to make the proper adjustments regarding your gait during running.  These adjustments will significantly reduce excess stress on the spine other than what would be caused by impact.  Just to get you thinking, these forces are in the axial (rotational) plane and sagittal (forward/backward) plane and the way the muscles tug on your spine during running.

I’m already tingling from the excitement of it!!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.

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