Running After A Lumbar Spine Fusion Part II

Just to summarize some of what was stated in the previous post regarding running after a spinal fusion:

• Pay attention to your level of pain, 
• Symptoms that were present prior to your fusion (you don't want to be experiencing these same symptoms), 
• The maturity of your fusion, and how your body responds after you've gone out for a run.  Don't start running too soon!  What I mean by this last statement is, 
• Pay attention to symptoms that are consistent with inflammation.  If there is too much inflammation, you'll experience a sharp spike in pain, swelling, and prolonged soreness.  Because of the excess swelling following a run or series of runs, this can cause pre-existing leg and back pain.  This is what you absolutely do not want!  So, to counter this, reduce the time or distance of your running, switch from running outside to running on a treadmill where the surface is more forgiving.

This last statement is an excellent segue into what is the most important:

• Pay attention to the way you are running!  

When returning to running after a spine fusion the mechanics of your running are going to have to go through an overhaul.  Here is a list of specific aspects of your running mechanics that you will have to change, modify, or pay close attention to:

1. Shorten your stride and slightly increase your leg turnover
2. Minimize as much as possible the amount of up and down motion that is present in your running stride
3. Maintain a "neutral spine" position during running.  You must not let your back extend in a aggressive or ballistic manner such as often happens when sprinting or performing speed work.  If you are familiar with the term anterior pelvic tilt, then limit the anterior tilt and perform a modest stable posterior pelvic tilt.  This means you'll have to put some time into keeping your abdominal muscles strong.
4. If you are used to using a firm stable shoe and striking hard through your heel, this will most likely not work for you anymore.  Switch to a more cushioned neutral shoe and retrain yourself so that you have a lighter heel strike and more of a mid foot or "bare foot" style of running mechanics
5. Finally, do not rush in to running too soon.  Make sure your trunk muscles are strong, your fusion has matured, and that you have performed a good thorough pre-conditioning protocol such as a course of physical therapy prior to resuming running!

Some of the above statements might not make sense to you or be confusing.  So, here are the explanations why you'll want to pay attention to each one.  Not all of these may need to be changed. 

Much of the above and below depends on the overall health of your spine following surgery, the reason for surgery, and the number of levels in your lumbar spine that were fused.  The more levels fused, then the more attention you'll have to pay with regards to using the best mechanics possible to maintain a healthy spine and ensure longevity of your running.  So, here are the explanations why you'll want to pay attention to each of the above mentioned:

1.  Typically, a longer stride means that there is an increased vertical component in your running stride. This equals out to a harder heel strike.  A longer stride also means that your back will be extending more and a stronger pull will be on your hip flexors.  Both of these add stress to your fusion.

2.  Even if your stride length is already shortened, you'll still want to make sure you've taken out as much vertical component out of your running as possible to limit a hard heel strike and often violent impact with especially newbie and heavy runners.

3.  With runners, the muscles along the spine become quite conditioned from just the running that you do.  Typically there is a large imbalance between your muscle along your spine and the abdominal muscles unless purposeful training of the abdominal muscles are being performed. Therefore, if the spine muscles are developed to an extent that this is adding increased pressure on your lower back through resting muscle tension alone, then keeping your abdominal muscles strong would be most logical in order to counteract the strength of the muscles along the spine.  When running, it will be very important to purposefully keep mild to moderate tension in your abdominal muscles to assist with avoiding excessive extension in your lower back and to avoid excessive pull from the hip flexors.  This is where maintaining a "Neutral Spine" or mild to moderate "Posterior Pelvic Tilt" comes in very handy.  The posterior pelvic tilt evens out load or impact absorption through the lumbar spine.

4.  Firm stable shoes were intended to be used for larger runners who have not developed or learned the necessary running mechanics specific to them.  The firm and stable shoe makes up, only in part, for the poor running mechanics, sloppy foot placement on the ground, and for at times violent impact by poor running mechanics.  By shortening your stride, your foot strike changes significantly and your running stride becomes much more cushioned.  There is more forward translation occurring when your foot strikes the ground with a shorter stride.  There is much less impact through the heel because the angle of dorsiflexion or the amount that your foot is pulled up is significantly less with a shorter stride.  This alone softens the heel/foot strike on the ground.  Vertical movement is significantly reduced, and much of the foot pronation that is meant to be controlled by a firm and stable shoe is not nearly as pronounced with a shorter stride.  In addition, through a shorter stride, there is less time between heel/foot strike and toe off.  There is more energy for forward translation with less effort!  Your running becomes more efficient, more muscles are used, and there is less incident of injury due to better running mechanics.  That being said, and with improved running mechanics, it just makes sense to move in to a lighter and more cushioned shoe to allow your foot to do what it is meant do and to enjoy your runs in.

5.  Finally, be patient.  It doesn't matter who you are, you still need time to heal!  For a spine fusion to be considered safe enough to resume short and easy runs, it will take a minimum of six months.  During this six month period, aerobically condition yourself on a stationary bike or swimming in a pool.  The aerobic conditioning will also help significantly with persistent pain symptoms.  Perform strengthening exercises for your legs and trunk while maintaining a neutral spine position.  When you do get back to running, I believe you'll be surprised at how well you'll do just from the cross training during this six month time frame. 

If you have any questions, concerns, or comments feel free to email me!

Happy Bipeding!

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