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Thursday, May 2, 2013

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.


  1. I'm looking at 14 level fusion....f2f to l3.....I do hope to bike again

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