Spinal Fusions are performed by surgeons to join two spinal segments (vertebrae), together where movement is causing unwarranted pain or discomfort. The fusing of the two spinal sections is done to encourage the bones to fuse together into one solid bone. Bone Grafts can be put in place and pins and rods may be used to bring two segments together and allow bone growth to occur resulting in restricted movement.
Arthritis in spinal segments, degeneration in intervertebral discs, wearing of the disc due to injury or impact as well as instability in the spine (due to tumour or infection) are all causes that can warrant a decrease in the functionality of the spinal segment and would warrant this surgery. It’s not something that is too common though, given that the point of the surgery is to restrict pain. All other avenues non-surgical/medication/exercise should be explored before investigating spinal fusion.
The issue is not always in the bones themselves, but often in the compression of nerves that exit the spinal column at this point and movement here that is causing irritation, inflammation and radiating pain. Imagine living with debilitating sciatica that means you can barely walk, stand up or sleep comfortably at night? At this point fusion of the spine sounds like a great idea – if it works!
The main focus of the fusion is to limit movement of the painful spinal segments and prevent any friction that is causing the pain from occurring. The trade off is some reduction in movement in the spinal section. Obviously depending on the location of the fusion, the amount of movement sacrificed has differing effects on the ability to move. Hence these fusions are more common in the thoracic spine where movement is minimal when compared to lumbar or cervical motion. Fusion at these locations has much more effect on the ability of the body to bend and flex in a normal range of motion.
So how to deal with spinal fusion once it has happened? One thing is clear - movement is key. The amount of movement that you have pre-surgery is vital to minimise the effects of fusion. Post Surgery the most important aspect is to allow enough time for any bone grafts to heal over – effectively for the bone to grow together. This is exactly the same as a fracture and can take anywhere from 6 weeks to 6 months of minimal movement or stress.
The subsequent recovery period once this has occurred is about regaining movement and flexibility to a certain degree. Included in this focus is the desire to create as much space as possible for normal range of motion to be maintained. In this way, bodywork can have a huge effect in ensuring the soft tissues that act on the area are as open and as malleable as possible.
Whilst not working directly on the fusion itself, working to maintain the ligaments and flexibility of structures such as the thoracolumbar fascia (relates directly to lumbar spinal fusion) are important to give as much space as possible. Flexibility in the rib cage and in the shoulder girdle are vital to ensuring the trunk and the appendicular skeleton (arms/legs) are flexible enough to deal with the localised restriction.
In this way the body is remarkably clever at finding solutions in restricted movement. A classic case is restriction in ankle dorsi flexion is often found in an increased flexibility or movement in the lumbar spine. The body will steal from elsewhere to perform a movement that is desired. Often you can manipulate this fact and exploit the ability of the body to achieve movements again. Focussing particularly on the main joint spaces of the pectoral girdle/rib cage/hips/ankles, you can sometimes return to your normal activity despite being told ‘you’ll never jump again’.
Particularly when it comes to composite motions (movements involving multiple joints) the ability to exploit bio-mechanics and kinesiology (the study of the body in movement) can find someone rejoicing in performing movements and activities that were thought beyond them after surgery. It’s all about how much you can beg, borrow or steal from another area to perform the movement with absolute structural integrity.
Take for example, a leg kick in martial arts. A movement where:
· the supporting hip must engage to provide a platform to stand upon,
· the back and pelvis must swing anteriorly (toward the front) to stabilise and maintain balance,
· the leg must swing in an arc in a forward motion requiring knee extension, hip flexion, ankle dorsi flexion
· the impact of the powerful induced force that has to be minimised by the lumbar spine and core muscles.
Now introduce restricted lumbar flexion into this equation. All of a sudden the amount of curve possible in the lower back is decreased so the obvious choice here is to increase hamstring extensibility to allow the leg to swing higher in an arc of motion and achieve the same height of leg kick but without compensation in the lower back. This is possible if you can maintain pelvic tilt posteriorly (to the back) whilst creating greater force in the hip flexor and increasing amount of extension possible in the hamstrings.
It sounds complex and it can be but there is a solution to the equation if you understand the biomechanics and forces involved. It’s exactly like watching an episode of the BIG BANG THEORY. Everyone needs to be as smart as Sheldon and then we can all understand theoretical physics and explore the concepts of existential human existence!
So with Spinal fusion, you can discover different ways of opening the body joints and tissues that directly impact on the movement required. This is where acute assessment and a working knowledge of the body in its supportive framework can be most advantageous to achieving the ability to jump, run, lift, push and skip again.
Not all surgeries need to be a debilitating death sentence to activities YOU deem fun. Obviously there is work involved and this is so often where most people fall short of expected outcomes. It takes dedication to re-train habits and movement patterns and you have to be committed to your goal to really get back to top form. You have to train like a demon to recreate that form and function. Just google Anna Meares.
