Print This PageMoving from Static to Dynamic Exercises
Fig 10: Diagonal curl-up
(larger view)
Fig 11: Alternate arm and leg,
all fours
(larger view)
Fig 12: Pull with resistance band
(larger view)
Fig 13: Lumbar diagonal rotation
(larger view)
Fig 14: Opposite arm and leg,
on ball
(larger view)
Fig 15: Sitting to bridge,
on ball
(larger view)
Fig 16: Prone ball walk
(larger view)
Fig 17: Kneeling ball walk
(larger view)
Fig 18: Bridge ball
(larger view)
After the initial 6-week recuperation period when the focus is on getting back to feeling good, more advanced exercise should be added to strengthen the back structures and increase overall fitness. Patients can add more rigor and variety to their routines by using an exercise ball or resistance bands. The exact timing of when a surgeon will recommend adding dynamic exercises is dependent on both the quality of stability achieved at surgery and the surgeon’s own personal preference.
Weeks 6-12 – Add dynamic stabilization exercises
Because these exercises allow for motion of the trunk, many times they incorporate use of an exercise ball into the program.
Illustrative mat movements
- Strengthen abdominal muscles with a diagonal curl: while lying on the floor with knees bent, curl the trunk by raising the head and one shoulder towards opposite hip a few inches. See Figure 10.
- Extend the back by alternating limbs: while on hands and knees, raise one arm and opposite leg, then alternate. See Figure 11.
Illustrative band movements
- Stretch the back by using a resistance band wrapped around a stationary pole or column, and leaning back with straight arms. See Figure 12.
- Strengthen the abdominals and oblique muscles by performing a diagonal pull with band: with band anchored low to ground, and feet shoulder width apart, grasp band and pull from lower right to left shoulder. Reverse sides. See Figure 13.
Illustrative exercise ball movements
When using an exercise ball, maximizing the range of motion is not as important as staying in control, which takes practice if a patient is not familiar with using an exercise ball. Don’t worry about counting repetitions, but perform the exercise until fatigue is evident or control becomes difficult. A set should last 30 to 60 seconds (so about the length of a commercial break during a television show). One set a day is usually recommended.
- Sitting on the exercise ball, slowly raise one arm and opposite leg; reverse. See Figure 14.
- While sitting on the exercise ball, try to “hinge” at the waist by rolling ball forward and under shoulders, keeping hips in line with shoulders. See Figure 15.
- While lying with stomach on the exercise ball and arms/hands in front, walk forward on the ball until it rests under the thighs, then raise one leg at a time. See Figure 16.
- With stomach on the exercise ball and knees on the ground, walk straight out on the hands, but don’t let the trunk twist or dip down. See Figure 17.
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- Variation: With stomach on the exercise ball and feet on floor, raise head and chest from the forward bent position to a straight (but not hyper-extended) trunk.
- While lying on back with the exercise ball under the calves, raise buttocks, hips and lower back from floor, keeping the stomach muscles tight. See Figure 18.
Weeks 9-12: Progress to more vigorous low impact conditioning.
In addition to stretching and strengthening exercises, regular aerobic conditioning is also important to help the fusion set up well. Regular aerobic exercise, even if it is just walking at a brisk pace for at least twenty minutes, will increase blood flow and oxygen. It will also burn excess calories, thus maintaining weight and preventing added stress on the back structures and surgical site.
Several exercises can provide conditioning. The key is start slowly with shorter intervals of exercise and increase duration to 30 minutes a day, in total, as long as pain is not experienced. Low impact exercises include:
- Brisk walking
- Swimming
- Exercising using equipment available in most gyms or for purchase for the home, such as stationary bikes, elliptical trainers, and stair climbers
Not all exercise is suitable, however. Higher impact exercise that has abrupt stops, starts and changes in direction can put a fusion that is still healing at risk. This includes exercises such as:
- Jogging or running
- Some forms of dance and aerobics
- Contact sports like basketball or football
None of these types of activities should be undertaken until a patient has been given approval by their surgeon. Finally, whatever exercise is chosen, always stop if there is any shortness of breath, chest pain, or dizziness. All these indicate overexertion that could overstress the back and rest of the body.
Avoiding activity after fusion surgery will do more harm than good for patients. Although doctors will have different opinions about the kind and intensity of post-operative activity and exercise recommended, most types of fusion will show better outcomes if an exercise regime is in place. Checking with the surgeon performing the fusion both before and after surgery will ensure that patients get the right advice for their specific situation.
Besides the above activities it is critical that patients who have a history of smoking do not use nicotine postoperatively. Nicotine kills the osteoblasts that grow bone (bone growing cells) and the postoperative results of patients who go back to smoking are much worse than of those who remain off of nicotine. Although remaining nicotine-free for the first three months after surgery is the most critical, smoking even after a solid fusion is achieved has been well correlated to chronic low back pain.
