The Do’s And Don’ts Of Exercising After A Spinal Fusion

When it comes to exercising after a spinal fusion there are some things you need to do and NOT do in order to stay healthy and on the right track to building strength safely. There are plenty of reasearch articles proving that the RIGHT amount and type of exercise can do wonders for those after a spinal surgery. 

This is exactly what we will be covering today!

Along with answering other important questions like:

==> How to exercise after a spinal fusion.

==> How to pick the best or safest exercises after a spinal fusion

==> How to train your core after a spinal fusion. 

==> Big core training mistakes to stay away from after a spinal fusion

==> What to do if your workouts are causing pain. 

and so much more!

I was on a popular spine health forum talking with a few people about spinal fusion and reading some of the answers they were giving…mind BLOWN! Now I truly understand why they say be careful what you read on the internet! By no means do I think I am the expert and my information trumps all other medical advice but the difference between what I tell you and what a lot of other people will, is to always consult with your physician FIRST.

You have to understand exactly what your situation is before diving into anything. What I want to teach you today are some key points you need to keep in mind if you are looking to get back into the gym after a spinal fusion.

A Brief Reality Check Of Why You Need To Be Careful About Where You Get Your Post-Fusion Exercise Advice From.

As an X-Back Pain sufferer, I know what’s going through your head as you frantically do the best you can to find solutions to your fear and pain. Doctors can only do so much and once you have been released by your therapists.

You are on your own.

So this is why I spend a lot of time in forums chatting it up and trying to bring hope and actionable steps you can take to get stronger without more pain or damage.

Enter In: The whole reason for this article.

I was browsing a popular post-surgery forum and I came across this gentleman who had 10 vertebrae fused using a metal rod in an attempt to correct scoliosis. Like most post-fusion warriors he was looking for exercise suggestions that were safe for those who have been fused specifically core exercises safe for fusions.

About 4 replies down somebody piped in and said weighted decline sit-ups.

I couldn’t believe my eyes! I literally almost had my blueberries and cottage cheese come out through my nose (I was eating it for lunch at the time).

Let’s state the obvious…

When it comes to having your spine fused we can safely agree that excessive spinal flexion may not be the best thing for you to do right now. This is advice given to you by your doctor and probably all of the providers you will see. Unfortunately, regardless of how severe or minor your fusion is the idea of “flexing the spine” becomes something with a lot of fear wrapped around it.

So the goal is not to FEAR spinal flexion but to have a healthy understanding of essential and nonessential spinal flexion

Depending on how large your fusion site is, how much you can/should flex your spine will vary and should be double-checked with the guy/gal who operated on you.

My rule of thumb (which I will break down how to implement with exercise) is to favor building a strong, stable neutral spine with most activities while allowing reasonable/sensible spinal flexion when needed.

Now let’s start talking about what we all came to learn about. Safe Exercise After A Spinal Fusion! 

As we unpack the do’s and don’ts of exercise after a spinal fusion I want to make this clear. This advice can be for ANY kind of fusion whether you were fused in your neck or cervical section, your mid-back or thoracic section, or your lower back also known as the lumbar section.

Spinal fusions are normally done on people who have some kind of degenerative disc issue or a severe case of spinal deformity. For example, If I were to push the envelope with my doctor, I would probably be a good candidate for an L5-S1 Spinal Fusion due to me rupturing the disc 8+ years ago and being diagnosed with degenerative discs above the site.

It makes perfect sense.

The disc in between the two vertebrae can no longer give the support it needs to so I would just fuse the two vertebrae together. In some cases this procedure brings relief but most of the time there are usually complications.

The pros and cons to getting a spinal fusion are not what’s important here. What I want to make you aware of is what to do once the procedure has been done.

To be honest, the recovery time can vary. For most, the first few months are the hardest but once you overcome this first obstacle, the movement gets much easier. Most providers want you to be strict about your therapy and the general recovery strategy that they give you for the first 3 months.

After this time has passed and you start to get cleared from your therapists they will actually encourage you to gently challenge certain movements because this will help make the fusion site even stronger (insert the importance of SMART exercise!)

The important thing to remember with a spinal fusion is the fact that you just had your vertebra fused together. This means you took two hard boney structures that used to have a spongy disc between them and screwed them together (not always the exact procedure but pretty common).

When you screw them together, you’re basically turning two separate vertebrae into one big one. Think about the effects this has on the spinal column. Think about how the spine is designed to support the body under heavy loads as well as twisting, flexion, and extension. Each vertebra was designed to move off of the other.

When it comes to exercising after a spinal fusion, proper lifting cannot be taken lightly.

Everything you do, you need to always consider the load the movement is placing on the fused vertebra.

It’s impossible to only use one part of the spine. To move fluently you need the entire column and its vertebra to move along with you. The thing about a spinal fusion is that now the discs above and below the fusion are forced to work even harder.

This is where a lot of people run into more spinal fusions 5-10 years down the road after their first one. They think that by fusing the discs,  the issue is taken away but in reality, you’re putting greater potential risk on the discs above and below it if you do not exercise SMART.

What to do in the gym after a spinal fusion.

Besides constantly working to maintain a healthy range of motion after the procedure, you want to be very cautious when doing something that directly affects the fused area. For example, someone who has had any range of cervical fusion should stay clear of doing exercises that require repeated flexion or extension of the neck.

Exercises like sit-ups with their hands pulling on the back of their head or repeated squats with the neck in a hyperextended position. Over time these movements are going to wear on the discs above and below the fused area.

This isn’t because these exercises are not healthy (besides the sit-ups) it’s just that now these other discs have to carry the weight of the now fused discs.

Make sense?

“It’s not the vertebra you had fused that you need to worry about, it’s the extra weight the discs above and below it are now responsible for”

The best thing to do is consider the load that will be placed on the specific area before committing to the exercises.

Can you lift weights after a spinal fusion?

One of the trainers at my gym has had multiple fusions throughout her spine and still maintains a healthy exercise program.

Her routine consists of:

==> Low Impact cardio such as fast-paced walking and bodyweight exercises performed on the ground.

==> Dynamic movements that work on balance and endurance for her entire body.

==> SMART strength training (yes she is 50+ and she trains with weights) to maintain healthy connective tissue and muscle.

If you are looking for Fusion safe strength training workouts this has become the number one resource for that exact thing [CLICK TO LEARN MORE]. 

She says her main goal is to constantly train in a way that throws her body off balance (safely) in order to strengthen the spine stabilizers.  You won’t see her do anything with repeated neck flexion or heavy spine loading exercises. Not that loading your spine is dangerous but you can get an effective workout in without doing so.

She is in great shape despite the obstacles she has overcome.

The people who normally have the biggest difficulty years after a fusion are the ones who continue to train the same way they did before the fusion.

I can’t stress this enough, keep an open mind to training in a way that protects the spine from future damage. Having a spinal fusion doesn’t mean you have some bionic part that makes you stronger. Fusions come with responsibility and the ability to adapt to a change in lifestyle. The people who can respect that are the ones who you can never tell had a fusion done.

This is a great topic to discuss because like most people after a fusion there are really sensitive and scared that exercising is going to cause more pain or discomfort.

The problem I see is post-fusion warriors will allow this fear to win when it comes to building strength and resilience in their backs after the surgery.

There are a few rules that I like to follow when it comes to strengthening your back after a fusion.

RULE 1: Don’t assume you have to train the lower back directly to build a stronger lower back.

Your muscles work together to build the stability and strength it needs to perform daily tasks or being able to do your favorite hobby without pain or damage.

This means you don’t need to go into the gym and do a bunch of bending over to get stronger or more capable of bending over without pain. 

Zoom out and think more about the big picture.

What exercises can I do that will hit the overall “Posterior Chain” while respecting the sensitivity in the lower back?

This means from head to toe your training the muscles on the back of the body. This will lead to having an overall stronger more resilient support structure INCLUDING the lower back!

Here is an example of a video that I put together for disc injuries and training the lower back. I use these same exact exercises for my Fusion clients.

The injury may be different but the attention to detail, approach with each exercise and specific coaching around a sensitive low back are what makes these exercises work.

Even if one of these exercises does not agree with your body that is OKAY. Find a way to modify the exercise so that it fits you.

RULE 2: Keep your training pain level at a 4/10 or lower

A big mistake I see a lot of post-fusion people make with exercises is pushing too hard or not pushing at all.

Your body is strong and wants to recover and get stronger. you are not made of glass. so allow yourself to feel the exercise some.

At the same time, you have to get rid of the “no Pain, No Gain” mentality. It’s garbage and does not belong in your recovery or future strength training plans.

This is why with my clients I give them a pain scale to rate themselves on during their workouts.

Research shows that if people keep their pain level at or below a 4/10 they have a better chance of maintaining a positive recovery pattern and minimizing the chance of flair-ups or increase in pain 24-48 hours after their workout.

This is a great sweet spot to be in and if you can remember to follow the pain scale rule with everything you do, your post-fusion exercise will not only be less painful but it will be more productive and working towards a stronger more resilient version of yourself.

Core training after a spinal fusion is EXTREMELY important. Not just to build a great-looking six-pack but to rebuild what I call “Core Coordination”.

There is a difference between blindly building core strength and focusing on the endurance and coordination needed after a fusion.

I get a lot of emails regarding exercise choice after a fusion (specifically safe core exercises). So what I want to give you is this list of 10 core exercises that I have dubbed “Safe For Spinal Fusions”.

Now of course like anything you read on the internet use common sense and respect your situation. I will say, when I am working with a fusion client this is where I start:

While we are on the topic of core training I want to touch on something that I see way too often in the fitness space and it breaks my heart to hear that post-fusion warriors just like you are being told this by their trusted fitness professional.

YOU DO NOT NEED TO PRESS YOUR LOWER BACK FLAT INTO THE GROUND WHEN DOING CORE EXERCISES!

In fact, I would advise you to stop doing it altogether.

There’s an ideal lower back position for you and you only that you have to be a detective and figure out for yourself.

This may be a little flexion in the lower back or it may be a little extension. Find the position that works for you and how your body is responding to the exercises and lock that it.

Practice that position with every exercise that you attempt.

I actually did an entire video on this topic where I teach you what you should do instead of flattening your lower back.

It’s been a HUGE resource for so many people like you I had to share it!

Symptoms and irritation are inevitable when you are jumping back into a normal exercise routine.

Before you do anything be sure to pick up my free download: 10 Rules To Exercising After A Spinal Fusion. It will dive DEEP into this topic with practical things to watch for [CLICK TO DOWNLOAD]

When it comes to pain and exercises there are a lot of variables. My rule of thumb is to start small (even if you consider yourself an avid gym-goer).

See how your body responds to even the simplest of exercises and adjust from there. You are looking for both a physical response to the exercise such as how it feels, limitations, and pain as well as a psychological response as in is your body responding or holding back out of fear? Is your tension or pain due to fear around a specific exercise?

These are both very important and building healthy self-efficacy is paramount for long-term relief and confidence in your body.

Alright so let’s wrap this up!

Key Takeaway:

==> Get cleared by your physician first before starting anything.

==> Seek to train the body with your spine in a neutral position.

==> Until you are fully recovered, repeated bending, twisting, and excessive loads need to be minimal and progressive.

==> Pay close attention to what you’re doing with the area that was fused.

==> Stay away from non-essential bending, twisting or loading that specific area.

==> There is always an alternative exercise you can do.

==> If you are experiencing progressive pain as the workout goes on dial back are-assesses the movements the exercise requires and make the changes if needed.

If you remember nothing from what you read above remember these 4 points.

A) Take out flexion-based exercises for the core. This means no more sit-ups, crunches, leg raises, flutter kicks etc.

B) Be mindful of the position of your spine while exercising. Fusing your vertebra takes the mobility out of that specific joint. If you treat your spine the same way you did before the fusion the discs above and below that fused joint will now take all the pressure.

C) Fill your workout program with lots of Anti-Rotation and neutral spine work like Stir the Pots, McGill Crunch and Pallof Presses Circles.

I put together a FREE mini-course of all the essential elements when it comes to exercise after a spinal fusion.

If you’re wanting to get back into the gym but have no idea where to start pick this up.

This is my gift to you!

If you found any value in this article, would you share it with someone you care about? You could really help them out!

Addicted to your health,

William

Resources:

McGregor, Alison H., PhD*; Doré, Caroline J., BSc†; Morris, Tim P., BSc†; Morris, Steve‡; Jamrozik, Konrad§ ISSLS Prize Winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER)A Factorial Randomized Trial to Determine Whether the Functional Outcome of Spinal Surgery Can Be Improved, Spine: October 1, 2011 – Volume 36 – Issue 21 – p 1711-1720 doi: 10.1097/BRS.0b013e318214e3e6

Monticone, M., Ferrante, S., Teli, M. et al. Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial. Eur Spine J 23, 87–95 (2014). https://doi.org/10.1007/s00586-013-2889-z

Tarnanen, S., Neva, M.H., Dekker, J. et al. Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC Musculoskelet Disord 13, 123 (2012). https://doi.org/10.1186/1471-2474-13-123

Phillips, Frank M., MD*; Slosar, Paul J., MD†; Youssef, Jim A., MD‡; Andersson, Gunnar, MD, PhD*; Papatheofanis, Frank, MD, PhD§ Lumbar Spine Fusion for Chronic Low Back Pain Due to Degenerative Disc Disease: A Systematic Review, Spine: April 01, 2013 – Volume 38 – Issue 7 – p E409-E422 doi: 10.1097/BRS.0b013e3182877f11

Fairbank Jeremy, Frost Helen, Wilson-MacDonald James, Yu Ly-Mee, Barker Karen, Collins Rory et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial BMJ 2005; 330 :1233

APA Tarnanen, Sami P.1; Neva, Marko H.2; Häkkinen, Keijo3; Kankaanpää, Markku4; Ylinen, Jari5; Kraemer, William J.6; Newton, Robert U.7; Häkkinen, Arja1,5 Neutral Spine Control Exercises in Rehabilitation After Lumbar Spine Fusion, Journal of Strength and Conditioning Research: July 2014 – Volume 28 – Issue 7 – p 2018-2025
doi: 10.1519/JSC.0000000000000334

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