Agreed wholeheartedly with loftearman. A disk is one thing, but when it comes to the actual fusion you have much more to worry about. The disk at least can scar over and be maintained, but with the fusion you have the small muscles surrounding the spine cut out as well. So along with the hypermobility of the spinal levels above and below, you also have the lack of stability from your paraspinal muscles. Definitely want to strengthen the lower back in some way, but I would limit it to lighter stuff. Higher rep stuff has light weight, but when you get to that level of fatigue form generally goes to shit. Be smart about it, start very conservative.
I had my L4-S1 fused my senior year of high school in 2012. I waited about a year and a half before lifting in the gym. And it took me 2 years to get to squatting 135 (on the smith machine though). I recently had a fall and got checked out in the ER. The doctor said everything looks fine. I also have scoliocis. I was advised to follow up with the surgeon to talk about what my limitations should be, because originally I was not expected to even walk normal after surgery. I ended up getting back to horseback riding and then picked up weight lifting and live a very active lifestyle.
I went very slowly. But how much weight would you think is to much weight? I’m 120 pounds and dropped my squat on the smith machine to 100 pounds instead of 135 pounds. I’m having a hard time even thinking about getting rid of the squat for my workouts. I’m just curious as to what TOO HEAVY to the point of moving the other vertebrae would be. I’m going crazy waiting to see my surgeon wondering if I’m unknowingly damaging anything.
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Hello. Are you still active on this site? I have a question in regards to spinal fusion surgery and lifting. Please respond if you can. Thank you!
Sure, what’s your question?
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OP here. I got an email notification so I might as well write an update in case someone would stumble on this thread in the future.
It’s now 4 years since I broke the L3 vertebrae and got L2-L4 fused. The problems I’m having are:
Something broke with the nerves that control the ab muscles in my fall. There’s a segment in the ab muscles that I don’t have much control over. When I try to use them there’s no strength and significant tremors/fasciculations. It looks exactly like someone who has never lifted anything tries i max lift. Except I have been training but the improvements haven’t been there. The first year after the fall I didn’t have any control over part of the ab muscles. They were just shut off. It has improved somewhat but they are still very atrophied and when I try to use them there’s mostly tremors. That makes it difficult to work them.
Bending over is hard and when the body is tired it hurts in the lower back. In the evening I just don’t pick up things like socks and clothes that’s on the floor. It’s just not worth it.
Squatting down doesn’t feel stable/good due to the lack of support from the core. I.e. the ab muscles aren’t really there to support anything so all the load goes to the lumbar spine which hurts.
Due to the core not doing their part I have developed compensation patterns in the upper back and shoulders. I had the right shoulder dislocated in the fall too, and it has been difficult to rehabilitate. As soon as I do anything that loads the shoulder area I develop trigger points in the scalenes and upper/middle trapezius. This leads to tension headaches and an overall feeling of being exhausted. It’s to the point that even taking a bike ride causes headaches that persist for several days. I think it has something to do with the static contraction of the neck and shoulders when sitting in a forward position on a bike.
I’ve tried most ways of training and rehabilitation. Lifting is just out of the question. It causes a lot of problem and doesn’t solve anything for me.
Mind you, the spine issues are not the only thing I have going so don’t draw too much conclusions from it without getting the whole picture. I also have ankylosing spondylitis (AS), a rheumatic disease in the spine. I’m getting TNF-alpha inhibitors for it so the inflammation is under control but I still suspect part of the exhaustion/tiredness is from the AS. It’s difficult to say how much of the muscle tensions are due to AS and what is due to the injury. But the net effect is that I’m having an extremely hard time relaxing. It feels like the muscle tensions are outside my control and I often have brain fog that makes it hard to concentrate. Before my injury lifting felt good and made the body work better. This is normal for AS patients. After my injury working out doesn’t really work. It leads to lots of problems and solves none. I’d very much like to work out and break a sweat in some way but I just haven’t found anything that doesn’t also cause pain and headaches.
Even though I don’t hang around here much anymore (no point really) I get email notifications for replies to this thread so feel free to post any questions or comments.
Take care.
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The rectus abdominus are innervated by the thoracic nerve roots (T6-T9 for upper abs, T9-T12 for lower abs) so the lack of stability and atrophy in your “core” is likely due to damage at the L2-L3 level which could be affecting your iliopsoas rather than your abs unless it is being caused by another, undiagnosed root pathology.
That’s… interesting.
For reference, here’s a picture from before the L2 injury. There’s some light coming in from the side causing some shadows. I guess it’s a pretty normal musculature.
http://imgur.com/yrQsHsH
Here’s one ~4 years after the injury.
http://imgur.com/ia7JFhI
There’s a section in what I believe is rectus abdominis about 3 fingers wide just above the belly button on both left and right sides that shows significant atophy. It’s more visible in person but this picture also shows the atrophy extending out the side and causing some weird wrinkling in the skin.
It’s interesting that you mention iliopsoas. I assume the atrophy shown in the picture is not in iliopsoas, right? But at the same time I had a massage therapist press on illiopsoas once (from behind the sacrum, he almost touched my butthole) and weirdly I felt slightly stronger after that. The kind of strength you need at the bottom of a squat that’s been missing since the injury. Do you have any suggestion on what to do for iliopsoas? Stretch it? Strengthen it somehow?
Thanks for taking the time.
Well, surgical treatment and electrophysiological diagnosis are my specialties, not conservative treatment, but I would recommend doing a lot of hip flexor exercises and stretches with light weights and very strict form so as not to recruit compensatory muscle groups.
Also, it is of the utmost importance to keep your hamstrings very, very long and flexible so that you do not have to round your back to reach down. Ideally, you want to be able to put your palms on the ground without your lumbar spine going into kyphosis. This won’t help treat the problem in your abs but it will help insure the longevity of your fusion and the spinal levels above and below.
A few questions: Have you had a post op MRI to confirm that your vertebrae have fused? Do you smoke cigarettes or “other things”? Did they do an anterior fusion, posterior fusion or both?
The atrophy could still be in the psoas because it would cause your abdomen to collapse somewhat causing the abs to sort of “sink in” but this is all just conjecture without an actual examination. I would find a physical therapist who works specifically with athletes and see what they can come up with.
WOW you responded!! Thank you!!! I’m new here and not quite sure how this site works. I didn’t get a notification to my email address… maybe it does not work that way… anyhow I just signed in hoping that you responded… and you did!! Would you mind emailing me?? You seem knowledgeable on spinal fusion and I am certainly not ( even though I had the procedure done 12 years ago). My email address is R_pargas@hotmail.com
I wont send you any spam mail… pinky swear lol
Like I mentioned I had a spinal fusion done 12 years ago. Fully healed 100% never had any complications. I began lifting 5 years ago. I had never lifted a weight in my life so at 100 pounds I was pretty harmless to myself… could not even lift my own body weight. Fast forward to now and I have gained some major strength. So this is where my questions begin…
Not sure what it’s called but here’s a picture of the fusion some weeks after surgery.
There’s some clipping going on when posting to t-nation. The image on imgur is larger and has more vertebraes visible. Let me know if you have trouble following the link there.
Do you have any suggestions for strengthening the hip flexors? Preferably something that doesn’t also work the lower back since that will give out first. The hip flexors are fairly tight, and of course weak since I haven’t been able to do much at all the last 4 years.
The hamstrings are very tight. I find it difficult to stretch them without causing pain in the lumbar spine but your comment makes me motivated to put some more effort into that.
Yes, I have had MRI and I assume it looks as they expect. The Drs haven’t expressed any concerns regarding that from what I remember. Last MRI was 6 months ago which showed active inflammation from ankylosing spondylitis in the pelvis (don’t know more exact location) and thoracic spine. So now I’m on infliximab which feels very effective for treating inflammation.
I don’t smoke anything. Legal or otherwise. It’s just not been my thing.
Now that you mention the “sink in” of the abs I do have a more marked midsection now. Women tend to want that hip/waist/bust ratio but for me it just looks off since it is due to athrophy and clearly from something being wrong.
That is a posterior lumbar interbody fusion (PLIF). It doesn’t appear to be the minimally invasive hardware, though, which is good. It does seem kind of odd that the surgeon skipped placing screws in the middle vertebrae. I haven’t worked with a surgeon that does that but if it has fused well then that is fine. I am guessing that you had a narrow pedicle on that vertebrae or that the surgeon didn’t do it because you were young and healthy and he (or she) didn’t think the benefit of putting more screws in outweighed the risk to the nerve roots.
I only asked if you smoked because it can stop your vertebrae from fusing. Smokers have a pretty bad prognosis after fusions.
As far as exercises to do, I would normally say feet supported, weighted situps but situps are hard on the low back and can be dangerous for people with lower back issues. I would really recommend seeing a PM&R physician or a physical therapist with experience in rehabing spinal fusion pts.
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Hello. This is rpargas just letting you know that I sent you an email. Please read it when you have a chance.
Thank you! 
Yes. I just sent you a “testing” email. Let me know if you receive it please. I’ll resend my email anyhow. Thank you!
I resent. Let me know if you receive it… If not do you have another email address I can send it to?
Yeah, weighed situps just isn’t gonna happen. Mostly because I don’t have the musculature to even do non-weighed situps. The ab muscles just shakes and not much happens.
I can do supine leg raises though. 1 leg at a time works pretty well with only minimal shaking. If I do both legs at the same time and the muscles start to shake. It’s not the “I’m weak and need to work on this”-shake. It’s more of a “I don’t have control of my ab muscles”-shake. It’s a little weird so I try to work light enought that it’s only very minor shaking. If I go too hard it feels like I’m not actually working anything. It just shakes uncontrollably.
I’ve seen a few physicians (I’m in Sweden so our abbreviations/specialities might be differnt from yours) and even went to a spine rehab program with very knowledgable people. That was before I was diagnosed with AS though (but I’ve had it for several years before getting the diagnosis) so none of us knew that there was other factors involved too. But I’ve learned a lot of excersises. It’s finding the energy and peace of mind to do it that’s a real challenge. Rheumatic diseases can leave you exhaused to the point that even cooking dinner seems like an insurmountable challenge. Add small kids and a job to the mix and there isn’t much energy left. It’s a catch 22. You need to do the excersises in order to get better. But you don’t have the energy to do the excersises.
I probably need to see an orthopedian about my shoulder/upper back/neck issues as well. When that part acts up (which it does from even very little excersise) with trigger points in the scalenes and middle trapz et al it’s like wrapping a blanket of dullness around the whole brain and upper back. You cease to take in things from the outside and just exist in this cage of pain and dullness. Moving around and doing excersises isn’t happening then. You don’t think straight.
Your previous comment about the hamstring really struck a chord though. In retrospect the fusion was done ~5% off the normal curvature (an orthopedian told me) so have too little lower back curvature. It was a fall accident and I would have never walked again without it though. So 5% off is still an improvement though. But it means I’m kind of always in a posterior pelvic tilt. Add short hamstrings to that mix and you’re fighting an uphill battle.
So yeah, I’ve got things to work on. Thanks for taking the time.
I just sent it! Thank you!
Hey what’s up J Rex. Saw your post about fusion on google not sure when it was it was from as I saw a ton of posts from you on the subject. I has a fusion in 2003 L1-4 and was paralyzed amongst many other issues. Things are tough I’m only a little guy but go as hard as I can. 5 9 150lbs. How do you stand now? Deadlifting and squats have been the biggest struggle. As time goes on I only squate from a squate machine and not too heavy where as deadlift I max at like 315 just not wanting to risk anymore. I honestly feel like I gain from working out but am failing over time from going heavy. Just hit 30 today and that’s why I’m researching all this stuff because I feel I’m slowly breaking down. Let me know how things are going now very curious to learn/ see what others who are dedicated to being fit are going through.
Big ole’ thread bump here.
How have everyones’ recoveries been going?
I’ve never posted on here before, but I’ve had a spinal fusion and I am looking to weight training to better the strength and ability of my body.
I had a S1-L5, L4 -L5 anterior, posterior spinal fusion back in 2012. I am very fortunate that my city has one of the best back surgeons in the world, Dr. Alexander Vaccaro. The surgery went well and so did the healing of the fusion. The spine has fully healed and I have been given the thumbs up to do any activity. In the doctor’s words: “No limitations”.
I just recently started weight training and I must say that everything is going really well so far. Though, I’ve been doing extremely light lifts for exercises that tend to compress the spine.
For deadlifts, I’ve been pulling 135lb for 5 sets of 10 reps once a week.
For squats I’ve been doing 100lbs front and back squats for 4 sets in each exercise, 6-12 reps.
For the most part, everything feels fine, aside from some expected soreness after lifting, but the next day I feel fine. I can definitely tell the difference between being sore from exercising and being sore because I’m injured. I think this is key to be able to know the distinction.
Some negative at the moment are that my hips and hamstrings CONSTANTLY feel tight. I’m really not sure what to do besides stretching and hoping that as I continue to lift they will loosen up.
My approach right now is to just just master form at the light weight and once my body feels comfortable, slowly add more weight to the lifts. My goal is not to squat/ deadlift over 350 lbs in my life, but rather maybe 50lbs above my body weight (sitting at 200 right now). My goal is to build a solid foundation for strength and to also look aesthetic. I truly believe that if I just am consistent and cautious, I’ll be able to achieve my goal of creating a strong and healthy body without further injury or harm to my back/the hardware in it.
My advice for someone going through the same thing as me: stretch and do planks every day. If you have a fused back, your flexibility, range of motion, etc. are forever hindered and therefore other parts of your body are compensating for that. By adding flexibility and strength to these other areas, you can avoid injury, but you just have to be cautious.
I will update with progress if anyone would like to hear.