The Safest Ways to Exercise Your Back After Spinal Fusion Surgery

If you're eager to get back to the gym after spinal or neck fusion, be aware that there are certain spinal and cervical fusion exercises to avoid, especially during the recovery period.

It could take months for the affected bones to heal and fuse together, according to the National Library of Medicine, so during the healing process, certain lifestyle changes need to be put in place, including a change in your exercise routine.

Depending on which stage of recovery you're in, a physical therapist will recommend exercises that are gentle on your neck and spine that won't cause too much strain and discomfort, and that may aid in the recovery process. A physical therapist may also advise you not to perform certain exercises, especially ones that put stress on your back and require lifting or twisting.

So, while some of your favorite exercises might be off-limits, it's only a matter of time before you can resume regular activity.

The goal of spinal or neck fusion surgery is to improve mobility, reduce pain or correct a deformity. According to the American Academy of Orthopaedic Surgeons (AAOS), a doctor can perform spinal fusion in any region of the spine, including the neck or cervical area.

The procedure itself, according to the Mayo Clinic, involves permanently connecting two or more vertebrae in your cervical area to reduce or eliminate the motion between them, and consequently, reducing or eliminating neck pain.

There are a few different types of spinal fusion surgeries, according to New Jersey Neck and Back Institute:

• ‌Anterior Cervical Discectomy and Fusion Surgery (ACDF):‌ Relieves pressure on the nerve roots causing pain, numbness or tingling in your neck and/or arms. This can be done to any of your seven cervical vertebrae (C1-C7).
  
• ‌Anterior Lumbar Interbody Fusion (ALIF):‌ Fuses vertebrae in your spine together to provide stability.
• ‌Lateral Lumbar Interbody Fusion (LLIF):‌ Provides relief from conditions like degenerative disc disease, degenerative scoliosis, spinal tumors or a herniated disc.
  
• ‌Posterior Lumbar Interbody Fusion (PLIF):‌ Fuses vertebrae in your spine together for stability.

Recovering from neck fusion surgery can take several months. That's why the University of Maryland Medical Center stresses the importance of being patient while strengthening the weakened muscles and soft tissue surrounding and supporting the neck. Adhering to the physical therapy routine and performing any other exercises your doctor recommends, will help you regain mobility and move you closer to your goal of getting back to working out.

Before you jump back into a regular fitness routine, make sure to talk with your doctor and physical therapist about the best way to move from supervised rehab exercises to a more traditional workout program, per the AAOS. If you begin high-impact activity too soon, you may put too much strain on the neck area and consequently, jeopardize your recovery.

In the days following surgery, you'll be supervised by your doctor and care team, and they'll lead any mobility exercises you need to perform post-surgery, according to Johns Hopkins Medicine.

While still in the hospital, you can expect to do the following exercises, per Johns Hopkins Medicine:

• Ankle flexes, in which you elevate one leg at a time and gently flex and extend your ankle, moving through a full range of motion (ROM).
• Rotations, which require rotating your foot clockwise then counterclockwise, gradually increasing your ROM.
• Toe raises, while keeping your heels on the floor.
• Heel raises, while keeping your toes on the floor.
• Leg sweeps, in which you lie on your back and bring one leg at a time to the side and return it to starting position, while keeping your knee straight.
• Glute contraction, in which you lie on your back with your legs straight and your arms behind your head and squeeze your glutes.

After you leave the hospital, it's up to you to follow through with your physical therapy appointments and work at home to improve your strength.

When it comes to the types of exercise, David Geier, MD, an orthopedic surgeon and sports medicine specialist, tells LIVESTRONG.com that quite often, a patient can start very light exercise in the days or weeks after cervical fusion surgery. What this light exercise looks like depends on each person and how they are recovering.

To begin with, it might be a slow progression on a stationary bike or walking, he says. Once you start physical therapy, you'll likely graduate to more challenging moves that target the muscles around your neck.

With that in mind, physical therapy will typically begin in the first six weeks following surgery, Dr. Geier says. During these appointments, the physical therapist will guide you through neck and upper extremity activity because they have the knowledge and expertise to suggest specific strengthening, flexibility and mobility exercises while still being cautious of the recovery process.

Low-impact exercises, such as walking and riding a stationary bike, are usually acceptable early in the recovery process and are part of ACDF, ALIF, LLIF and PLIF surgery rehab protocol. Dr. Geier explains that you also need to be working with your physical therapist so you can learn how to perform motion and strengthening exercises for your neck and arms in the weeks after surgery.

"Often there are exercises you can do with bands, like shoulder shrugs and scapular (shoulder blade) retractions in the early weeks after surgery," he says.

At your six-week follow-up appointment, you may be advised to follow a spinal fusion exercise program that you can begin at home. According to Johns Hopkins Medicine, some of these exercises six weeks after spinal fusion may include:

• Standing with your hands flat against a wall, your front leg bent and your back foot back and straight, push into the wall, keeping your heels on the floor. You'll feel a stretch in your calf. Do this on both sides.
• Lying on your back, support your right thigh behind your right knee with your hands and straighten your right knee until you feel the stretch at the back of your thigh. Do this on both sides.
• Kneeling on one knee, push your pelvis down while arching your back. Do this until you feel a stretch in your front hip. Do this on both sides.
• Crossing your legs, right over left, pull your lower knee toward your chest until you feel a stretch in your glute/hip of your top leg. Do this on both sides.
• Sitting on a chair with your knees spread apart, bend forward to the floor. You should feel a stretch in your lower back.

When recovering from spinal fusion surgery, minimize any stress on your back. Avoid heavy lifting and always maintain good posture, bending at your knees and hips instead of your waist, per Johns Hopkins Medicine.

Other post-spinal fusion exercises to avoid include repetitive strenuous activities that combine lifting, twisting, jumping and bending back too far because they can cause stress around the fusion, according to Johns Hopkins Medicine.

"Generally, any significant impact with exercise, as well as upper extremity strength training will be restricted for at least four to six weeks," Dr. Geier says.

Many people who compete in athletic events or competitive activities often wonder if they will be cleared to return to play after the recovery process. For them, knowing the exact cervical fusion exercise to avoid is critical to stay safe and continue with the recovery process.

While Dr. Geier says the decision to resume certain events depends on the specific nature of the surgery, there are specific activities such as collision sports and some contact sports that you might have to discontinue indefinitely. Short of that, he points out that most patients can resume weightlifting and just about any cardiovascular exercise or conditioning after being cleared by their doctor.