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Old 05-11-2007, 12:15 PM   #1
Will Lennon
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One of my Marines was injured in Iraq and ultimately had this procedure instead of a lumbar spinal fusion. The procedure was done about 2 years ago and although he gets around day to day, he can do very little physical training. A Marine PFT would be out of the question. At this point he will be facing medical discharge if he cannot over come his current limitations.
Anyone have any experience with this and if so what type of physical/physio therapy would you recommend. I will be starting with stretching and body weight exercise. Any help would be greatly appreciated.
Here is a link to a similiar procedure. W/F safe
http://www.spine-health.com/research...ificial05.html

Thanks Will
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Old 05-11-2007, 02:28 PM   #2
Elliot Royce
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Will:

Sorry to hear about your buddy. I have two cervical disk herniations and looked into a lot of the different repair methods including fusion and a little into the artificial disk. As I recall, they don't yet use the artificial disk for the neck.

I think you'd need to explain more about what prevents him from exercising. I had thought that the artificial disk provided a superior result to a fusion, but even with a fusion he should be able exercise (although not advised to play contact sports).

Was the operation not successful? If not, it would make sense to look at another surgery, even a fusion if required.

When I was doing therapy for my neck, there were specific exercises so I can't speak directly to those. We have some PTs on the list so they may be able to help, but surely with the resources of the Marine Corp, he can get some expertise involved to get him fully recuperated.

Until he gets some sound advice and they figure out why this is a problem, I'm not sure he should be doing even stretching or body weight exercise. For instance, if there is spinal instability, that would need to cured first. Or if the disk is not in the right position, I would guess.

Neurosurgeon + MRI would be my prescription!
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Old 05-12-2007, 05:01 PM   #3
Wayne Nelson
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Assuming no complications from the surgery - Addressing stability first is a good place to start. At this point stiffness in the back is your friend, so stretching of the low back is probably not a good idea. However, stretching of legs and upper back with a neutral spine may very well be indicated.

The next thing to address is reactivation of the stabilizers of the low back. There are a bunch of exercises that address this aspect. Exercises should be performed in neutral spine and challenge especially the deep muscles of the spine. The starting point depends on what he can currently do properly.

Core strength and endurance development come later and follow an important protocol. He should avoid lumbar flexion (forward bending of the low back) at all times but especially in the first hour in the morning. And, no exertion after prolonged sitting or other forward flexion positions for at least 30 minutes.

We could go on and on on this, but... An excellent resource for low back rehab is McGill's book: Low Back Disorders. It addresses the issues I have mentioned here, and much more. It is available at www.gymballstore.com.
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Old 05-12-2007, 05:04 PM   #4
Wayne Nelson
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Just remembered - This totally safe website is a very good resource of exercises. Begin by loking through the Tissue Sparing section first.

http://www.lasportsandspine.com/exercise.html
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Old 05-13-2007, 07:02 AM   #5
Elliot Royce
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Wayne:

You seem remarkably expert. What is your background? And keep on posting!
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Old 05-13-2007, 09:49 AM   #6
Will Lennon
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I appreciate the replies. The surgery was 2 yrs ago and his physical activity is limited by pain. By medical standards the surgery was overall a success although he still has pain, it is significantly less than before the surgery. Day to day activities he functions ok, but the rigorous physical activities that will soon be required of him, would currently be too much for him. He has only met with his physician and not a physio/physical therapist. My first recommedation to him is to get a referral to one ASAP. He was the first one in the military to get the surgery, and it is not all that common in the US yet, so I have not found a lot of info out on the interent when it comes to rehab.

Thanks
Will
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Old 05-16-2007, 10:32 PM   #7
Wayne Nelson
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Thanks Elliot, I am a DC and I am board certified in rehabilitation. I specialize in functional rehab and performance training. It's all the same continuum, you know.

Will, Is he also in Northfield VT, or somewhere else? A functional approach to rehab is just what he needs. Not heat, e-stim, ultrasound, massage or any other unproven modalities for such a chronic condition. Although they may help with resolving some of his pain issues, and that is good. He needs active, functionally oriented rehab that respects his current condition and is directed by his goals.

2 years, eh? There has got to be some muscle atrophy, very flawed motor control, and lots of tissue damage after that time. This is not a back to squat 1.5BW in a couple months situation.

The first thing to address is the pain, then altered motor control, building endurance, coordination and balance, then strength, and finally power. The order is important.
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Old 05-16-2007, 10:54 PM   #8
Wayne Nelson
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Will, I went to that site. Very interesting information. I then went to PubMed, the search engine for Nat Lib of Med. and put in "Charité Artificial Disc" and searched for the last 5 years under "Limits". This will tell you more about the disc. It does tend to be a little technical, though. It won't tell you why he still hurts. Sorry, I haven't read it yet.

All the dysfunction that is going on is most likely propagating the majority of his discomfort. Not likely the disc. It is the dysfunction that should be the focus at this point. The dysfunction needs to be dealt with anyway, because some of it was there before and caused his problem to begin with.


www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed
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Old 05-17-2007, 11:41 AM   #9
Will Lennon
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Wayne,

Thanks for the input. He has a few appts this week and will update when I get more info. And yes he is located in VT as well.

Will
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