Sometimes, despite our best efforts people’s discs are just beyond repair and at that stage you can get a shiny new one! Many years ago the only option available when you got to this point was ,fusion of the spine, which, as I am sure is fairly obvious, isn’t an ideal solution for a column that needs to move and flex!
So artificial discs were invented, the first one in 1950! Take a look at the paper cited at the end of this for some really interesting reading on the ,history of the artificial disc (Salzmann et al., 2017).
What is very interesting on reading this paper, is that one of the issues for the success of the various discs created, was their ability to ,tolerate load, and therein lies a problem. If we simply replace a disc but don’t address the reasons why that disc got damaged in the first place, the new disc will most likely fail as well. Most discs are damaged (ignoring those damaged by trauma or disease) by a weak spinal canal causing a narrowing of the disc space and it is muscles that maintain that disc space. In fact, the article goes on to explain that the purpose of a replacement disc is to recreate disc space, it doesn’t solve the other issues in the spine such as facet joint pain, nor does it provide any stabilisation to the spine. So, given these points, any client that presents in your gym or clinic having had disc replacement surgery is probably desperately in need of some ,spinal stabilisation work.
Which muscles am I specifically talking about, well our old favourites Interspinales, Rotatores and Intertranversarii’s are a good place to start, coupled with the Transverse Abdominis so we get the thoraco-lumbar fascia doing it’s job…. Now these muscles aren’t under conscious control. They have a very large number of ,spindle cells in them as they are designed to respond to movement and the forces exerted on the spine. So, how do we train a muscle that isn’t under our conscious control?
Well we have to start by putting the body into a position that forces the stabilisers to switch on. Spinal stabiliser muscles are designed to hold the spine in it’s correct anatomical position, even if the body is in an unstable one, so a good place to start is to put the body in an ,unstable position and gradually increase that instability to overload the muscles more and more. The simplest way to do this, is using the exercise ball.
By its nature, this is an unstable surface, so sitting on the ball, even if you have to hold on to begin with, creates movement within the spine that it has to deal with. There are infinite ways to use this piece of equipment, so use your imagination and think about the person you have in front of you and what workload they put their body under. Above all, ensure your client is having some fun.
If using this for CPD try to answer the question below.
- How can you take the exercise ball and train an 80 year old lady on it, where could you start and how could you progress them?
- Now think about your 25 year old weight lifter, who has just had a disc replacement but wants to get back to lifting again. Where will you start them and how far do you need to progress them to allow them to safely lift heavy weights again?
Then write it all up in your CPD Logbook. For your FREE Reinge Education Logbook,
Salzmann SN, Plais N, Shue J, Girardi FP. Lumbar disc replacement surgery-successes and obstacles to widespread adoption. Curr Rev Musculoskelet Med. 2017;10(2):153–159. doi:10.1007/s12178-017-9397-4
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