How to Safely Train Clients with a Spinal Fusion

Posted on December 29, 2022

To watch the full video, click here: https://youtu.be/mdJ89JLtFd8

All right, what’s happening? Trainers all across the world, all across the country, Michael Hughes here, founder of Gymnazo Edu, and super excited to go live today. Because we get kind of real content from our own MDMC series, or even those trainers out there who have just a real deal question. And we kind of asked this question like, What do I do in this scenario? Or what about this? What about that, and I’m honored and be quite frank with you, privileged in a sec, to have experience in this of being in the field, for as long as I have, with the knowledge that has been given to me, has put me in a lot of interesting situations. So I’m gonna dive into what happens when you have a client who has a spinal fusion, sensually taking these bones right here of the spine, and you essentially go into a surgery, that essentially instead of having them having equal mobility in essentially the thoracic spine, or relative equal mobility through the lumbar spine, or even to the cervical spine, they start to fuse pieces together. So the way that I was taught the spine as I have seven o’clock is when I have breakfast, so you have seven cervical spine, I have lunch at 12 o’clock, and I have 12 thoracic vertebra. And then I have dinner at five o’clock, and I have five lumbar spine. So that’s kind of how we can break it all down seven, in the thoracic spine, and then another tool, excuse me, 12 in thoracic spine and another 12, adding up lumbar, and the good old fashioned cervical 24 different joints, and they all move a little bit differently. And they move in a chain reaction, no questions asked about that. So what happens when you take the lumbar spine? And you fuse it? Well, I think I want to ask a question before then why would that ever need to be needed to be done? That’s right, that’s understand kind of the pathology in a sense of, of getting there? Well, there’s certainly a lot of simple answers. I got in a car crash, I fell, someone hit me, force was acted upon me that I had really had no control over and move my bodies in ways that the body needed repair and the repair was so was the needed repair was so great, that in order to create stability in areas, I couldn’t have a joint there anymore, I needed to take away a joint space, again, going through lumbar spine, here we go, we have an we have a sacrum, and we have an L five and l four. So basically, that disk space wouldn’t be a floating space, it would be essentially a fused together space. And you can do that by rods, or I’ll skip all that medical stuff. But glue anyways, there’s amazing ways that science has evolved to keep a spine relatively stable. So what do you have a client who says, gosh, you know, I have a spinal fusion. And this was the case is so I always ask again, how did that process come about? And typically, in the training and conditioning world, the process comes about like this. I just had lower back pain for years and years and years. And it was relatively active, I jogged ran with kids played sports as a kid and I got a desk job and did a and it just kept throwing out my back and I bet kept hurting and the doctor said orthopedic said, you know, from fuse those two together, we’re going to eliminate the back pain. And often it’s successful. And often unfortunately, it’s successful only a short period of time because of what I’m going to describe to you. So I’m looking at this from a movement perspective, right? Not from a or from it a movement problem, not from an injury per problem that that forces putting upon them via car accident, etc, etc. Though this techniques still apply the strategies a little bit different. If a client comes to you with a, a lumbar cervical fusion, excuse me, Wow, I’m getting too excited. With a lumbar vertebra fusion, you have to ask yourself is why were those lumbars moving too much? Why were they over? hyperactive? Okay, same thing. I’ve worked with a client and who had pretty much heard and thought your entire thoracic spine fused. This was more from a scoliosis problems. Okay, well, what do we do about that? So let’s understand the lumbar spine, the lumbar spine, the five different vertebra are not designed to move very much relatively to the cervical parts of the cervical and thoracic spine. The lumbar spine is designed to be very stable, very, very stable. So we have to understand that that first if you look back, deep into this spine here and you start to look at these different facetted placements of fuzz that’s essentially is where the bones kind of either kind protrude out, just keep it simple, or where they come together, I’m just gonna keep that simple. They’re called different things. But just for the sake of it, right? You look at these little kind of outliers here, right? Those are essentially tie down straps. Right? Those are tie down straps that you’d see in a bed of a truck, ropes attached to those things, muscles, attach those things and then go somewhere else. So it’s a good place to kind of anchor some something down. And you can see that the entire spine has them all the way through, well, then you have these other little spots that kind of come together right here. And those are kind of the junctions of the two different. You have the lower half of this one coming in to the upper part of that one right there, and they come together and there’s nerves, you can see these little yellow things, there’s nerves that live and come in between those. And if they start to lose space, if that space starts to get gets crowded. Because there’s not a lot of wiggle room that this thing has, right, there’s not a lot of wiggle room, there’s it’s really fast, really dense, huge fascial density there, there’s not really like an open space, like there’s rooms really open. There’s nothing like this in the human body, unless you have a lot of gas in your intestines or in your stomach or the case, right? It’s all everything’s taken up. So if you get those lumbar spine to move too much, it hurts especially in the transverse plane, especially in the rotational plane, the lumbar spine has good flexion and extension, definitely good extension, it’s actually pre positioned in a good extension position. It has decent flexion, it has less lateral motion, but it hates rotation. Okay, but the lumbar spine it needs to rotate, it has to rotate. But here’s the difference. It needs to rotate what we call as an in sync pattern. What got it to its fatal problem was an out of sync rotation pattern right there in sync all day long. out of sync, big problems. That’s what is going on. So how do you rotate a client? Who has this fusion, I’m going to say it over and over again. You keep the shoulders and the pelvis in sync. That means you can do medicine ball throws, presses in reaches. deadlifts with rotation, you can do anything you want. You can do anything you want. But again, it’s it that simple. Well, it’s never just that simple. But that’s the answer. Keep the pelvis and shoulders in sync, you’re going to get real bone motion of rotation. But it’s going to be in sync bone motion, where the L five and l four, L three, l two, etc, etc. all move together.

Why it didn’t do that and why a movement problem comes up is when people have a spinal fusion is L five and L for when the opposing direction. They went somewhere that they didn’t go together. Why would something like that happen? Well, you have to look at the two massive joints below called the hip joints. And the 12 massive bones above called the thoracic spine because these 12 middle bones and these two joints in a sense, love to move. They’re designed to have excessive movement built into their patterns. Hence it’s a ball and socket joint. It has an ample sagittal ample frontal and ample transverse thoracic spine, yes, it is more of a forward flexing joint it has the capacity, the capacity she has been to go through extension. It has great frontal plane or lateral flexion. And it has amazing transverse plane or out of sync rotation capacity at these points. So it’s it’s though they’re though they’re neighbors, they have different jobs. It’s when we lose any of those three patterns at these three, or essentially we’ll call this a segment of a joint areas, we start to require more motion at the in between joint, the lumbar spine. I’ll say that one more time. When we start to lose three dimensional movement at the hip joints or in the thoracic spine movement is still required the task in the brain to the body is still required to get that job done. So what does the body do? It steals from Peter to pay Paul to pay Paul. It steals from Peter to pay for it steam it basically this can’t do it. This makes it do it. And that’s how the body functions. That’s how movement pain movement dysfunction happens is always that case will know it’s different for every part of the body. But that’s very, very common of how why the lumbar spine does does that. So if we want to train our client ideally and not have always have to be fearful, which it is a fear to hurt your client, no questions asked about that. We want to gain access back at the to hip joints and the thoracic spine. Typically, typically, from what I found, most trainers fail to address the inability of internal rotation at the hip joint. Essentially, what we’ve been taught in traditional school is that motion pattern, but that is the fault. Education, we are taught open chain internal rotation, closed chain internal rotation on the right hip is this. That is from the pelvis, internal rotation from the thoracic spine into the pelvis is this driving through my upper body? Again, I’ll show that one more time. A lower body drive into internal rotation at the hip is my foot coming across like this and some pattern, my upper body, feeding into internal hip rotation at the right hip is this, both create internal rotation at that right hip joint. But here’s the problem if my hip can’t do that, but I still do it anyways, what else is going to do it? Well, the problem either goes to the lumbar spine, or it goes to the knee, it probably goes to both just the lumbar spine hit it more or worse. If my thoracic spine can’t rotate, right, then who does it? Well, it either comes up to my cervical spine to my shoulders, or goes to my lower back. It’s very, it’s it’s very simple, right? It’s simple to kind of look at it that way. What are the next available joints? Well, if those available joints aren’t designed to do what the what the capable joint isn’t doing, then it causes problems. So we need to provide soft tissue freedom around the entire hip joint, add extension flexion at a B duction. At a deduction, external rotation and internal rotation, all six of them and really combinations, we need to provide soft tissue freedom, flexibility, fascial freedom had flexion of the thoracic spine extension of a thoracic spine, lateral flexion, lateral flexion, rotation, right and rotation left and all those need to be pain free at the corresponding joints that they surround. If you try rotation at hurts the lower back. Is the lower backs fault. No. It’s thoracic spines fault. Simply put, if you try to do a crossover Carioca step in a locomotion drill, and that hurts the knee or the lower back is the knee lower back fault. No, it is more than likely the foot or the hip or something like that. It’s another joint who’s the bully you need to find the bully and and get after the bully. Don’t mess with who the bully is picking on in the clients cases of a lumbar spine fusion it is the lumbar spine is getting picked on. So this is where you get to have some fun. This is where you could say wait a minute, do I know how to use a foam roller? Oh, absolutely. I know how to use a foam roller. We’ll then go after the different parts of the pelvis. That would give more extension. Okay, that’s going to be the quadriceps, especially the one that crosses the hip joint. And the hip flexor. Awesome, maybe even the abdominals K. What’s going to give it more, more more flexion cool, that’s great for the glutes. Let’s go for the hamstrings and some inside sight when they said that it kind of covers the whole whole thing inside that’s kind of always the answer in a sense. What’s gonna give me more a reduction definitely add doctors. What’s gonna give me more ad reduction TfL lateral glute into the IT band, even though the lateral calf, what’s gonna give me more external rotation abductors for certain he may be even a little bit of medial quad. What’s gonna give me more internal rotation, okay, lateral hamstring, the whole glute complex even more of the Lateral Quad. Okay, so those are going to help gain more so you foam roll those spots, you stretch those spots and then you retrain them to access that range of motion through a series of gentle progressive patterns which I can go into whole detail about this later on how to access those motion patterns cable about the thoracic spine. I don’t have very good flexion then go after the extensors. loosen them up, get against a wall. If I don’t have good extension, then go after the abdominals. Go after the anterior ribcage grab to the pecs let those open up I don’t have good lateral flexion go left to the lateral core ribcage serratus anterior subset The lyrics the rotator cuff, muscles have to have good rotation the same move the same muscles just in a different access point, stretch them out, allow them to have the range of motion, and then retrain them to access that motion without causing the lower back to read to revert itself again, that’s where the detail comes in. That’s what this whole other video should be happy to, to cover based upon your guys’s comments and questions. So what if you do none of that? You say, Michael, I don’t have time for that. I got I got to train somebody. They don’t even want me to work on any foam rolling they came in to just work hard and put a fitness program together. And I gotta do it. Well, this what you do, you first of all, go to our YouTube channel, where we just talked about how to tweak for lower back pain in a video that we just posted about you that after this, though, what you do about let’s say it’s a medicine ball roll rotation. I did that in the video, right? So if I throw a ball this when it hurts, right? And it hurts, I’m basically saying that through my upper body’s movement pattern, it hurts my lower back. So how do I position myself to make my lower back hurt less? Well, if it’s internal rotation, that’s basically or the right rotation that’s happening from the thoracic spine? What if you position yourself at a 45 degree angle to the wall and do a throw? Why basically, when I’ve ended that throw, I’m now ending at more of a zero degree angle than at a 90 degree angle? Am I still getting a minister ball rotational throw? Am I still getting that same training effect? Yes. Am I getting the same range of motion? No, of course not. But that’s the point. What if it’s coming from the pelvis? Okay, well, if you if you want to throw more and want to get more twisting motion pattern, and it’s the hurts when they release, then put that foot behind you. Now you have given the hip way more access to internal rotation before it even gets to quote unquote, internal rotation. What if it’s the opposite foot, and you throw this way, and it’s an external rotation problem at the pelvis, it hurts, it hurts at a different point, whether you can put that foot in front, and now you put it into more internal rotation. So it has more access to external rotation. I can keep going about every single plan in motion, but it’s really the problem solving. So thinking that needs to kind of be adjusted. So what don’t they have access to? Let me position them to give them more access to that range of motion. And that progress. Progress is the keyword slowly from there, allowing knowing that there’s definitely a soft tissue problem. They’re too tight, too limited. And they have a neurological proprioceptive problem.

They don’t really know how to sequence their movement pattern to not move through the lower back or not move through where that spinal part is. So it’s not just going to happen, right? I really wish I could just go run a marathon today. But I haven’t trained myself to do that. Can I do that? I certainly can. But I’m going to pay for it in pain later. And your client will be no no different, you have to slowly train their body to move in the right sequencing. And you can do that by start allowing their body to move in a pattern that they couldn’t even do before by pre positioning different joint patterns. Then from there, you start with moving right the cool thing about moving alone, it starts to loosen things up. Good movement produces better movement, worse movement or painful movement produce pierces worse movement. So you can even start to to progress. One day you got a 45 degree angle, and then you slowly go to a 30 degree angle, slowly go to a 20 degree angle over time, you can slowly start to loosen up just by the movement itself. You want to go faster than than that. That’s when soft tissue skills and using true stretches and MOBE sticks and things like that really progressed the process faster. Okay, that covers the bases. Now it’s really about where do you want to take this, this conversation? What sparked another question, what sparked something like, oh, I don’t believe what you just said. Could let’s let’s talk about that. Now Brent, maybe mispronounced a few things here and there. Don’t worry about those. But the myth, the message, the principle of what I’m going off of, please, if you have a question on it, or don’t think it’s accurate, let’s dive into it. I’m not here to be against or for. I’m here to educate on my empirical data, and the education that I’ve been given so we can uplift each other and really come down and train our clients better. Why? Because our our society needs it. We are very, very sedentary lifestyle, and it’s really messing up our entire health care system. It’s ruining it. Matter of fact. And there’s so many situations that have happened in the last year and a half that has proven that so we are the forefront of preventative health. We are the forefront of the health care system. We have the sick care system very well figured out. We have we’re dialed in on that. Hence the spinal fusion. What about preventing someone from even getting there or void Getting them from getting worse. That’s what we want to share. That’s what we’re here to do. And that’s what I’m going to do the rest of my life doing. So, ask some questions, throw some comments in there, and really appreciate your guys’s time and your questions, and we’ll see you next time.