Spinal Loads during Post-Operative Physiotherapeutic Exercises

Abstract

After spinal surgery, physiotherapeutic exercises are performed to achieve a rapid return to normal life. One important aim of treatment is to regain muscle strength, but it is known that muscle forces increase the spinal loads to potentially hazardous levels. It has not yet been clarified which exercises cause high spinal forces and thus endanger the surgical outcome. The loads on vertebral body replacements were measured in 5 patients during eleven physiotherapeutic exercises, performed in the supine, prone, or lateral position or on all fours (kneeling on the hands and knees). Low resultant forces on the vertebral body replacement were measured for the following exercises: lifting one straight leg in the supine position, abduction of the leg in the lateral position, outstretching one leg in the all-fours position, and hollowing the back in the all-fours position. From the biomechanical point of view, these exercises can be performed shortly after surgery. Implant forces similar or even greater than those for walking were measured during: lifting both legs, lifting the pelvis in the supine position, outstretching one arm with or without simultaneously outstretching the contralateral leg in the all-fours position, and arching the back in the all-fours position. These exercises should not be performed shortly after spine surgery.

Methods for Avoiding or Reducing High Spinal Loads in Everyday Life

“…However, lifting the pelvis and lifting both outstretched legs in a supine position caused forces similar to those for walking [21]. Outstretching one arm cranially in the all-fours position, with or without simultaneously outstretching the contralateral leg, led to forces higher than those during walking, which was also the case when arching the back in the all-fours position.…”

“…The spinal force when lifting the pelvis in a supine position depends strongly on the lifting height [21]. Thus, when using a bedpan, the pelvis should not be lifted higher than necessary.…”

“…Outstretching one arm cranially in the all-fours position, with or without simultaneously outstretching the contralateral leg, led to forces higher than those during walking, which was also the case when arching the back in the all-fours position. Thus, these exercises should be avoided in the early postoperative period [21]. Pulling a rubber band that was fixed to the wall towards the floor reduced the loads on the VBR, whereas pulling a rubber band that was fixed to the feet increased the spinal load.…”

Simple implantable wireless sensor platform to measure pressure and force

“…Smart implants also have value as research tools. The measurement of in vivo forces in orthopaedic implants has been used to provide a better understanding of knee, 2 hip, 3 spine, 4 shoulder, 5 and fracture fixation biomechanics. 6 Yet, despite the potential clinical value, the use of smart implants has thus far been limited to small cohorts of patients.…”

A Bluetooth Low-Energy Wireless Sensor Platform for Continuous Monitoring of a Bioreactor Environment during Cell Manufacturing

“…Cumbersome needleor probe-based transducers [15] have been largely replaced by wireless sensor technology [16,17]. Implantable wireless sensors have been used in the field of orthopedics to monitor the forces acting on bones and joints [17][18][19]. Wearable sensors have also been used to provide a non-invasive alternative in many patient monitoring applications.…”