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.
References
[1]
Cappozzo A (1984) Compressive loads in the lumbar vertebral column during normal level walking. J Orthop Res 1: 292–301. doi: 10.1002/jor.1100010309
[2]
Cholewicki J, McGill SM (1994) EMG assisted optimization: a hybrid approach for estimating muscle forces in an indeterminate biomechanical model. J Biomech 27: 1287–1289. doi: 10.1016/0021-9290(94)90282-8
[3]
De Zee M, Hansen L, Wong C, Rasmussen J, Simonsen EB (2007) A generic detailed rigid-body lumbar spine model. J Biomech 40: 1219–1227. doi: 10.1016/j.jbiomech.2006.05.030
[4]
Han KS, Rohlmann A, Zander T, Taylor WR (2013) Lumbar spinal loads vary with body height and weight. Med Eng Phys 35: 969–977. doi: 10.1016/j.medengphy.2012.09.009
[5]
Marras WS, King AI, Joynt RL (1984) Measurement of loads on the lumbar spine under isometric and isokinetic conditions. Spine 9: 176–187. doi: 10.1097/00007632-198403000-00008
[6]
McGill SM, Marshall L, Andersen J (2013) Low back loads while walking and carrying: comparing the load carried in one hand or in both hands. Ergonomics 56: 293–302. doi: 10.1080/00140139.2012.752528
[7]
Shirazi-Adl A, El-Rich M, Pop DG, Parnianpour M (2005) Spinal muscle forces, internal loads and stability in standing under various postures and loads–application of kinematics-based algorithm. Eur Spine J 14: 381–392. doi: 10.1007/s00586-004-0779-0
Sato K, Kikuchi S, Yonezawa T (1999) In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine 24: 2468–2474. doi: 10.1097/00007632-199912010-00008
[10]
Wilke H-J, Neef P, Caimi M, Hoogland T, Claes LE (1999) New in vivo measurements of pressures in the intervertebral disc in daily life. Spine 24: 755–762. doi: 10.1097/00007632-199904150-00005
[11]
Wilke H-J, Neef P, Hinz B, Seidel H, Claes L (2001) Intradiscal pressure together with anthropometric data - a data set for the validation of models. Clin Biomech (Bristol, Avon) 16: S111–126. doi: 10.1016/s0268-0033(00)00103-0
[12]
Rohlmann A, Graichen F, Bergmann G (2002) Loads on an internal spinal fixation device during physical therapy. Physical Therapy 82: 44–52. doi: 10.1016/s0021-9290(96)00103-0
[13]
Rohlmann A, Graichen F, Bender A, Kayser R, Bergmann G (2008) Loads on a telemeterized vertebral body replacement measured in three patients within the first postoperative month. Clin Biomech 23: 147–158. doi: 10.1016/j.clinbiomech.2007.09.011
[14]
Rohlmann A, Graichen F, Kayser R, Bender A, Bergmann G (2008) Loads on a telemeterized vertebral body replacement measured in two patients. Spine 33: 1170–1179. doi: 10.1097/brs.0b013e3181722d52
[15]
Rohlmann A, Dreischarf M, Zander T, Graichen F, Bergmann G (2014) Loads on a vertebral body replacement during locomotion measured in vivo. Gait Posture 39: 750–755. doi: 10.1016/j.gaitpost.2013.10.010
[16]
Rohlmann A, Petersen R, Schwachmeyer V, Graichen F, Bergmann G (2012) Spinal loads during position changes. Clin Biomech 27: 754–758. doi: 10.1016/j.clinbiomech.2012.04.006
[17]
Rohlmann A, Schmidt H, Gast U, Kutzner I, Damm P, et al. (2013) In vivo measurements of the effect of whole body vibration on spinal loads. Eur Spine J 23: 666–672. doi: 10.1007/s00586-013-3087-8
[18]
Rohlmann A, Zander T, Graichen F, Dreischarf M, Bergmann G (2011) Measured loads on a vertebral body replacement during sitting. Spine J 11: 870–875. doi: 10.1016/j.spinee.2011.06.017
[19]
Bergmann G, Graichen F, Rohlmann A, Bender A, Ehrig R, et al. (2008) Design and calibration of load sensing orthopaedic implants. J Biomech Eng 130: 021009–021001. doi: 10.1115/1.2898831
[20]
Rohlmann A, Gabel U, Graichen F, Bender A, Bergmann G (2007) An instrumented implant for vertebral body replacement that measures loads in the anterior spinal column. Med Eng Phys 29: 580–585. doi: 10.1016/j.medengphy.2006.06.012
[21]
Graichen F, Arnold R, Rohlmann A, Bergmann G (2007) Implantable 9-channel telemetry system for in vivo load measurements with orthopedic implants. IEEE Trans Biomed Eng 54: 253–261. doi: 10.1109/tbme.2006.886857
[22]
Rohlmann A, Dreischarf M, Zander T, Graichen F, Strube P, et al. (2013) Monitoring the load on a telemeterised vertebral body replacement for a period of up to 65 months. Eur Spine J 22: 2575–2581. doi: 10.1007/s00586-013-3057-1
[23]
Rohlmann A, Zander T, Graichen F, Bergmann G (2013) Lifting up and laying down a weight causes high spinal loads. J Biomech 46: 511–514. doi: 10.1016/j.jbiomech.2012.10.022
[24]
Rohlmann A, Hinz B, Bluthner R, Graichen F, Bergmann G (2010) Loads on a spinal implant measured in vivo during whole-body vibration. Eur Spine J 19: 1129–1135. doi: 10.1007/s00586-010-1346-5
