Golf After Spinal Surgery: Part 2 of 2
Part II: Hitting the Links after Lumbar Fusion
In the last issue we discussed the recovery process and rehabilitation of patients who wish to return to golf after lumbar discectomy. In this issue we will explore recovery after a significantly more invasive low back operation, lumbar fusion, and discuss guidelines for returning to golfing.
Learn 11 easy golf exercises to prevent back pain in our golf and back pain slideshow.
Recovery after Lumbar Fusion
Fusion operations typically require a 2-3 month period of back external immobilization (bracing) to help the bone graft and fusion solidify. In order for the fusion mass (bone mass) to solidify movement must be kept to a minimum. The metal screws and rods placed to augment the fusion act as an internal brace to maximize stiffness in this region.
This internal immobilization is often combined with an external back brace (either hard plastic or soft girdle with support panels), and sometimes a bone fusion stimulator, as well.
During the first 12 weeks after surgery extensive range in motion is limited to allow bone healing. Although the initial internal metallic construct is strong, over time it could ultimately fail if bone cells (osteoblasts) don't migrate into the fusion area and form a new bone matrix in and around the hardware. The metallic screws and rods act like rebar whereas the in-growth of bone offers the true concrete that creates a lasting solid fusion.
During the first 12 weeks activity should be limited to walking only. At a period of three months after surgery Xrays are obtained to verify the fusion is in progress. If the Xrays show evidence of an advancing fusion, the brace can be discontinued.
During the post-operative period between weeks 12 and 16 usually only a light stretching regimen is initiated. This consists of abdominal and low back muscle stretching. After 24 weeks of recovery I typically will allow patients to begin swinging short irons at the practice range if they are doing well and are experiencing a good recovery from their pre-operative symptoms.
Light swinging at 24 weeks after surgery is not universally accepted; some surgeons recommend a longer convalescence. In fact, some spine surgeons like to keep their fusion patients off any swinging regimen until a full six to nine months of recovery has been completed.
"For my fusion patients, I really like to start them back very slowly." Says Arthur Day, M.D., well known neurosurgeon at the University of Florida who cares for many professional golfers. He adds: "I keep them from swinging for six months after their surgery, and then we start from scratch with stretching and flexibility."
Gerald Rodts, Jr., M.D., well known sports medicine spine surgeon (neurosurgeon) at Emory University emphasizes that golf rehabilitation after fusion must be individualized. "Treatment must be tailored to the individual patient and what their overall clinical situation mandates.
Since some patients don't even begin to see the benefits of their fusion until six to nine months after the operation, a good population of these patients will not be ready to return to swinging until a six month recovery period."
He adds: "If, however, there is good Xray evidence of a maturing fusion at 16-20 weeks after surgery and the patient's symptoms have resolved, I feel it is probably safe for them to begin their golf rehabilitation at 20 weeks post-operatively."
If all is well at 24 weeks after surgery he encourages his fusion patients to return to light swinging with the proviso that any flare up of pain is an automatic pause for the golf rehabilitation phase until a total of six to nine months have passed since surgery.
The importance of a warm-up and cool down period that consists of easy stretching and range of motion exercises cannot be overemphasized. This is part of "low back maintenance" and needs to be considered a part of life for any patient with back pain. I try to emphasize to my patients that back stretching and warm-up is like flossing your teeth or warming your car up in cold weather. It is something that one must do every time as a routine.
If the patient continues an uneventful recovery they can be advanced to mid-range iron shots with light swinging at 24 weeks post-op. This can be advanced to the long irons and woods by 28 weeks. A controlled range practice with limitations on number of balls hit is safer and easier on the recovery compared to embarking on a round of eighteen or even 9 holes.
When playing "live golf" players are often faced with a variety of shots that require them to alter their stance, posture, and leg position. In addition, the varied surfaces i.e. thick vs. thin rough, downhill or uphill lies, and sand present too varied a swing resistance for the recovering patient.
Most often it is not the predicted movement or swing that causes injury or recurrent injury, but the unpredicted shift in weight, accidental turn, or unexpected resistance during the swing that is the recipe for trauma. Probably the most common statement on the injured golfer heard in clinic is: "I hit the ball fat, doc, and that's when my back started to flare up."
At 28 weeks after surgery patients can begin to play short 9 hole rounds of golf. It is important again to emphasize to patients that they should strictly adhere to only nine holes because as one fatigues their potential for re-injury increases. When playing, patients should not hit thick rough shots or angled lies. These ball positions should be avoided completely during the recovery phase.
If you ever wanted a doctor's excuse to carry out on the course with you to give you a special dispensation this is the time to do it. Sand shots can be allowed but only from shallow traps. Deep pot bunkers should be avoided at all costs as the power necessary to extricate a ball from this treacherous region could undo all the good work your surgeon performed some 28 weeks ago.
Golf after lumbar fusion is feasible and encouraged by most sports medicine oriented spine surgeons provided that the proper recovery period has passed and the patient's pre-operative symptoms have improved. Proper back hygiene is paramount including warm-up and cool down stretching and exercises at any round of golf.
In the next issue we will discuss golf after neck surgery. Other upcoming topics will be Sex after Spine Surgery and Recovery after Spine Surgery: The Mental Edge-Your Ace in the Hole.
Important Points to Remember