Wake up Spine: spine rehabilitation, neurosurgery and programming the deadlift

There is a new population segment in our societies which sits 8-12 hours per day, whether for pleasure or work. This sedentary lifestyle can lead to detrimental changes to the spinal column, sometimes requiring surgery. Patients undergoing a discectomy or flavotomy are a small yet fast growing special population among spinal injury patients.

Successful operation and early phase rehabilitation aim at restoring the passive and active subsystems of the spine’s overall stabilizing apparatus, but the long-term adaptation response (like poor posture) created by the neural subsystem along the way to herniation also needs to be corrected in order to avoid further injuries or more disc degenerations gradually leading to complete dysfunction.

Rehabilitation in the postoperative period requires a safe transition time and follow-up activity program to allow patients to learn to cope with everyday challenges of life, re-establish the capacity of their spine and focus on spine-hygiene. According to McGill (2), spine-hygiene refers to the daily upkeep of the spine, including daily recovery routines and necessary changes to daily motions all day long, to remove the movement flaws that cause tissue stress.

Why the Kettlebell Deadlift?

One of the most frightening movements for this population is lifting objects from the ground, probably because the poorly-performed lifting or putting down of seemingly harmless objects is the most typical movement causing severe disc herniations. The patient’s lifting pattern can easily and quickly be rewritten using kettlebells, taking advantage of the unique shape of the device. Yet, before actually lifting or moving these ball-shaped weights, there are additional capacities that require assessment in a follow-up rehabilitation program focusing on rehabilitation of the spine, specifically foot and hand disorders.

Regarding the feet, examination and, if determined by assessments, corrective exercises, massage therapy and taping may also be a necessity before starting to learn kettlebell deadlifts to prevent typical symptoms like: hallux valgus, hallux rigidus, accompanied by early phase flatfoot deformities alternate sensation of center of mass during exercise, and work as degenerative forces against joints and the spinal column.

Regarding the hand, refining the differences between grasp, precision grip and power grip and strengthening the latter is a crucial point in preparing the musculature and nervous system to lifting. Power grip stabilizes and controls the resistance (weight) the body is working with. This is a skill to be mastered not only in the training room, but during everyday life activities like shopping, carrying or holding objects at a workplace or in the household.

The Path to the Kettlebell Deadlift

The weight of the kettlebell for performing Deadlifts does not need to be great for beginners (4-6-8 kg), and the load can slowly and gradually be increased when breathing and technique are safe, providing the lowest possible risk of sudden overload.

Slowing movement and stopping movement for observation is beneficial to achieve safe and adequate performance. (Feldenkrais basement of movement) While ballistic exercises do not allow slow motion by their nature, the Deadlift does. Especially at beginners’ level, performing a very slow hip hinge, i.e. reaching out, inhalation and exhalation – for 5-10 seconds – are excellent maneuvers to improve body awareness and to regain or maintain control over the whole body. Slow motion repetitions are performed without weight; thus they are called „empty reps”.

A properly performed deadlift is a full body movement requiring a balanced involvement of paravertebral muscles, the entire core musculature, and engagement of the gluteus-latissimus bridge involving the thoracolumbar aponeurosis. When a patient has lumbar surgery, the thoracolumbar aponeurosis becomes an artificially injured tissue during the operation. The scarring left at the place of the incision made during the operation must also be observed and documented regularly, during at least the first year of rehabilitation.

When neutral spine position is achieved and maintained by the patient, he/she can begin to perform a hip hinge, engaging the latissimus dorsi while moving hips backwards, tighten up his core musculature when grabbing the handle of the kettlebell and inhale. When lifting the training device, the patient must press his/her feet into the ground, keep intra-abdominal pressure under control and finish the movement with explosive tension breath exhalation, an exhalation during which core musculature does not relax but stays tightened, resulting in articulation of the hissing sound „tsss”. There is a checklist of skills to be practiced to a technically satisfactory level before and while moving the weight and replacing it between the feet on the ground.

The Deadlift may proceed slowly, but patients are going to meet and correct basic false patterns in a simple movement they have been practicing every single day in their lives.

The functionality of the so-called Sumo Deadlift – the simplest Deadlift variation performed with one weight placed between the feet- is very simple and obvious: since we are living against gravity, lifting by using a balanced and strong spine and associated musculature is a basic skill in everyday life.

The Deadlift, when performed correctly, can be programmed in training with a series of variations: Suitcase Deadlift, working with one or two kettlebells (in latter case symmetrical or asymmetrical) and Single-leg Deadlifts, working with one or two kettlebells (in latter case symmetrical or asymmetrical). The Deadlift is an exercise that, together with adequate isometric protocols, and should by no means be left out by any means from spine patients’ trainings even on an advanced level.

An example of building up a Deadlift program over two training periods per week for 8 weeks for beginner groups of 10-12 spine patients toward the end of their clinical rehabilitation. The exercise is taught during the first movement class as an introduction to kettlebell training. Each training includes bodyweight/ isometrics, muscle relaxation and corrective exercises as well. The first training of the week should be technical, the second loaded. In 8 weeks the trainees should have developed capacity to perform about 50 deadlifts in variations. There is no time measurement, nor pressure for speed of performance, and during the whole training session rest time should be as long as needed.

By the end of this program, a trainee can safely proceed to exercises like Single Leg Deadlifts and Swing (see below). For those lacking hip mobility for the drill, an elevated plate is used.

Abbreviations:

SDL: Sumo Deadlift, performed with one kettlebell placed between the feet.

SCDL: Suitcase Deadlift, performed with two symmetrical kettlebells (of equal weight) placed by the lateral sides of the feet, handles looking forward. Each of the weights should be lighter than the one used for SDL.

aSCDL: Asymmetrical Suitcase Deadlift, performed with two kettlebells of different weight or/and size. Both lighter than the one used for SDL.

SHDL: Single Hand Deadlift, performed with one kettlebell in the form of suitcase deadlift, one hand empty, the other holding weight, lighter than one used for SDL.

Training 1.

Rest between sets

Training 2.

Rest between sets

Weight

1. WEEK

SDL:

introduction

3-3-3-1 reps

as needed

SDL:

4×5 reps

As needed

Female: 4-6 kg

Male:8-12 kg

2. WEEK

SDL:

4×5 reps

SCDL: introduction

3-3-3-1 reps

SDL:

5 relaxed breaths

SCDL:

as needed

SDL:

4×5 reps

SCDL:

2×5 reps

SDL:

5 relaxed breaths

SCDL:

5 relaxed breaths

SDL:

Female: 8 kg

Male: 12-16 kg

SCDL:

Female: 2x6kg

Male: 2×8 / 2×12 kg

3. WEEK

SDL:

2×5 reps

SCDL:

2×5 reps

aSCDL:

introduction

3-3-3-1 reps

SDL:

3 relaxed breaths

SCDL:

3 relaxed breath

aSCDL: as needed

SDL:

2×5 reps

SCDL

2×5 reps

aSCDL:

2×5 reps

3 relaxed breaths

SDL:

Female: 8 kg

Male: 12-16 kg

SCDL:

Female: 2x6kg

Male: 2×8/ 2x 12 kg

aSCDL:

Female: 6-8/8-6 kg

Male: 8-12/12-8 kg

4. WEEK

Technical supervision

SDL:

2×5 reps

+ slow „empty rep”: 1-2

SCDL: 3×5

+ slow „empty rep”: 1-2

aSCDL:

4×3 reps

slow „empty rep”:1-2

3 relaxed breaths

SDL:

2×6 reps

SCDL: 2×6

aSCDL: 4×4

3 relaxed breaths

SDL:

Female: 8 kg

Male: 12-16 kg

SCDL:

Female: 2x6kg

Male: 2×8/ 2x 12 kg

aSCDL:

Female: 6-8/8-6 kg

Male: 8-12/12-8 kg

5. WEEK

SDL:

2×6 reps

SCDL:

2×6 reps

aSCDL:

4×4 reps

SHSD

introduction

3-3-3-3 reps

3 relaxed breaths

SDL:

2×6 reps

SCDL:

2×6 reps

aSCDL:

4×4 reps

SHSD:

2×5 each side

2-3 relaxed breaths

SDL:

Female: 8 kg

Male: 12-16 kg

SCDL:

Female: 2x6kg

Male: 2×8/ 2x 12 kg

aSCDL:

Female: 6-8/8-6 kg

Male: 8-12/12-8 kg

SHDL:

Female: 6-8kg

Male: 8-12 kg

6. WEEK

SDL:

10 reps

SCDL:

10 reps

aSCDL:

2×6 reps

SHSDL:

5-5 each side

2-3 relaxed breaths

SDL:

10 reps

SCDL:

2×8 reps

aSCDL:

2×8 reps

SHSDL:

6-6 each side

2-3 relaxed breaths

SDL:

Female: 8 kg

Male: 12-16 kg

SCDL:

Female: 2x6kg

Male: 2×8/ 2x 12 kg

aSCDL:

Female: 6-8/8-6 kg

Male: 8-12/12-8 kg

SHDL:

Female: 6-8kg

Male: 8-12 kg

 

Safe and effective: the Kettlebell Swing

Not only for spine patients who have undergone surgery, but also for those who have battled chronic pain, herniated discs or instability and have won the struggle against pain against with the help of conservative treatment, appropriate exercise is not an option anymore, but a must in order to maintain their pain-free, active lives.

An exercise that has proven to have an extremely high carryover and impressive safety record to a great number of modalities, especially „general strength” defined as performing physical work successfully, is the Kettlebell Swing, discussed here for its very low injury risk. The Swing should be taught to those having achieved good results in the Deadlift, which contains basic Swing mechanics.

Performing a Kettlebell Swing

The kettlebell is set in front of the feet. The patient grabs the kettlebell by reaching forward – this should be performed while keeping the spine in neutral position. The eyes should be looking forward at a spot 6-10 feet in front of the patient.

After hiking the kettlebell backward aggressively („the backward swing”) it must be swung up to the front (the „upswing”), chest-height, similarly to a jump without letting the body move forward- the exercise is a forward force projection- while alignment of the body is kept.

At the end of the exercise, the kettlebell is returned to the starting position from the „backward swing” point.

Programming injury risk-free progression

Programming for ones with a history of spine injury requires slow, attentive learning of the exercise. The number of repetitions for the first few weeks, even months should be kept low, allowing enough time for rest, i. e. 1-3 minutes.

Reaching forward for the kettlebell is a challenge which requires a dynamic hip hinge with neutral spine (shoulders above hips, hips above knees) : it does take quite a while to perform correctly having a spinal column that is not used to keeping its position throughout an exercise. The patient’s center of mass and the kettlebell’s moving center of mass of gets rapidly confused by the brain when not progressing gradually.

A very effective little trick to help with safe start before moving the weight, and which may be applied to the Deadlift as well, is lifting the toes – and only the toes. The rest of the feet structure stays planted on the ground for a while before moving the weight. This tiny movement pushes the axis of the whole body backward, especially if an incorrect forward-leaning position has been performed and needs to be corrected. This example of a take-home drill saves patients from injuries while practicing at home as well.

Breathing technique should be perfect on every single repetition. Learning satisfactory performance requires focused, systematic work. For a spinal patient, performing a swing is not only a power exercise, but also a kind of first aid for removing an old collection of bad motor pattern habits, and activating his inhibited muscles (gluteal amnesia) that will work to improve posture maintenance and relaxing the hypertonic ones. The kettlebell swing can be addressed as a dynamic posture restoration drill, yet its transfers to jumps and conditioning are well known. (3)

Once learned under supervision, the kettlebell swing and its variations (performed with two hands, one hand and alternating hands) can be practiced for a long time without evolving into monotonous sets of identical repetitions. The weight of the kettlebell, number and variations of repetitions can be combined to infinite number of „games” of adaptation improving focus and stability within one drill.

Strength is a skill. A skill can be refined through attention, practice and professional, benign control of a trainer.

The Kettlebell Deadlift and Kettlebell Swing are one of the safest, most effective exercises from which a spinal patient can benefit outside the training-room. Improved strength and body awareness is going to be paid back both in physical and mental capacity, posture control, endurance and absence of muscle fatigue as a consequence of a balanced, „educated”, strong spine.

The patient demonstrating deadlift and swing in the photographs provides living evidence of the efficacy of deadlifts and swings, and that one can grow strong following an operation ending in laminectomy because of a sudden bleeding complicating the operative procedure resulting in a loss of 1800 ml of blood. A cautious, well-built rehabilitation protocol made him able to deadlift a 60 kg kettlebell and swing a 48 kg one 16 months after the operation. 18 months after his operation he has participated in and successfully accomplished the well-known Bamaco Rally on his motorcycle fighting all the difficulties of the challenge without any injuries. As an illustration, documents of the scar of his lumbar spine operation shortly after the operation and 2 years later.

 

REFERENCES

  1. Feldenkrais, M.: Awareness Through Movement. New York: HarperOne, 1990.

  1. McGill, S.: Back Mechanics. The Step-by-step McGill Method to fix back pain. Ontario: Backfitpro Inc., 2015.
  1. McGill, S. M., & Marshall, L. W.: Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads.: The Journal of Strength and Conditioning Research, 2012. 
  2. Moseley, L.G.: The Graded Motor Imagery Handbook. NOIGroup Publiations, Australasia Pty Ltd. 2012.
  1. Panjabi, M.M.: The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement. New York: Raven Press Ltd., Journal of Spinal Disorders, 1992; 5: 383-389.
  1. Panjabi, M.M.: The Stabilizing System of the Spine. Part II. Neutral Zone and Instability Hypothesis. New York: Raven Press Ltd., Journal of Spinal Disorders, 1992; 5: 391-397.
  1. Tsatsouline,P.: Enter the kettlebell. St.Paul, MN: Dragon Door Publications Inc., 2006.

  2. Janda, V.: Muscle Function Testing Butterworth, London, 2013.

  3. Vleeming, A.: The thoracolumbar fascia. An intergrated functional view of the TLF and coupled structures. Fascia, The Tensional Network of te Human Body: Elsevier Ltd., 2012: 37-43.

  4. Splichal, E.: Barefoot Strong. Unlock the Secrets to Movement Longevity: BookBaby., 2015

  5.  Neumann, Donald A.: Kinesiology of the Musculoskeletal System: Foundations for Rehabiliation.Missouri: Mosby Elsevier, 2012.

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