Lower back pain

What's it like after you have surgery? What do they do? If I ever get to that point and have to do surgery, can I go back to doing all the things I do now?

 

What's it like after you have surgery?
Initially? Moving around sucks and you're pretty limited. Some have more pain than others. A much broader region of muscles will atrophy quickly (the rest of your low back muscles, glutes, etc). Inflammation associated with surgery is very bad to your musculature. With spinal surgery, often you'll have to temporarily wear a back brace and have limitations to how you can move (e.g., no bending, lifting, twisting). Spine surgery rehab isn't too bad when compared to other joints. Typically, you can expect 6-12 months of recovery time before you feel 100% or close to.

What do they do?
This depends on what you need done. Does the surgeon only want to clean up the area or does he want to put hardware in? This can range from opening up space by shaving down parts of the bones to inserting spacers, to fusing the affected joints with brackets so it can no longer move.

Can I go back to doing all the things I do now?
This depends on what the surgeon does and what activity level you want to achieve. I'll give you a couple of examples: the average person who has spinal surgery will go back to their previous quality of life; my coworker in his 50's had both of his knees replaced and had lumbar surgery, and is still able to enjoy competing in recreational softball leagues (although he doesn't do much to maintain his body so he's basically falling apart); I had arthroscopic surgery on my hip (my femur had excess bone growth and was fraying tissue at my hip joint) - It's been 13 months and I'm still able to beat the hell out of my body, lift as much if not more, and have PR'd my mountain trail runs. What really matters is are you going to take your rehab seriously and be self-motivated after surgery and even after PT/rehab.

When should you get surgery?
Surgery should be considered only when other conservative methods fail. I've had too many patients who jump right into surgery because their surgeon told them they *had* to do it but then they become an emotional wreck when their quality of life doesn't change and they still have the same pain as they did prior to surgery. Surgeon's advocate surgery because that's what they do and how they make money so of course they are going to say you need it.

How do you know you need surgery?
Like I said above, exhaust all other options and get serious about making yourself better. Some methods work better than others and I can't fix everyone. I get patients who tell me this is the best they've felt in 10-20 years. Those are the ones who make lifestyle changes to better their quality of life. I also have the patient's who don't have a change in status. They patient's are usually ones with chronic pain, changed psychological factors (their PCP or pain management has told them they have a "degenerative" condition and now they focus on these negative labels), are overweight/obese, sedentary or don't do a damn thing at home, and/or seek care expecting a quick fix and not have to take an active approach. For most of those failed cases the mentality is "fix me quickly and let me continue my crappy life habits".

I'm pretty against surgery and think it's over utilized. However, I understand there are cases where it's the best option. In regards to my hip, I got to the point where I could barely handle a gym workout and standing on one leg was extremely difficult. My body produces more inflammation than the average person so I began having to fall asleep with an ice pack to my hip, eating ibuprofen like candy, and waking up in the middle of the night pissing razor blades and feeling like someone stabbed me right in my genitals. I went from working out 6-7 days a week to struggling to maintain a limited 4-5. 13 months later I'm eons better than I used to be.

So your x-rays and MRI showed something was "wrong".
Most (if not all) people, regardless of pain, have some sort of degenerative changes or dysfunction in their spine. There was a large study completed a few years ago where they performed spinal imaging on ~1500 asymptomatic individuals with NO history of back pain. 20-30% of people in their 20's had degenerative changes and it rose to 100% by the time you hit 80 years old. It's a natural part of aging and depends on many many factors.

Hope that helps.

 

At 24, if you are having back issues I would seek advice from an ortho surgeon who ONLY does spines, not a general ortho guy and a physical therapist.

You are young enough to want to find effective ways to avoid surgery for as long as possible (or avoid completely).

A lot of chronic pain issues are from people not addressing imbalances over their lifetime.

I would also avoid injections as much as surgery. Steriods trash cartiladge over time. Increases the chances you’ll have to have surgery. Plus there is an infection risk people seem to blow off.

Also work on your flexibility. 4-6 times a day be stretching. If your hamstrings are tight and you have back pain... good chance they are linked. When your hamstrings don’t stretch to accomodate bending over... your back does, and it wasn’t made for that.

You are 24. You should be able to put your palms on the floor while your legs are straight.

 

Funny you say that. I finished up with a young and active knee patient last week. A knee ortho sent them to me for a knee pain diagnosis. Their knee symptoms didn't improve and upon thorough evaluation I determined it was actually the hip so I referred them back to their knee ortho with a comprehensive assessment and informed the parent about what I wrote. Surgeon blew me off and persuaded the patient's family to proceed with arthroscopic knee surgery. They then came back to see me for post-op rehab. After 4 weeks they were not recovering at the expected rate. I reassessed the hip before I referred them back to the surgeon. I could reproduce their knee symptoms by isolated hip tests. The surgeon basically screwed up this teen because they specialize in knees and was too arrogant to refer to another surgeon who is more knowledgeable about hips.

Agreed about the injections. I'll also add that injections don't work for everybody. It ranges from no effect to months of relief. By all means roll the dice on how long the band-aid lasts, if at all.

I could write a short book on how much I disagree that the hamstrings are the culprit. In the past year I have prescribed zero hamstring stretches for people to perform at home. It feels good and that's about all it does. The problem usually arises from neural tension and issues with the pelvis and spine.

 

I had foot pain after playing basketball that persisted for 3-4 months. It changed my gait and never got better.
PCP did xrays sent me to a podiatrist. Podiatrist gave me an orthotic, no help after 8 weeks. Then we did a boot for 2 months. No help.
He wanted to do injection in my big toe, said no way. We did thin slice MRIand CT. Apparently both fine.
Took everything to another podiatrist and a general ortho. They said I basically needed the joint cleaned up. I had a weird feeling in my gut so I paid big money to see an ortho who only does feet and ankles.
He saw all my scans, we did new xrays (it must have been 10 months since my first set by this time)

Hes like “yeah you broke your foot, it healed bad, you have additional bone growth that basically is preventing you from bending your big toe and now you have arthritis”
He showed the problem on all my scans and Xrays.

Nothing like having a doc whos only job is one body part nothing else. Although thats what podiatrists are supposed to do but I don’t trust that specialty anymore.

I did the same thing with my rotator cuff surgery. Found a doc who only did shoulders.

A great doc is only half of it though. My PT is why I’m 99% after my rotator cuff surgery. I’m 26 y/o 5’9’’ 175lbs max bench/dead/squat/military is 295/350/280/165.

I’d be nowhere without him.

 

I'm not a doctor, I don't play one on TV (or movies), and I haven't even stayed in a Holiday Inn Express, but I've gone through this myself. Check with your doc to make sure you won't do further damage to your back if you decide to try any of the stretches you find on the Internet - there are LOTS of YouTube videos on how to stretch particular muscles.

While I do have a bulging disc at L5-S0, prior to that diagnosis, Docs thought I had sciatica from sitting on my wallet all day (basically) and compressing my sciatic nerve. I think what I really have/had is piriformis syndrome. The only way I can describe the pain I was having is that it felt like my hip bones were grinding on each other. It was painful to stand up straight, especially after sleeping horizontally, or sitting for even short periods of time. When I stood, I made grunting noises to get through the pain and I sounded like an old(er) man every time I got out of a chair or bed.

I went to a chiropractor, which helped (even had a lumbar facet injection which didn't help), but I think what helped more were the "nose-to-toes" (you can search google) stretches he prescribed plus some other stretches I found on the internet (search "nerve flossing" and/or psoas/piriformis).

The stretches DrSouthpaw linked earlier stretch both the psoas and piriformis muscles which connect the torso to the lower body. This is also why traction (hanging as described earlier, either by your arms or by your ankles upside-down) helps. IT Band stretching may also be beneficial (I also went to a sports massage therapist who worked on my IT bands quite a bit).

 

Back surgery veteran here.
About a year and a half ago i woke up with pain and numbness in my right leg. No warning,it just happened.
No back pain at all.
It got to the point in the Summer/Fall of 2016 the pain would start at 7:00 pm like clockwork in my lower leg. Like an acetylene torch type of pain. Spent most nights hobbling around.
Most nights I was getting about 2 hours sleep and that was marginal at best. My work was a Telco Lineman, so that wasn't helping matters.Hurt like hell during the day, but I was moving.
Fortunately, we have an outstanding Ortho group in my area and they did shoulder work and repaired a torn biceps in the past.

I saw their back guy and after a MRI, he said my L4/L5 was blown out and causing sciatica in my leg.
That much I figured out already.
I had 2 injections to start.
1st was weird. I felt every nerve ending in my right leg light up and it knocked the pain down slightly.
2nd, not so good. It felt like molten lava flowing down my leg, and that did nothing.

I was prescribed pain killers that Summer. I am not big on those to begin with, and I have a CDL on top of it. I did take them twice, on a Friday night, since I wasn't driving. They did make me sleep, but big time constipation only taking 1 pill. That's not the way to go.

Around Thanksgiving last year, I talked to the surgeon. I asked about PT, inversion , and the like.
He said, in my case, that's all good, but we'll be having this same conversation in a month.
At that point , I wanted to get cut.

So, a couple days before Christmas, I went in. He basically did a shave job, relieved contact and pressure on my wire harness(best description of the nerve bundle), and removed some arthritis material.

When I woke up from surgery, I told the nurse I had to go to the bathroom. She told me that I have 2 good legs, get up and walk over to it. WTF! Couldn't believe it.

When I got up, I had zero pain,zero numbness, and i wasn't dragging my leg like I was for 6 months.

Spent the night at my sister's and went to my house the next day. I was semi functional in a week and GTG in a month, returning to work.
A year later, all is good. I'm careful with my back. Switched jobs in my company to a no impact job.
4 toes on my right foot are semi-numb right now. Doc says that could take up to 2 years to get back, if ever.
Small price to pay if I don't.
Back surgery always scared the piss out of me as we all heard the stories.
In my case it was the best thing to do and it worked.

 

Just checking in. Better, same, or worse?

 

Same, haven't been doing everything I should as far as stretching and exercise goes, been busy with work. My parents are also building a new house, so I've been helping with that... I'm feeling pretty good right now. I cut up a tree and carried it to the burn pile today, no pain at all.

 

Already have a fusion. lasted 15 years now its back again...

3 more above the last

I cant get comfortable ever.

i am not taking PAIN killers..

injections may be my only hope.

welcome to the old tall man situation!!

 

I just looked up what a fusion is... ouch. Mine is a herniated/bulged disc I'm pretty sure. I haven't been to have that confirmed, but this has been ongoing for several years without getting worse. Sometimes I feel great, I can extend my back without pain, but after it happens once, it takes a while to go away again. It's always there if I push it too hard, but if I don't aggravate it, it stays dormant, if that makes sense?

 

The probability of spontaneous regression of lumbar herniated disc: a systematic review.
https://www.ncbi.nlm.nih.gov/pubmed/25009200

"The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs."

CLIFFS: The worse the disc herniation, the better it heals.


Systematic literature review of imaging features of spinal degeneration in asymptomatic populations
https://www.ncbi.nlm.nih.gov/pubmed/25430861

"Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria."
"The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age."

CLIFFS: Disc degeneration and herniations are a natural part of aging and don't automatically equal cause of pain

 

I have ankylosing spondylitis (symptoms for 25 years; diagnosed 7 years ago). If anyone newly diagnosed has any questions about diagnosis or treatment, I'm happy to share my experience and/or offer advice.

 

I would go to a chiropractor. In the meantime, anti-inflammatories can actually help reduce swelling and make you feel better. Keep us updated on how you're doing.

 

I've actually been feeling great the last week or so. It comes and goes, it's not bad enough even when it's bothering me to load up on pills.

 

Joint manipulation for a herniated disc. Sounds smart.

 

Go see an orthopedic spine surgeon. Definitely a herniated disk. He/she will take conservative measures to ensure you try everything else besides surgery.

 

Small update, I got a new mattress with an adjustable base a month or two ago. It took a little while to get used to my new mattress, but it’s made a big difference. Lately I’ve been able to hang from a pull-up bar and extend my back with absolutely no pain upon letting my back recompress by putting my feet on the floor and standing, which didn’t happen before at all. I’m still not 100%, I occasionally get a little pain (not the sharp stabbing pain like before) if I move a certain way, but it’s a lot better than it was.

 

Havn't read through all the way, so forgive me if this is a repeat post... but.

What is your bed situation? I used to suffer from some daily sometimes near debilitating back pain, no matter how much I tried to strength train it, stretch, massage, standing desk etc.

I bought a mattress from here: www.bearmattress.com and havn't had back pain in over a year. Small price to pay if you think about it, and you get 100 nights to try it out... takes about a month or so for your body to adjust, but overall, it's been my go to recommendation to everyone I know.

edit: just saw you got a new matress lol, hope it works for you! I recommend bear for anyone else contemplating

Good luck!

 

Thanks! I actually went with a Tempur-Pedic, it’s a little firmer than I thought I wanted, but my back has never felt better so I guess it was exactly what I needed.