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Physical therapy after microdiscectomy and reherniation

AnonymousUserAAnonymousUser Posts: 49,899
edited 06/11/2012 - 8:18 AM in Exercise and Rehab
So I'll be starting physical therapy soon. Probably next week. The physical therapy place is right in the same building with my surgeon. They share a computer system since when I went over there they already had all of my info in the computer.

I have never been to physical therapy in my life. What can I expect? I noticed on the sheet that I brought over there from my surgeon it said to work on strength, stretching, pain relief. There was one more but I can't remember what it was. I'm going to be a nervous wreck. The only thing I feel safe doing is walking and that hurts if I do it more then 20 minutes.
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Comments

  • If the PT is working that closely with your doctor, I wouldn't worry too much. The first time I went to pt, they did an initial evaluation of what I could and couldn't do. Like watcking you walk to see ifyou favor one side, strength tests (for example putting a hand on your knee and asking you to push up) asking you to bend and measuring how far you can go. then they set up a program the is tailored to you. If anything they ask you to do hurts, tell them.

    Next week I get to start PT (7 weeks post op) and I can't wait! Keep us posted on how the session goes.

  • They sure need to work with me on my left leg strength. I'm still walking with a limp some. I'm not hurting too bad right now but my calf is really weak and I can barely push myself up on my toes on that side one time. It'll be interesting to see what they have me do.

    I was noticing your signature that says you went back to work 3 weeks after a microD and your disc collapsed. What kind of work do you do?
  • Hi M,

    I had a micro-D on May 19 and started PT last week. I also started back to work last week (half time).

    I think Anna is right on the mark. Your first visit will likely will focus on setting a baseline on where you stand, such as testing strength in toes, calf, mobility, etc.

    During my first post-op vist, my PT outlined what I would be doing, who I would be working with, and what my goals would be. I too have decreased strength in my left calf (the bad side) and toes. The surgeon noted a difference in calf size (atrophy) and my strength doing a calf raise (on my toes) is much less on that side.

    In my case I was lucky and the PT is very experienced with backs, which increased my comfort level. I had seen her previously when I was trying to beat this thing without surgery, and so I've done a lot of PT in the past 1.5 years, but the experience is different post-surgery compared with before the surgery.

    Before I was doing a lot of work in the gym, working on strength training, core fitness, etc.

    Post-surgery, since I had a very large herniation at L5/S1 and need to be very careful to avoid re-herniation, they are staring me off slowly, with water walking in the pool (combined with specific arm movements) daily on my own time, and some other home exercises. So basically they have been using the time in PT to show me what I should be doing on my own to build core strength (to protect the back) and to build strength.

    Your PT should be tailoring your program to your specifics.

    I guess the only red flags would be if you don't get good explanations about your condition, what the goals of the program are, etc.

    I actually like PT, since it is something tangible I can do to help my own cause. Hope your experience is similar!
  • PT is great, as long as they do a careful assessment of where you're currently at.
    You learn the difference between good pain (muslces working) and bad pain(when you should stop!)
    You REALLY have to dedicate a proportion of your life to practicing it at home though -3 x a day prob for ~20mins each otherwise you will not benefit. This has to become your daily religion-get used to doing it when you watch your fave tv programme, whilst waiting for dinner to cook or whatever.
    You will be doing things that look really basic at first-but they work as long as you do them properly (slowly!) and often.
    All the best!
  • That's what I was hoping is that they would show me safe exercises I can continue on my own. Right now I am doing the exercises they taught me in the hospital the day after my surgery. There are 8 that I do now twice a day. Things like laying down and flexing my thigh muscles and moving feet up and down and pressing heal down working the hamstring muscle and flexing glutes and abs things like that. Last time 3 years ago after my microD I kept doing the exercises for a year then stopped. I wasn't sure if I should have continued them or not or if they were just for the initial after surgery therapy to keep the muscles from seezing up. Now going to physical therapy I can get a good idea of what I should continue on my own to keep the muscles around my spine strong.

    I'm still waiting for them to call me though. I was in there last thursday and they said they were going to get approval from my insurance company and then call me. My insurance is really good and has paid for everything so I'm sure it'll be fine but I'm just waiting here for the PT place to call so I can get this started. In the meantime I'll be going outside walking today like I do every day now and doing my PT exercises they gave me in the hospital.
  • Well they called me today and my first appointment is July 7th so I get this week off. It's an evaluation appointment. So that'll be interesting to see what level I am at. She said they evaluate me and decide from there how many PT sessions I will need. I'm not sure how it will go since my surgeon is having me lower my dose of neurontin and then go off of it within the next couple weeks.

    I'm not sure how much pain I'll be in without the neurontin. He basically wants to see how I am doing without it and then if my pain increases he wants to do another ESI.
    Hopefully my pain levels do not go up though. Starting PT and lowering my neurontin at the same time doesn't thrill me. If I have an increase in pain I won't know for sure which it is from.
  • I think it unlikely that the PT will casue an increase in pain-they don't really give you anything to do that will cause an injury to get worse or anything. Good luck, July 7th is quite soon!

    I was off painkillers altogether about 2 weeks after surgery but can only speak for myself! Good luck! Let us know how you get on.

    Also, I started a pilates class and am loving it-as long as you start at very beginners level and work your way up slowly it's very simialr to a lot of the physio exercise you do-ask your physio if it's OK though.

    A xx
  • I am 6 days post L3-4 hemilaminectomy and discectomy. This is a redo as I reherniated after my December 08 surgery as a result of overzealous PT and manipulation by a chiropractor. Surgery was at The Mayo Clinic. Mixed impressions that I may go into at a later date. I have relatively minimal pain now that is well controlled by 3 percocets and 1 celebrex daily. Mainly, my problem is that I just have very weak "core" muscles, I guess, as standing erect for any length of time or walking for more than just a few hundred yards is very difficult. I literally just can't stand up straight for more than just a few minutes. I have to fight just bending over while standing or walking.

    Questions for members. How soon should I start formal physical therapy? Are most physical therapists qualified for my needs or do I need to seek out someone who specializes in post op lumbar surgery? Anybody have symptoms similar to mine?

    All answers will be appreciated and thanks in advance.

    I am a 62 yo male nurse anesthetist and hope to bring some of my expertise on different topics to members of this forum.


    Respectfully,

    John C. Perry
  • :jawdrop: Yeah a chiropractor sounds dangerous. 3 years ago one turned my small disc protrusion into a large herniation with severe nerve compression. That's one place I'll never go again. My mom swears by them she doesn't have disc issues though.

    I actually went out on my bike last night for a half hour and feel fine today. No more leg pain then normal. I went for a short 10 minute ride on the weekend just testing it out. My surgeon said I could. I would never have had the guts to go out bike riding but it was his idea. My leg is feeling stronger since biking already. Going on my walk was much easier today. My calf was feeling stronger already.

    My sister was over today and was telling me that in physical therapy they will be having me lift weights and I'll be very sore from it. I know this is not true from reading this board for months. They don't have someone just weeks out from back surgery lifting weights. She's never had back surgery before just a sore shoulder with no known cause. But that's what they had her doing in physical therapy. I didn't even argue with her. I'll just wait until I get in there and tell her what my experience is. Non spineys just don't get it.
  • Mchell, glad the bike ride went well. I'm in my second week of PT (and week 7 post surgery). I've got a routine in the pool they have me doing daily, and now they will have me walking with poles (i.e. trekking hiking poles) daily as well, so it works upper back more while I am walking (all using the techniques they taught me). They also taught me how to walk up and down stairs properly ... seems silly, but they have me leaning forward a little as I go up/down to recruit the leg and glute muscles more than the back. Today I did my first "weight lifting" (6 pounds lifted at once with both arms) while seated in a chair. But mostly my exercises thus far don't involve weights. Of course, everyone's program will differ, based on their needs, etc.

  • Hi John, I think the advice you'd get from most people on the message board is that your surgeon should be the one deciding when PT should be initiated, and what restrictions should be followed. In fact you will need a prescription from the surgeon before a PT clinic will treat you. At least that has been my experience.

    The surgeon is in the best position to know how much internal trauma you've had from the surgery, how vulnerable your disc is, how fast it is healing, etc. So I don't think an "average" value from the group will be very useful.

    Re: a lumbar specialist vs. a generic PT ... I was fortunate to be treated by someone who is very knowledgeable about backs and treatment both pre and post surgery. This PT left to work in a different State for about 6 months and I noted the difference working with another PT who was "OK", but I could tell she had less experience and knowledge treating backs. So if you can get that type of specialized expertise, I think it will serve you well.

    Also, I have a colleague who's wife had the same surgery I did, and based on the feedback I've heard from him, that PT is not providing value for the $$, and the wife isn't getting the kind of treatment she needs. So there are some poor therapists out there.

    Personally, I had a large herniation at L5/S1 and started physical therapy at week 6, but don't let that drive your decision.

    Hope this feedback is helpful.
  • Akguy, just curious have they started you on doing any kind of straight leg raises?
    Im 2 weeks out from L5-S1 micro-d today and all im doing is walking,walking,walking :sick:
  • No, nothing like that. I am going in 3 days a week and they are adding new things each day, so that I am continually challenged. So today, for example, I was "taught" how to do step ups/step downs on an aerobics/step platform, but it was laying on the floor (probably only 3 inches high). She tried a couple different methods until seeing what would work for me.

    Today my PT also added squat type movements on a recumbant "sled" with no weight (other than body weight), and lat pull-downs with very light weight.

    So most of the leg motions have been more of a squatting nature, with proper form of course (using glutes and legs, not back). Nothing with a straight leg. I would think that would put a lot of pressure on the lower back?

    For me, pretty much everything is being done to strengthen the core and my left leg, which is weak. PT said after injury and surgery, your core muscles "turn off" and need to be retrained/re-engaged. Same with some of the muscle fibers in my affected leg. Nerve compression resulted in fewer muscle fibers getting nerve stimulation (and so some atrophy).

    I'm pretty impressed with the PT's I am working with. I have a main PT who seems to know backs really well (and who oversees my overall program), and an exercise specialist she has me working with one day a week. And starting next week, a massage specialist to work on the muscles running along my sciatic nerve. I think I am lucky to be working with the folks at this particular center, given their knowledge and the range of skills available as needed.

    Finally, Pitt, at two weeks, I think that is all you are supposed to be doing. At least that was my surgeon's opinion. He is big on walking and nothing else, for at least the first 5-6 weeks. Your surgeon may have a different philosopy. But at two weeks, I think most of them would encourage you to balance walking with resting.

    Sorry for the long post. I get carried away sometimes.
  • Hey Pete from Pgh?
    At two wks,walking is all you wanna do.Don't push it,PT will start when your body is ready.
    Walk and rest,walk and rest and if possible,take a nap during the day.

    Best wishes to everyone,G.
  • Hi...I am a special education Teacher, I have an Autistic k-2 class. The disc didn't collapse because of anything I did. When I went in for my micro-d the herniation was large and the surgeon thought it was best to go with the most conservative surgery first. It was great for the first 4 -5 months, then it slowly deteriorated. I am concernced about when I'll be able to return to work this time. Some of the children I deal with are pullers, runners, or will be holding your hand an suddenly drop to the floor. I really love what I do...so I'm hoping for the best!

    Let me know how your PT goes. My left leg is weak too. At my eval. I could barely get my heel off the floor once, it didn't even count. I did get some home exercises, that helps to keep me going in between.
  • The surgeons really do like to do the most conservative first that's for sure. Mine has done two microD's now on the same disc and even though it herniated again he mentioned doing a 3rd microD if the ESI didn't help. I am improving so now we'll see how PT goes.

    I'm looking forward to the evaluation to see how I am doing. Sometimes I just really can't tell until I do something that hurts that is. Today I walked more then normal and my tailbone area was really hurting tonight so I was icing it which helped quite a bit.

    That's great that you are able to go to PT just two months after Fusion. Are you starting to fuse?
  • Not from the burgh,just a big Steeler fan :)
    Ak,you are lucky to have such a great PT and I didnt find your post long,only informative.Thanks
    Im just getting so dam bored with walking, but "I'll keep it up since Doc said thats all he wants me doing till my next appt on Jul 25th 8)
  • I didn't show any real signs of fusion,just some fuzzy threads. My OS put enough hardware in that even if it takes forever to fuse, I don't think that anything will go wrong.

    My eval showed good strength, excpt for a couple of things. And I had relatvely good range of motion. Hopefully that will help. The therapy place I'm going to is the same one I went to when I first hurt myself, and they are really great. They take it slow and easy and check with the doc on a regular basis. And...if I tell them I can't do something they back off until I'm stronger and try again. I can't ride a bike yet and still have leg pain, but I'll work thru most of it, and let up if need be.


    left side bar & screws
    image


    front plate and stabilization bar
    image


    I've been told many times that I'm very stubborn and strong willed....I hope those traits pay off now!

    Let me know how your eval goes. PM me if you want.
    Anna
  • Your hardware looks great. Your PT place sounds good too. I go in tomorrow for my eval. Should be interesting. I'm a bit on edge since my surgeon wants me to try going off of Neurontin and I'm down to taking just 1 today and I'm getting quite a bit of pain in my tailbone area shooting into my butt cheek. I feel like just laying down all day but I walked on the treadmill and I'm going to go to the pet store here with my hubby soon.

    My surgeon wants to do another ESI if my pain increased so I'm thinking about doing that. I'll see how I feel in a few days. I noticed that when I lowered my dose from 3 to 2 a day I had pain for a couple days then too and it went away. Anyway I hope you are feeling pain free today. I'm off to the store hopefully it doesn't hurt too much.
  • Well I had my PT evaluation today. She said my leg strength was good and thinks it's more of an endurance problem when I walk and my calf gets really sore and tired to where I am limping. I was actually able to push myself up 5 times on my bad leg so that's definately improving since I've been walking every day.

    She said they'd have me work with an exercise ball or on a mat depending on how it goes. I have one of those exercise balls that I bought a few years back. It caused me back pain so I stopped using it but maybe I was doing it wrong. I'd really rather do exercises on a mat. I don't feel safe at this point on one of those balls. What do you all think? Do they normally use the exercise balls? I've never been to PT of any kind before.

    Also she set me up for just 5 sessions. Doesn't seem like much but from what I gather they are going to show me how to do the exercises and I continue on my own. So my first PT session is this Wednesday. They are set up for only a half hour. They must not think I need much work.

    They asked me about what restrictions my doctor has set up for me now and I really don't know at this point. I knew what they were a few weeks ago but I'm at 7 weeks since my surgery. My paperwork says a limit of 5 lbs for 2 or 3 months and the PT woman said that seemed low so I called my surgeons PA just now to see. I'm waiting for a call back about that now.

  • Hi Michelle,
    maybe you've done it the wrong way,or it's just not for you.I am in my 3rd wk of PT.My girl hasn't even mentioned the ball yet.If it hurts you,let them know.5 visits sounds sort of short time.Didn't your NS give a script for PT?
    Good luck with it,and I hope it helps!

    Cheers,G.
  • Yes my surgeon gave the script for PT. It's right across the hall from them also. In talking to the PA today they see how I am doing after 5 sessions and if I feel I am not back to my normal functioning then they will approve more PT so I guess we just see how it goes.

    They gave me a workbook to read and from what I got out of it they will be using the C.T.L. S.A.F.E. Method. Then it says the exercise six-pak in the restabilization program consists of 6 basic exercises that work to strengthen the internal back brace. I'll be working up to 200-400 repititions a day. Will I have time for anything else..lol..j/k.

    So that will be part of it then they are going to show me how to safely do certain things with proper posture like laundry for one. She mentioned using a grabber to get the laundry out. I don't know about that I'm pretty happy just having my husband do the laundry :) since that seems to be what took me out this time.



  • Is this 200-400 reps combined for all six or per exercise?If combined,it won't be taking that much time...I think.Hubby will have to do laundry a little longer,hehe.
  • It says with 200-400 total repetitions a day. So that's total between all 6 exercises. If I'm understanding this correctly then it says that these 6 exercises will be incorporated into all functional movements and other exercises.

    It'll be interesting to see what they have me doing. I just hope it doesn't hurt too much.


    Yeah I'm going to tell hubby they said I could never do laundry again... :D ..haha.
  • It will hurt a little,but this is the "good pain".My PT turned the heat up on my a**.My gluts and hips are screaming at me, but hey,if I wake tomorrow and be able to stretch and walk...
    I'll take pain every day.Today I did about 150 reps in 7 exercises,with additional weight.PT said my own weight is not enough anymore.Just after 2 wks.
    Stay focused on it,do it carefully,and you'll be fine!
  • Oh Pete,...good to hear from you again. You make me laugh!!! I am now 7 weeks post op and i was SOOOOOOO bored too.

    Walking only for you bud!!!!! Don't over do it.

    I start physio this week......yikes....looking on how to find a good one, as my last one got me into this mess!

    Happy recovering, i hope you have a lap top.
  • Hey Gogo...my neuro said i could play competitive sport before i could sweep or vaccuum the floor!!! Now thats my kind of surgeon :)

    Actually, shows how tuff we are!

    I was going to ask you.....my surgeon just said go and do pilates.....no further info on rehab......you all seem to have specific instructions to follow??? Hmmmm
  • because mine told me that I'll have to learn my limitations. Aren't you going to start PT this week?Did NS recommend Pilates for the future?I'll give you my philosophy on the issue...I had a PT coming at home.After a 6-7 wks of work with her,I was able to move a little more and get down on the floor for more serious exercising.She asked me if I'd heard about Pi lates.She said these are the same exercises.
    Last weekend my wife dug out a magazine with some Yoga "moves"
    I was doing my PT exerc. when she walked in and said "I found Yoga exerc. for back pain relief".There were 6 of them, identical to what I was doing.So,I guess I am doing Yoga and Pilates....Proud of myself! 8)
    I am sure that you'll find out what helps you most with the help of therapist(an educated one,eh).One thing I can tell you is that I see a huge improvement in my condition after only 6 sessions.Strength,flexibility are coming back.
    BTW,I Googled the Australian Spine Method,nada.I thought you should know about it.You live down under,don't you?

    Cheers,G.
  • Thought I'd add my 2 cents - I'm a PT and am a spine specialist. Backs are interesting - no two cases are ever really the same. As a general rule, however, you should always leave your sessions feeling better than when you came in. And remember, there's more to healing and getting well than just getting stronger (things like restoring muscular coordination and endurance are other important functional qualities to consider). Optimizing healing of the injured or irritated tissues (i.e. nerve tissue, muscle, etc) is also crucial. All PT really does is work with your body to help mitigate pain and provide an ideal physical environment for healing. I wish you a speedy recovery!
    -David
    http://www.moveathink.info/exercisesforlowerbackpain
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