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 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

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

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.

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)

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... ..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!

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

Well today I learned how to contract my Transverse Abdominal. It was challenging to isolate contracting that muscle. I have sets to do a few times a day and I'm supposed to have it down by Monday and then I learn how to do exercises with that muscle contracted. Then I also have some stretches to do.

I just got back from my walk and I noticed that my spine feels way more stable when I walk with it contracted so I must be doing it right. I think I'll put some ice on my back now. I'm just starting to get some weird feelings in my back. Not really pain yet. It'll be interesting to see how I feel tomorrow.

In learning this I can see why my disc reherniated again after 3 years. I wish I had known this stuff before. It was after my hysterectomy and I was doing everything I could not to use my abdominal muscles while doing laundry so totally putting my disc at risk by not supporting it with my TA. How stupid is that now in hindsight which is always 20/20. At least I am learning this now.

It is really tough though to isolate that muscle. I have the hardest time when laying down trying to contract that muscle. I'll just keep working on it until I get it right. By the way I feel really good tonight. I just got back from a bike ride on my mountain bike with hubby and I was feeling pretty good. All of my walking and walking is really starting to pay off too. My legs felt really strong tonight on the mountain bike and I didn't have any back pain while riding.

Anna, I was wondering when your first day of PT was . I hope it all goes well.

Mchell:

I wouldn't use a reacher to do laundry, especially this early...

I've got a reacher, but I can only use it to pick up things that are extremely light. (Like pieces of paper)

Laws of physics cause the weight of whatever you're trying to lift with reacher to weigh a whole lot more.

I'm glad that you were able to activate your TVA. Now, were you able to activate while you were walking or just while exercising?

I find that when I learn something in PT, I'm able to do it while I'm exercising, but tend to forget while I'm going about doing daily activities.

That's the challenging part, putting it into real life.

Linda Age 51
DDD since who knows when.
SIJ joint dysfunction.

Fibromyalgia
Congenital Spasticity

IDET L4-L5, L5-S1 2002 for annual tears and discogenic pain
Current MRI (May 2008) Herniation L5-S1 3mm Anterior to Posterior 1 cm across left lateral recess
L4-L5 broadbased protusion

EMGs Polyphasics Peroneal, Ant Tibs, Gastroc with Silent Paraspinals

Have had burning red feet for the last 18 months, which left me unable to wear shoes or exercise. Lack of exercise probably ruined my back.

Meds: Too many.

I've been able to activate my TVA while walking. Then I also do my sets each day of contracting the TVA while laying down and sitting and standing. I also try to activate it while getting up out of a chair. Sometimes I can do it right and sometimes it doesn't feel like I'm doing it right. She hasn't given me any exercises yet to do, that will be on Monday.

I'm starting to get pain like a hot poker stabbing me right above my tailbone and below my incision. It's the nerve being irritated. I am not sure if it's the stretches or contracting the TVA muscle that's making it hurt. My PT did tell me any new movement would increase pain.

I'm going to stop trying to contract the TVA constantly I think I overdid it yesterday I just kept trying and trying. I'm going to cut back to just what the PT said to do was my sets 3 times a day. I'll do those and then let my PT show me how to do it properly during exercising on Monday just to make sure I'm doing it right. The stretches she is having me do are probably irritating the nerve also. I can tell they really stretch my legs and back out I feel all wobbly after I do them.

Thanks for the warning about using a grabber to do laundry. That does make sense. I'm actually to scared to even attempt laundry still. I'd like to get a front loading washer and dryer that sit high up. I hear that's the safest way for someone with back problems to do laundry.

Well I'm going to go look for one of those gel packs at Walgreens that I can freeze. They have one that comes with a belt type thing so you can strap it in place on the back. I've been using frozen peas and it's hard to hold those in place.

the easiest way to try and work on TrA (transversus abdominis) is to lie supine (on your back). bring your knees up so the soles of your feet rest on the floor and let your back relax in whichever position it remains, there may be a small gap or no gap...dont try and push it into the ground. take your index fingers and put them on the bony point at the front of your hips, then come about 1 inch inside this (towards your belly button). having your fingers there will help you know when you are firing your TrA. if you give a small cough you will feel the muscle contract. when you try and consciously contract the muscle you only want about 30% of your strength. effectively you are trying to draw your belly button to your spine - do not push your back into the floor as this is no a TrA exercise. now hold that contraction for ~10 seconds. important is that you should still be able to breath through your tummy and relax your shoulders - if you cant you are using your more superficial abdominal muscles not your deep abdominal muscles. once you've mastered this you can try it seated and standing, the same principles apply. once you can do these, you can start adding small movements into it.

i am interested to read about the australian spine study. i have googled this and cannot find anything on it? i am well read on the subject and have worked in the industry for a number of years. interested to read more if someone can point me in the right direction...

thanks

Very interesting article. Thanks for posting that. So far I'm just working on the TA muscle. I got paperwork from PT that talks about the other spinal stabilizing muscles also like the deep lumbar multifidus, and the posterior fasciculus. I wonder how she'll have me work on those. This is challenging to say the least. It's not like I can just do some stomach crunches. There is a lot of thought that goes into the movements. I'm starting to really get the TA contractions down now. I am already doing it just automatically when getting up out of a sitting or laying position. In the paperwork they gave me here it says to hold contraction for duration of the following activities.

Reaching, Lifting, Positional changes/Forward Trunk Lean (sit -> stand, getting out of bed, washing face etc.)
Push/Pull activities (i.e. opening and closing doors including car doors.

The hot poker feeling in my tailbone is going down quite a bit. I only got it twice today. Part of it may have been trying to quit neurontin. I am down to only 1 300 mg capsule a day and I tried to go without it yesterday. Now is probably not a good time to be doing that with starting PT.

I am definately improving. Just a few days ago driving to two stores my left side really started hurting when I took a right turn and then hurt the rest of the night. Today I barely got any pain doing the same things. It's still there but less.

thanks for that, i am very familiar with richardson, et al., just had never heard it termed the australian spine study.

good stuff on the PT, you sound like you are doing really well!

Pmazz:

Thank you so much for posting this article.

I find the info about local stabilizers extremely helpful. I have found that that "little things" hurt more than "big things". For instance, I can dig a hole in my garden, with little pain, but staking a plant, is next to impossible. This article seems to explain it.

I wonder if weakened posterior fasciculus of the poases is one of the reasons for sitting pain? (Another example of a "little thing", that is a "big pain") Both sitting and staking a plant require very little global strength.

I wonder how calf muscles play into things?

Can someone tell me more about doing stretches. My PT has me doing these nerve glide stretches where you lay on your back and raise one leg up as straight and as high as you can with the other leg laying flat on the floor or bed in my case. Then you hold the leg with a belt or sheet or something around the back of the thigh and as it's held up as high and straight as you can get it you pull your toes towards your face. What is this supposed to feel like.

They have been causing me nerve pain and I think that's what gave me those jolts in my tailbone area. Last night I was feeling more flexible and pulled back a little further and could feel the nerve gliding in there and WOW last night I had that hardest time sleeping I was in so much pain. Both of my feet hurt even. I think I really over did it. I was putting ice on my back as often as possibly safe and ended up having to take another neurontin.

Also my feet felt numb as I was doing the nerve glide stretches. Is this supposed to happen. The PT when she was stretching out my legs the first time I was there I had the same foot numbness and she made it seem like that is normal. It is really irritating my nerve though to stretch this much. Today I'm being way more gentle. Not sure if I'm even getting the nerve to glide but it just hurts so much.

I'll have to ask my PT on Monday about this.

Mchell:

It is easy to overstretch hamstrings when nerves are inflamed.

However, since you are recovering from surgery, you are probably even more vulnerable.

Some of the other members who have been through surgery can give you much better advice.

I just wanted to let you know that you aren't alone. I've overstretched mine.

Thanks, at least I know my limits now. If my feet go numb while doing it that's bad. In reading more about it there's only supposed to be gentle resistance and to not push past that resistance which I did a little bit. Sure hurts doesn't it overstretching the nerve. or the hamstring I'm confused about all of this. Does doing this just stretch the hamstring muscle or does the nerve stretch also? Anyone who knows anyway.