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L5 S1 lami and foraminatomy and still can't sit

After 1 year of conservative treatment, and not being able to sit, and having sciatica pain in my left leg, and buttox, and in the "sit bone area", a EMG showed chronic nerve problems at L5 S1. MRI showed severe bilateral foramidable stenosis. On January 15th, 2009, I had a lami, at L5 S1, and a foraminatomy at S1. The neurosurgeon said the compression was severe, but he did not believe the damage would be permanent. I have had many improvements, but still have limited sitting. Hamstrings are so tight, and I work them at least 4 times a day. Piriformis is now at 100%, and I am walking more. I still have swelling around the lower back, and buttox, and I do ice it, and although I have asked for a Medrol pak or something for the swelling, the Dr. wants me to lose the swelling with PT. So, my question is, at 16 weeks out from the surgery, should all of this be resolved, or am I just impatient. From reading the post, I am starting to find out, that the back can take 6 months to a year to feel better, just as the surgeon said, but I just feel that I should be so much better. Did anyone else have pain in the "sit bone area", or groin area, and struggle with the sitting issue. I can only sit for maybe 30 minutes at a time, and not all the time. By 6PM, I am done. Swelling is up, and sitting is over!! Also, has anyone had swelling last this long? The Dr. said some people have swelling for 6 months! :''(


  • You can read my surgery info below. I'm now 9 or 10 weeks post and still have some issues. Today I woke up with a 4 or 5 of 10 pain in my back and right leg to the foot. Its aggravating, but I think the weather is involved. Extreme storms moving in. I can sit longer than 30 minutes but, my tailbone does ache. Try sitting on a memory foam pillow. It helps a lot.
  • Sweet Tater.....I had a foraminotomy at S1 and L4-5....My surgeon told me post op. not to sit in a "straight back" chair any longer than 10-15 min. 3 times a day for at least 2 months....today I went to my first P.T. session....he had me sit in a chair, and he saw that I was "slouching"...he said that "slouching" is the worst thing you can do while sitting, and that it can lead to leg/back pain.....So be sure that when you're sitting you are straight up (even with a slight arched back)...Also when walking stand as straight up as you can...don't rotate your shoulders forward, pull them back.....hope this helps.
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  • To add on to woodysdad's comments: also when sitting, do not cross your legs. Try to keep both feet on the floor...do not cross your legs "like a lady", meaning one leg crossed over the other at the knee. This puts almost all the weight on one side. Also be sure the neck is not forward.

    This is also true if you walk with one or both feet pointing outward. It twists the pelvis and results in improper alignment of the spine.

    Interesting little factoid: Sitting puts 30% more pressure on the spine than standing.
  • Thank you for your comments. Did any of you have pain in the "SIT BONE AREA"? I am not sure if it is referred pain, or something else. Also, after 6 weeks of PT, I have developed severe knots in my legs, which is hindering my recovery. I have done massages, and the both the massage therapist, and the neurosurgeon think PT was way to agressive with me, after being totally laid up for 1 year. Has anyone had the knots in legs after surgery? I do sit on a kitchen chair, straight back. I tried to sit on the couch, and it felt like a knife in the tail bone area. So, I went back to the kitchen chair, but sitting is so limited. I also get burning in the back of the left leg, and most of my knots are behind the knees in both legs. Will this ever get better? Am I being to impatient? Thank you for all your help.
  • Since your surgery was about 4 months ago, it does seem like you should be better by now. However, when you have a flare, it can really set back your recovery.

    I know several surgeons who no longer order PT for their patients because they have seen it cause more harm than good. My current surgeon hired his own PT and has now worked with him for about twenty years, so they are definitely "on the same page." It does sounds like what you went through was too much too soon.

    It may be that you have to kind of go back to the beginning (ie., take it easy for awhile) and just rest and walk for exercise. Then, gradually start adding back some very basic exercises and stretching. Now you will need to let your legs heal as well as your back.

    Do you have access to a warm pool or a place to do aqua aerobics? Walking gently in warm water might feel good and get your legs back in shape. You might want to take magnesium supplements for the muscle knots and gentle massage them several times each day.

    What did the surgeon say about pain in your "sit bone area?" The L5-S1 area has so many muscles and ligaments that tie into the pelvis and buttocks area, like the piriformis muscle, the pudendal nerve, etc. Pelvic floor dysfunction can cause pain such as you describe.
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  • The surgeon said because the S1 nerve was compressed for so long, that sitting would take some time to come back. My piriformis muscle is at 100% and I stretch it 3 times a day. Also do obturator stretch, hamstring, and flossing as to prevent scar tissue. Another MRI showed no scar tissue, hip, pelvic, and groin area, and L5 S1 looked great. He said the swelling was causing alot of my pain, and said that because I had muscle wasting, and nerve compression for so long, it would take awhile for me to recover. He said 6 months to a year! I guess, I'm just not sure what to believe. The pudendal nerve was ruled out, as the only symptom was sitting, and all pelvic things work fine. No pain in that area. SI joint looks good. I do have a S2 perinural cyst, about 1CM in size, but they said that they don't feel that is causing the problem. Is it true that back surgery and nerve healing can take that long, with the type of surgery I had done? He did say it was a severe compression, and he took alot of bone out at L5 and S1. I also have had internal work done, and check out OK. Any other thoughts? I guess I am just looking for some reassurance. It has been a long haul. Thanks!!
  • I forgot to add in my post above that after the comment the Physcial Therapist made about "slouching" while sitting, he asked me what I was doing as far as exercise or activities that I had been doing post op.....I told him I was walking a lot and that I swim every other day (using a snorkel and training fins)....free style is not good because when you take a breath you turn your head which twists your spine)....The P.T. told me nothing was better than walking and swimming for my recovery since I had no "hardware" put in. ...As far as any pain in the "sit bone" area I have have a few "jolts" of pain but that was only while sitting, and it wasn't sustained pain, just short "jolts" (hard to explain)...felt like they came from the area worked on in the foraminotomy.
  • That is reassuring that you have had all those pelvic area things checked out and everything seems OK.

    As spine surgeries go, the one you had is not that complex. But healing is a very individual thing and we all heal at different rates. Yes it is true that it can take forever for nerves to heal. Six months to a year is a common time frame. Sometimes it can take even longer. There is someone on the board who is finally feeling some relief at the two year mark. The frustrating thing is that during this time, you have no idea whether the nerve is just healing slowly or whether there is damage and you're just kind of marking time. There is nothing that can be done to hurry along the process.

    The nerve heals from the source of the surgery outward and most books state that something like 1-4 mm per month is a normal "pace" for recovery in most people. Some doctors will tell you an inch per month.

    When a lot of bone is removed, there is always a chance for instability. But the most likely cause of your pain is the inflammation from the surgery itself, and then from the PT and other daily activities aggravating the situation. When a nerve is badly compressed, the surgeon usually has to tug around on the nerve to free it up. The surgery is a very traumatic process. Nerves are very sensitive and react badly to being handled, so it is no wonder that many of us are still very sore and suffer many of the same pain symptoms after surgery.

    Try not to worry. There is nothing you can do at this point other than to be the best patient you can be! Follow your surgeon's instructions; rest and walk, rest and walk. Hopefully you will be among the majority of patients whose nerve pain symptoms resolve sooner or later!!

    Hang in there.

    xx Gwennie
  • I haven't had surgery but understand the coccyx pain. That is referred pain my Dr says and the epidurals I've had have helped that pain. I also use a ball to loosen up those muscles. I did have a coccyx cushion for sitting with a gc shape cut out so when you sit you're off your butt. I just wanted to ask what do you do for flossing? Maybe it's somewhat what a excercise ball does? I hope you have less pain soon. Did you have another MRI after the surgery? Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Hi, for the flossing, I sit in a chair, back straight, and do 10 leg raises in each leg to keep the nerve moving. Other people have also done this, as it does keep scar tissue from forming. On my MRI 3 weeks ago, they say no scar tissue, and I have been flossing since 5 weeks post-op. I guess I need to be patient, but so want to sit. I can sit better in the AM, when the swelling is down, but supper time on, swelling is up, and sitting is gone. :''( I so want my life back. I have gotten such valuable information from this forum. Thank you so much to all of you that have responded. It helps to not feel so alone, and to hear about others who are going through the same. Do any of you feel that to judge the success of your surgery, how you are in the early part of the day, is a good judge as to the outcome? Someone told me that, and wondered your opinions. Thanks again.
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