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Conflicting reccommendations from physiotherapists

It's amazing how conflicting can be the views of PTs. The condition is same - L5 S1 herniation - and one reccomends exercises based on flexion (knee to chest) and stay away from extension exercises and another PT just reccomends vice versa. One reccommrnds ice, another heat and so on. So all we have to do isnjust to figure out the rightmones by ourselves. So far, after one year of struggling my sciatica, I can tell that flexion exercises make things worse in acute phase where there is lot of inflammation. I was told that extension (the McKenzie school) eases the pressure on the nerve and should be preferred exercises. And does the ice, that reduces inflammation. On the other hand, doing just extension reduces spine flexion that in turn causes hyperlordosis and other problems. In my case I can do gentle flexion ex-s only in non-acute phase. Unfortunately the last month has been constantly acute phase and only icing and extension helps. A bit. Last week I had an appointment at new PT on the recommendation of a friend and he said that in my case I should consider the surgery but also said that I must prepare myself for the surgery by doing flexion exercises. Otherwise I will have a localized back pain after surgery because of the altered mechanics, although the pain the buttock and leg my resolve. Maybe he's right but how can I follow his advice if increased flexion puts more pressure on the nerve and creates more pain. I tried to do these exercises but had to stop after the third day as my pain increased enormously. So I stopped and turnd back to icing that provides some relief. My own theory is that the pain I have in my low back is not caused by the altered biomechanics (overlordosis) but the lordosis is caused by the disc compressing on the nerve and to reduce the pain I unconciously kee my my back in extended position. That of course puts mor weight on the spine. So, I really dont see any solution exept to hop that my theory is right and after surgery the lordosis improves by itself as there is no pressure anymore on the nerve and I should be able to flex my spine abit more. Anyway, as my condtion is so bad, I'll go for the surgery if the surgeon says that I'm a candidate. I have two friends who have done L5 S1 years ago and live normal life now, so its engouraging. What do you think is my theary plausible or do I live in the dreams?


  • dilaurodilauro ConnecticutPosts: 11,347
    edited 03/17/2013 - 4:29 PM
    before surgery, is your surgeon. Physical Therapists and others mean well, they have a good on-hands knowledge of the body and mechanics. But they are NOT trained to perform surgery.

    Your theory may be sound, I cant really comment. If it works for you, so be it.

    But again, anything you do needs to be run by your doctor(s) for their approval
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
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