Rehab after discectomy, + Degenerative disc disease.

[Will S]

Been a loooooooong time since I've been around here.

22 year old male, right-side discectomy L5-S1 (+Laminectomy, neurolsys, etc), and degenerative disc disease in L5-S1, and L4-L5

Prior to injury i was powerlifting with a 230kg deadlift, and could press a 48kg Kb over head for 2. I only just started training squats, and thats what did me in. (poor form, and upping the weight fast - I did 3x170kg after only 6 months squatting). I was 105-110kg, 6 foot. Now around 92kg from inactivity and not eating like a horse.

Long story short, about 14 months ago I bulged a disc in my back (sciatic symptoms, etc), and stopped training under instruction and tried all the conservative treatments i could to correct this. Got progressively worse for a couple of months (6 Panadene Fortes a day to just manage, I'm very anti-drug), and eventually started to correct itself (still pain, and unable to do anything seriously physical, but i was sitting and working and attending uni). I saw a surgeon in this time (Dr Ian Farey), but i was very anti-surgery, and i was getting some results from my conservative treatments.

For about 6 months it chilled at "painful and annoying, but i can live" and still could not train, etc and had horrible range of motion in right leg). Mid July 09, I stood up from the couch and fell to the floor in agony. We still don't know how, but i burst my disc. I was numb from the mid-shins down, and was unable to stand/move ankle without extreme pain (bed-ridden). 1 week later I was under the knife (took a week to get voltaren out of my system so i could be cut upon). Surgery Aug 5.

I am yet to have a follow up appointment with Ian Farey, but it will be soon.

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I have heard many and varied responses to what my rehab should be, and what my limits are from now on. Ian Farey really doesn't seem to give much though to post-surgery, and really doesn't care what I do, as long as i stay away from pilates and 'weights'.

I have been given many different reponses to what my physical limits should be, which are all quite disheartening.

Ian Farey - never, ever, ever, ever, ever lift more than 10kg again. (This scares me).
My Rheumatologist - said i'll be able to build up to 30/40kg in a couple of years. But he quickly bailed and changed his mind after Farey said 10kg (with no explaination, and i am unsure if he is overly 'playing it safe').
Chiropractor - Regardless of what you or other people may think of them, I respect this man highly who agrees with the 30/40kg prescription after a couple of years.

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Big message, but that's it all.

- What type of rehab should i be looking at?
- Can you recommend anyone in Sydney?
- What, in your opinion, are my 'limits'? (And I'll understand if you are unable to comment).

I'm quite scared of the 10kg limit, the 30/40 i can manage with. You can do a lot with that weight.

Thanks!

[abowe]

Hi Will

What a terribly sad and unfortunate story. I am in no way qualified to give you any advice on what you should do in your rehabilitation. Back rehab is exceptionally complex and contentious. Think of what follows as general support for your difficult situation.

For what its worth, in the short term I think you should take your time ( patientience) and listen to your surgeon. Use the time to read widely from repuitable scientic and medical peer reviewed journals. In addition read other relevant accounts of other peoples injuries and their rehab. Follow your physios rehabilitation advice.

Regarding arbitrary statements like never ever lift weights again or pick up anything above 10 kgs, I don`t believe that these statements are particularly helpful in the longer term. In the shorter term they are a forceful reminder of the severity of your injuries and the importance of a cautious and educated approach to rehabilitation. But in the longer term ie 2-3 years it is to difficult to speculate whether this will still be the case. At all stages listen to your body and rehab cautiously but incrementally.

There are many examples of people being ruined by this type of injury and their are also many examples of people who have bested these challenges. No matter what the experts say to you regarding what you may or may not be able to do in the future you must maintain a focus on your own goal, and an ardent conviction to returning to some sort of regularl physical practise.

Good luck!

[VictorVondoomPhD]

Hi Will,
I'll get back to you with a more expansive response perhaps tomorrow. Yes, to be given a 10Kg lift limit really does not tell you much.

When you walk down the street and step off a curb there will be greater forces applied to the spine than to stand and pick 10 Kg off a table keeping the weight close to your centre of gravity.

It also begs the question. What happens if you put on weight? If you put on 11 or more Kg of bodyweight, then what is the difference to having to lift more than 10Kg once?

So it may be worth us putting together a questionaire sheet for you to fax or email to your surgeon. Sometimes a better way to get a response.

Glad to see he distains pilates!

Should be back to you later tomorrow.

[Will S]

Thanks guys,

Abowe, I am taking the injury very seriously, and I would definately not do anything i reckon do any sort of injury.

Victor, you are preaching my sentiments exactly! The surgeon, who is very unforthcoming with advice or anything post-op, answered some quick questions, etc, and even stated i could do basketball as an example. I asked wouldn't jumping up and down place more load than 10kg?

As for the bodyweight issue, i had that exact conversation with my Rheumatologist (when he was on the 30-40kg after 3 years bandwagon, not after he jumped ship to 10kg), and i asked, "sooooo, if i drop 10kg in weight, can I lift 20kg?" and "Ya know, from the waist up, my body weighs 40kg, 10kg seems a little crazy".

I see the surgeon this Friday (6 weeks post-op). But i doubt i'll heavily discuss these things. He really does not like having anyone question his assertions, even if you arn't arguing, but just clarifying points. He is the "startest guy in the room", and can not handle otherwise. Amusingly, if you try to insinuate "i know a little bit about physics" and how weight on chest, as opposed to weight at arms length are vastly different, he immediately changes the topic to "what was your UAI? what are YOU studying? Yeah, thought so, I'm a surgeon. *smug look*" (and he is a damn good surgeon, some say the best in Aus, but he goes in loops or off topic when you question the physics of 10kg).

hmm... this may be getting a little slanderous, but the conversation goes in this direction all the time. :(

I'll shut up now.

[Rick]

Good luck with it Will.
With your knowledge and help from guys like Andrew Lock, you'll be sending vids to your surgeon with you bent pressing the Bulldog in due time!

[Paul in Hobart]

Hey Will , sorry to hear of your suffering, but I am confident you have the right mindset to overcome the "bleak" outlook of your cutter. You know , surgeons tend to like the saying "you only heal with cold steel" .As it happens , I dont know of any who lift weights , seriously - most are confined to treadmills or bikes or the pool.

Dont forget Valentin Dikul...
Keep the faith and keep the muscles full of blood, strong & supple. You have your whole life ahead of you. Good luck mate!

[stoyan]

Hey Will, I feel for you, that's serious and keeping off the iron is even worse. I just had my wisdom teeth removed and it's killing me that I haven't been able to touch weights for over a week. Remember though that you can still train your mind and keep the neuro-muscular connections alive and fresh by visualising yourself doing all the lifts.

I think that Vasily Ginko said that he had a discectomy and yet he is still very impressive in GS. Paul, Eugene or Yelena may have more details on what his operation/condition was.

I hope you find a solution soon.

[vikk]

Hi Will

I'm 33 yr old guy with a similar story ... long term disc degeneration L5/S1 - very painful for last 3 yrs, with few, brief periods of relief, managed to stay active (martial arts, lots of yoga/pilates, occasional run/swim, and some weights training 3-5 times a week) despite the pain. Things got worse 7 weeks ago after I had a bad case of whooping cough pneumonia after which I developed the neurological symptoms that come with badly herniated lumbar discs (leg weakness, numbness, twitching/spasms) as well as much more severe pain. So I sure can empathise with what you are going through.

I had an L5/S1 discectomy last Wednesday (still enjoying the hospitality, and narcotics, at north shore private actually), and used the same surgeon. I specifically asked him the 10kg question yesterday - he said I may be able to lift weights greater than a few kg at about 6 weeks, building up to 10kg by no sooner than 3 mths, and if all is well, greater weights after. He did say (and I've had other surgeons confirm this) that my days of challenging weights sessions are over - light weights and muscle toning exercises after the 6 mth mark, limited to exercises with a fully supported back (another surgeon said bench presses might be ok, but definitely no leg exercises with weights). I'm guessing Ian's had more time to think over the 10kg question since you put it to him last - would be very interested in hearing what he said at your 6 week post-op appointment.

As the surgeons seen what your lumbar spine looked like (and Ian does have an excellent reputation), I'd follow his advice exactly for the first 6 mths, and then find someone with practical experience of longer term rehab from discectomies (lets face it, most surgeons don't). I've been looking for someone (mostly osteos, physios, chiros) for a while and would be happy to share names/experiences if you are interested. I suspect the long term outlook is not as bad as the surgeons make out, and they set conservative expectations so that we are pleasantly surprised if things work out well, rather than the other way round.

I struggled with communication with this surgeon too, then got some good advice from friends that had a little more experience dealing with hot-shot medicos than I have. Happy to share/discuss if you like.

Hope everythings gone well with your post-op rehab so far Will - wish you all the best for your recovery. I'm still having doubts about having had the op, but its only been a few days so too early to tell really ....

cheers
vik

[Will S]

Vikk,

I saw him Friday. He pretty much repeated the same mantra of 'no more than 10kg', but also there was also a slight (very slight) air of acknowledgment over 'you are not an invalid, get out there are move'. Perhaps he was very more stern as I have 2 degenerative discs, and I am young. Being 22, and accompanied by my mother (they're payin' for it all/insurance, and i am still under their house), we did most of his talking down to me. Actually may have been better if she wasn't there, as every question i asked was accompanied by the 'adult-to-adult glance' between them with the 'oh kids, they'll never understand' look.

Overall, he was very evasive about clarifying, and whenever I asked a logical question like 'reverse loading' on the spine (Weighted pull ups, etc) he got angry and said "No weights!". I probed further, explaining that, for example, if i had weights on my ankles and pulled up, there would no direct weight upon the spine, he merely gave a puzzled look and asked "why would you add weight to a pull up?". Generally went in circles and it typically ended in him ending the conversation with "You're not going to be Mr Universe". Damn that was such a stupid answer, but we eventually had to move on.

His exercise prescriptions where treadmill and swimming. Didn't really answer stuff on bodyweight exercises. Due to his recommendations, I will definitely be seeking specialist advice (Victor Vondoom, i understand you are busy, but I hope to hear from you!).

More importantly, as for my health:

- Still avoiding twisting or lifting anything sizable.
- After a year of atrophy, and this is more a shameful depiction of those i know, i am still one of the most muscular people in my friend circle. But i am weak though.
- Got a gut. :( But i had one when i was 105+kg. I am just know where near as broad in shoulders/arms though.
- Relating to above, still basic body make up, Skinny weak upper body, behemoth from the hips down. 1 week training, and did over 1000 bodyweight squats over 1 day last week. Cycling up and down in 400-800s of reps each day. Endurance + bodyweight is boring.
- My push ups are lame, but i am working them. Like, really lame, I have my arms raised.

I am thinking on buying rings, they are also on sale now... These will be good for variation in pressing movements, and levering(nothing drastic, just like flies, etc). Also, i fear my pull ups are almost non-existent, so I will be able to work up with them.

So... Now i just play the patience game.

p.s: Vikk, I was also at North Shore private. Don't go overboard with the narc (I actually didn't really touch them, which they were uneasy about), and if they offer you endone 2x5mg after they take the drip out, prepare a surreal experience. 1 + panadol was much easier to manage. Also, on your menu, select the prunes. Thank me later.

[vikk]

yeah, prunes are important - thanks for the reminder!

just curious - how are your symptoms now (6 wks post op?). sounds like you're pushing yourself quite a bit already. did it a take a while for things to improve?

vikk

[Will S]

You are probably feeling it now, in the muscles of your lower back. They faded, um, 2 weeks? Depends on how you move.

Remember to do you walking, and those really piss-weak physio exercises. But walking was the key for me. I strapped on an ipod and was walking 20minsx5 within 2/3 days of hospital, and 30x5 under a week. Your mileage may vary.

Walking always made me feel better. <------

I started training a week and a half ago. Just push ups and squats. Right now, i feel decent (in health, not fitness). I am very inflexible in the hamstrings, simply because i haven't been able to lift my lift my legs in a long time.

I only feel the sciatica lightly behind my butt and pins and needles on the back of my heel if i push a stretch a little too far. Farey says this is to be expected.

Frankly, the primary feeling now is a feeling of constriction. I want to do more, I feel i can do more, but i know i am not allowed/shouldn't do more. Sucks.

[macrylinda1]

Good luck with it Will.
With your knowledge and help from guys like Andrew Lock, you'll be sending vids to your surgeon with you bent pressing the Bulldog in due time!

Hey Will , sorry to hear of your suffering, but I am confident you have the right mindset to overcome the "bleak" outlook of your cutter. You know , surgeons tend to like the saying "you only heal with cold steel" .As it happens , I dont know of any who lift weights , seriously - most are confined to treadmills or bikes or the pool.

Dont forget Valentin Dikul...
Keep the faith and keep the muscles full of blood, strong & supple. You have your whole life ahead of you. Good luck mate!