Discectomy Pain

Tag - failed back surgery syndrome

Stu McGill’s Big 3

I first heard about Stu McGill on a podcast about the rehabilitation of high-performance athletes.  He was describing how some world class performers trained to get back into top form after injury.  He was reaching peak academic nerd-speak with ‘muscle activation’ this, ‘motor pattern development’ that, when he mentioned his “Big 3” for the everyday back pain sufferer.  My ears perked up as he distilled all physio stretches into just three simple exercises.

As a professor and researcher at the university of Waterloo (Canada), McGill is an expert in the field.  At his Spine Biomechanics Laboratory, he focuses on a few core objectives involving how the back functions, how it gets hurt, and how to fix it and prevent further injury.

The four quadrants of muscles that support the spine are the rectus abdominus at the front, the obliques at the sides and the extensors at the back .  As McGill states, ‘true spine stability is achieved with a “balanced” stiffening from the entire musculature’ within the load tolerance (pain threshold) of each individual.  The “Big Three” exercises strengthen these muscle groups and help to increase endurance during lifting, pushing or pulling.

Remember to never over-exert yourself doing these movements and if pain persists, please check with your physiotherapist to ensure that proper form is being used.

Stu McGill’s ‘Big 3’ Exercises 

1.  Modified Curl-Up
Laying on  your back, one knee is bent and one knee straight. Your hands are placed under the arch of your lower back and begin by bracing your abdominal muscles and bearing down through your belly. While keeping this brace, breath in and a breath out. With your spine in your neck and back joined together, pick a spot on the ceiling and focus your gaze there, lift your shoulder blades about 30° off the floor and slowly return to the start position.

2.  Side Bridge
Laying on your side, prop yourself up on your elbow with your elbow directly under your shoulder to avoid straining.  With your legs straight, place your top foot on the ground in front of your bottom foot. Place your top hand on your bottom shoulder – be sure that your upper body does not twist or lean forward, brace abdomen, squeeze through your butt muscles, and lift hips up off the ground. Hold for 8-10 seconds, repeat 3 times. As the exercise becomes easier, increase the number of repetitions as opposed to the length of time.

3.  Stirring the Pot
This exercise starts on your hands and knees,  with your hands shoulder width apart directly under your shoulders, and knees hip width apart directly under your hips. Brace through your abdomen and squeeze your gluteals. Ensure you can maintain this while you take a breath in and out. Lift your right arm in front until it’s level with your shoulder, squeezing the muscles between your shoulder blades as you do so. At the same time, extend your left leg straight back until it is level with your hips, squeezing your gluteals, and keeping your hips square to the floor. Return to the starting position in a slow and controlled manner, and perform the same action with the left arm and right leg. That is one repetition. Perform 3 sets of 8-10 repetitions.

 

 

McGill also advises full-time desk jockey’s like me, who have a ‘flexion intolerant back’ to not focus on range of motion with back exercises.   His Big 3 have just as much to do with which exercises you shouldn’t do, than with what you should do.  McGill makes us keenly aware “that the spine discs only have so many numbers of bends before they damage”.  In a nutshell, he bluntly states that it’s better to do less of the thing that’s hurting you, flexion in many cases, rather than take medications to treat a strained back, or worse, protruding discs.

As always, check with your health care expert before attempting these exercises to prevent further injury…and take care.

 

Pain After Discectomy Surgery

The most commonly searched term on this blog is “pain after discectomy”.  So I’ve decided I would dedicate a post to this topic based on my personal experience and some recently published articles and videos.  This is by no means an exhaustive search for all that ails us after a discectomy, but I’ll do my best to provide relevant information that can answer the most common concerns regarding the types of pain some of us experience after undergoing this procedure, and possible treatments.

A discectomy is the surgical removal of the whole or part of an intervertebral disc that is often pressing on a nerve root or the spinal cord.     The procedure is most often performed by a qualified  orthopaedic surgeon or neurosurgeon.

Inflammation: 

One of the most common issues after surgery is inflammation especially at the incision point. Even minimally invasive, arthroscopic surgery will irritate some tissues and nerves and during this process inflammation can persist.  Most physicians will suggest over-the-counter medication to control and reduce inflammation.  I was sore for about a week and as you can see here, there was still a bit of puffiness around the 1″ incision.

Epidural Fibrosis (Scar Tissue): 

Sometimes after a discectomy, scar tissue forms near the nerve root and can cause extreme burning or nerve pain even if the surgery was successful in relieving the initial pain.  This type of postoperative pain is commonly called failed back surgery syndrome because you’ve swapped out one type of pain for another.

As Spine Health points out “Scar tissue formation is part of the normal healing process after a spine surgery. While scar tissue can be a cause of back pain or leg pain, in and of itself the scar tissue is rarely painful since the tissue contains no nerve endings. Scar tissue is generally thought to be the potential cause of the patient’s pain if it binds the lumbar nerve root with fibrous adhesions.”

Numbness:

After my last surgery (discectomy at L4/L5), I experienced some tingling and general numbness in the areas where my Sciatic pain was the most intense (bottom tibia/ankle and toes).  Months later a EMG revealed that I had permenent nerve damage caused not by the surgery but by the constant ‘zapping’ of the Sciatic nerve, pre-surgery.  Those who have had Sciatica know the feeling of this type of excruciating nerve pain which most likely deadened some areas on my leg and foot.  Here’s several accounts of other patients going through similar foot/leg numbness.

Aches / Spasms: 

Post L4/L5 discectomy, as the nerves began to heal I had a mild ache in my leg around the site of the sciatic nerve shocks.  I was told by my surgeon that this wasn’t uncommon and was caused by the nerve trying to repair itself.  Massage therapy can help with the aches as muscles can sometimes tighten from being inactive and without any type of stretching may lead to issues such as piroformis syndrome.

Re-herniation:

Current research suggest that there is a 2-18% chance of re-herniation dependent upon the size of disc defect as well as other factors such as disc height, pre-surgery.  It is most likely to occur in the first few weeks after surgery, and it’s strongly discouraged to lift anything heavier than 3-5 pounds during this period.  As this research concludes, there are no hard and set rules that make it more likely for re-herniation, however my personal suggestion would be to not strain yourself within the first 2-3 weeks and when ease into a work schedule rather than full-time duties with no easing in preparation.  Post surgery is also a good time to re-examine your sitting posture and to explore other options for working at a desk.

 As always, consult a doctor if you are experiencing discomfort and take care.

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