A general discussion on all aches and pains related to the back and related symptomatic areas.
For years, when describing my back issues, I mixed up the terms bulging disc with herniated disc and vice versa. It wasn’t until a neurosurgeon corrected me that I learned that though both conditions deal with disc impingements, each was a separate problem with separate solutions.
Failed back surgery syndrome (or failed back syndrome) is a general term to describe an unsuccessful back surgery. These patients continue to feel pain after they’ve had a surgical spine procedure and can experience a wide range of symptoms which may include chronic pain in the back, neck, or legs, which could be either dull or sharp, aching, tingling, burning, or radiating. In my case, it was a buildup of scar tissue around spinal nerve roots which caused a a considerable amount of discomfort around the surgical area.
With the rise of podcasts as a platform for free-flowing dialogue and discussion, Here’s some of the most informative and enlightening conversations with doctors and medical professionals about the various types of back pain ( conditions / injuries), treatments and new medical advances in spinal care.
Like many people reading this blog, along with bulging discs and Spinal Stenosis, I have Degenerative Disc Disease. It’s hard to pinpoint exactly how this contributes to my overall level of chronic pain, but generally speaking, DDD causes a lot of stiffness and instability. I wake up with an achey lower back, and spend most of my day trying to minimize the amount of bone on bone (vertebrae – L5/S1) pounding it takes.
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.
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.
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.
In a previous post I listed the seven most famous professional athletes to undergo back surgery, and as a followed up I’d like to shine a spotlight on the struggles of Tiger Woods, and his recovery from the crippling backpain that has sidelined his illustrious career.
Here’s a timeline of the spine procedures he has undergone:
April 2014 — Back surgery No. 1: Woods undergoes his first back microdiscectomy to repair a pinched nerve that forces him to miss the 2014 Masters.
September 2015 — Back surgery No. 2: After playing in the Wyndham Championship, Woods undergoes his second microdiscectomy to remove a disc fragment that was pinching his nerve. “I’ve been told I can make a full recovery, and I have no doubt that I will.” Woods is forced to miss the Frys.com Open, Bridgestone America’s Golf Cup and his own Hero World Challenge.
October 2015 — Back surgery No. 3: Woods has a follow up surgery to his September microdiscectomy. From all accounts the minor procedure is a success.
April 2017 — Back surgery No. 4: Woods withdraws from the Dubai Desert Classic in February and announces that he will undergo spinal fusion surgery in April leaving doubts he will compete in the 2017 Masters. The surgery involved removing the damaged disc and re-elevating the collapsed disc space to normal levels. This allows the one vertebrae to heal to the other. The goal is to relieve the pressure on the nerve and to give the nerve the best chance of healing.
May 2017: Woods is arrested in Jupiter, Fla., on suspicion of driving under the influence. In a statement, Woods says alcohol was not involved and he had “an unexpected reaction to prescribed medications.” It’s reported that Woods had 5 active drugs in his system upon his arrest. “The report, prepared by the Palm Beach County Sheriff’s Office, says Woods, 41, had THC, the active ingredient for marijuana; as well as the painkillers Vicodin and Dilaudid; the anxiety and sleep drug Xanax; and the anti-insomnia drug Ambien in his system when he was arrested at 2 a.m. on May 29 about 15 miles from his home in Jupiter”.
The stiff, aching and often burning sensation in my lower spine started in my late twenties and ten years later, when I had my first MRI, it was clear that Degenerative Disc Disease was one of the root causes of my lower back pain.
It’s said that as many as 80% of healthy adults experience some sort of back pain between the ages of 30 and 50, however Degenerative Disc, the loss of fluid in the discs between each vertebrae are padding for the spinal column, and without them every step can send shockwaves through the spine, making healthy living a real challenge. Age, poor posture, and injury can weaken discs between vertebrae, causing tearing along the disc walls.
To treat DDD, many medical specialists first recommend conservative, non-surgical treatments such as physical therapy or chiropractic treatment in an effort to stretch the space between discs and relieve the pressure on surrounding nerves. Manual manipulations on a decompression table can lift and separate discs to ease the strain on the lower back and some doctors may also recommend non steroidal anti-inflammatory drugs to reduce the burning sensation that often builds up when there’s no separation between vertebrae caused by collapsed discs.
Surgical options to reduce the pain of DDD include:
Discectomy: the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by stressing the spinal cord or radiating nerves.
Laminectomy: surgery that creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.
Spinal fusion: a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and prevents any movement between the fused vertebrae.
Lumbar Total Disc Replacement: With artificial disc replacement, pain relief is brought about by removal of the painful disc and motion is maintained with the use of a prosthetic implant made of metal (with or without a plastic bearing surface). This is more similar in theory to the artificial hip, knee, and shoulder joints that orthopedic surgeons have been using for more that 35 years to maintain motion and relieve the pain of arthritic extremity joints. However, there is a significant difference in that only one of the three joints that are present at each vertebral level is being replaced, whereas a hip or knee joint the total joint is replaced.
In recent months, restorative types of treatment have emerged to repair damaged vertebrae discs.
Mesoblast Cell Therapy: All therapies for progressive, severe and debilitating pain due to degenerating intervertebral discs treat the symptoms of the disease, but are not disease-modifying and thus do not address the underlying cause of the disease. This type of treatment involves a single intra-discal injection of 6 million MPCs resulted in meaningful improvements in both pain and function that were durable for at least 36 month. For more information regarding this new therapy, please check out this link.
Platelet-Rich Plasma Therapy: A clinical study of 49 patients who underwent intradiscal platelet-rich plasma (PRP) injections for low back pain found significant improvements in pain and function through two years of follow-up. Dr. Gregory Lutz, Founder and Medical Director of the Regenerative SportsCare Institute, and Physiatrist-in-Chief Emeritus, Hospital for Special Surgery, presented the two-year results at the Interventional Orthopedics Foundation’s Annual Conference in Broomfield, Colorado last month.
It’s also worth mentioning that a recent publication in the New England Journal of Medicine revealed that ‘patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically’.
For simple, home-use products, Dr. Dan Perez outlines a few options and the advantages / disadvantages of each:
Here’s a video describing What Degenerative Disc Disease Is, Causes, Symptoms, Treatments
Other Resources:
In May of 2015, the Sciatic pain down my left leg was so intense that I couldn’t get out of bed for three weeks. I had surgery for a herniated disc (the root cause of Sciatica) at L4/L5 in June of 2015, and here’s an update a year and a half later.
I started playing piano when I was 22, and by 24, I had severe tendonitis on both arms because of poor technique. My wrists were locked, elbows too bowed, shoulders too tight and I basically white knuckled it all the way towards early retirement from the concert stage (I was never really on the stage, but you get what I mean).
