Looking for advice - L5-S1 herniation

[yayeti]

I met with a spinal surgeon today regarding a L5-S1 herniation with annular tear. He told me treatment options were injections or disc replacement. I asked him if Id be able to still go to the gym and do squats and deadlifts...he said he wouldn't lift more than 20 or 30 lbs!!!! I was shocked, I really hope this doesnt mean I can't lift weights anymore.

Just looking for anyone with experience in this area.

[K-R-M]

What's your doctors experience with powerlifters?

"There is no evidence that patients need to have activity restricted following first-time lumbar surgery. Although commonly prescribed following surgery, the effectiveness of formal postoperative physiotherapy is uncertain.

A systematic review, including literature published through 2001, found a lack of high quality studies, and insufficient evidence that physiotherapy immediately following lumbar disc surgery is effective, although it did not cause harm [54]. On the other hand, intensive exercise programs started four to six weeks after surgery were more effective than mild exercise programs for short-term improvement in function and return to work, with no difference in long-term outcomes. The components and intensity of physiotherapy ranged widely in the included trials, and an optimal post-operative rehabilitation regimen could not be identified.

A single blind randomized study of 120 patients with uncomplicated lumbar disc surgery evaluated a twelve week course of immediate physiotherapy, compared to sham therapy (neck massage) or no therapy; all patients received education on ergonomics, lifestyle changes and back exercises [55]. Scores for low back pain at twelve weeks were better for physiotherapy than no treatment, but were not significantly different for physiotherapy or sham therapy, suggesting that psychological factors and patient expectations may have influenced outcome. There were no differences between outcomes for any group at long-term (1.5 years) follow-up"

From uptodate, which is the top medical reference.

Your ortho sounds like an school doctor who didn't even bother checking the facts. Get a new one, one with extensive experience with athletes. Take some time before starting doing deadlifts again, but really, go according to feel and make sure every rep is perfect. If you're not feeling pain, chances are everything is fine, just go start low and go slow after your surgery.

[yayeti]

I took 2 weeks off from training and Im looking to make a program with exercises that will spare my lower back. Obviously squats and deadlifts are out so what else can I do?

Chest: Barbell bench and machines are probably ok. DBs prob not because of the stress of getting the weights into position. Dips....most chest exercises are probably fine.

Back: This is a little tricky. I guess I should just stick to machines...any ideas?

Shoulders: side laterals...not sure about shoulder press, I feel like both sitting and standing would put stress on the lower back. Maybe use machines here too

Legs: Does leg press put lots of stress on lower back? Leg extensions and leg curls should be Ok. maybe split squats. Sticking with single leg work might be good.


Unfortunately I dont have good health insurance and can't afford to go to a physical therapist. Any advice would be appreciated.

[Off Road]

Dude, get some medical help and stop relying on internet forums.

[chris mason]

I am no doctor and what I say here is merely relaying my own experience and personal opinion.

First, that doctor is a moron! You need to see someone used to dealing with athletes. They will at least have a more empathetic perspective towards strength training.

Next, I have herniated multiple discs more than once and have gone on to a best to date deadlift of 775 lbs.

I personally rehabbed myself (I can recall the 2nd time best as it was about 5 years ago) using light, high rep stiff-legged deadlifts (1-2 sets) starting about 2 weeks after the initial injury. I would do them 3-4 times per week and slowly increased the loads over time. Once I got back to a pretty heavy load for 20 I began to lower the reps and increase the loads even more. After a few months I resumed light squats and so on.

I would ice the area after every session and multiple times per day. I continued this practice for months. I also took plenty of fish oil.

My goal was to train the involved musculature without making the injury worse. For the first couple of months each set was painful, and when I felt like the pain was getting to a point that I feared might lead to additional injury I would stop the set.

My personal story. My opinion, and I learned this from Louie Simmons, is you begin training the injured area directly (obviously very lightly) as soon as possible. Stressing the area within the confines of not further injuring it will hasten the healing process and or the body's adaptation to the injury.

[Justin Randal]

I lived on the reverse hyper after herniating my L3. hurt at first but definately made a huge difference!!

[Off Road]

I agree with Chris. I've hurniated three disks and squats and all forms of deadlifts have brought me back to a healthy back when the doctor said it wouldn't happen. Luckily for me I had a good PT that introduced me to progressive weight training as part of my rehab.

[yayeti]

Thanks for sharing, Chris. Im trying to rehab myself. Its hard to find someone that works with athletes, I don't really know where to begin. I'm trying to put together a program for myself. From what Ive read, glute activation is super important as is hip motility. I got the magnificent mobility dvd and have been reading bunch of articles by Cressey and Robertson on Tnation.

How did you come up with your rehab program for your back?

[tmor6]

A single blind randomized study of 120 patients with uncomplicated lumbar disc surgery evaluated a twelve week course of immediate physiotherapy, compared to sham therapy (neck massage) or no therapy; all patients received education on ergonomics, lifestyle changes and back exercises [55]. Scores for low back pain at twelve weeks were better for physiotherapy than no treatment, but were not significantly different for physiotherapy or sham therapy, suggesting that psychological factors and patient expectations may have influenced outcome. There were no differences between outcomes for any group at long-term (1.5 years) follow-up"

[B]From uptodate, which is the top medical reference.[B]

hahaha! uptodate is the Wikipedia of the Academic realm. I'm also familiar with the study of 120 referenced, which was rudimentary at best. An average n (50) violates the assumptions of any form of statistical analysis rendering the researchers to rely on basic math (ANOVA and Chi-square) in an attempt to delineate patterns - absolutely worthless. They also use an imputation formula from the 50s to deal with missing data (again, really detrimental considering the same n's). If you do read the report, the first thing they do is caveat their findings with an explanation that their power of analysis is relegated to 80 percent, thus their null finding (p<.05) is already sitting at a value of .75.

As for the point being made, sure it's a possibility - but I wouldn't rely on crack-pot science; something the medical field is notoriously good at.

[chris mason]

hahaha! uptodate is the Wikipedia of the Academic realm. I'm also familiar with the study of 120 referenced, which was rudimentary at best. An average n (50) violates the assumptions of any form of statistical analysis rendering the researchers to rely on basic math (ANOVA and Chi-square) in an attempt to delineate patterns - absolutely worthless. They also use an imputation formula from the 50s to deal with missing data (again, really detrimental considering the same n's). If you do read the report, the first thing they do is caveat their findings with an explanation that their power of analysis is relegated to 80 percent, thus their null finding (p<.05) is already sitting at a value of .75.

As for the point being made, sure it's a possibility - but I wouldn't rely on crack-pot science; something the medical field is notoriously good at.

Short of demonstrating that you understand statistical analysis and thus stroking your ego why would you not write the above in a manner which a layman might understand?

In other words, if you any thought of communicating an idea should you not do so with a thought for the audience?

[chris mason]

Thanks for sharing, Chris. Im trying to rehab myself. Its hard to find someone that works with athletes, I don't really know where to begin. I'm trying to put together a program for myself. From what Ive read, glute activation is super important as is hip motility. I got the magnificent mobility dvd and have been reading bunch of articles by Cressey and Robertson on Tnation.

How did you come up with your rehab program for your back?

I thought of it myself. The thought would be a product of my years in the iron game and thus both experience and reading on the topic.

[Off Road]

My PT started me off with several different abdominal exercises like crunches and sidebends, back raises off a flat bench, and leg curls. Eventually we added deadlifts with a milk crate and as I progressed we would throw more weight into the crate. Once I had all that up to a decent level I was cleared to start using a basic weightlifting program. I was happy to have a knowledgable professional giuding the process.

[tmor6]

Short of demonstrating that you understand statistical analysis and thus stroking your ego why would you not write the above in a manner which a layman might understand?

In other words, if you any thought of communicating an idea should you not do so with a thought for the audience?

Fair enough - first it wasn't intended as an ego stroke (I'm a stats prof), but I figured if people rely on this stuff, they had an understanding of how such conclusions are made - especially people on this forum who are clearly more informed than most of the "bro science" out there. In terms of this article, the authors clearly state their sample size is so low, that representative statistical conclusions cannot be made - something I wished to highlight as these types of discussions seem to reoccur every so often.