My wife had a lumbar discectomy 2 years ago and even though she is no longer suffering terrible sciatic pain I would say that she is far from sorted. I am real advocate of core strength / posterior chain exercises and keep trying to educate her that lower back pain is most likely down to a really weak core / glutes and tight hip flexors resulting in anterior pelvic tilt …

Now, not being a physio I could be talking complete b!llocks, but I really want to help her get her back sorted out. She has PT once a week (when her back permits and isn’t sore) the PT guy is also at a loss of the best way forward.

Anyone have any recommendations as to the best way forward. She is petrified of having back surgery again so that does not help matters.

Had double microdiscectomy (L4/L5 & L5/S1) in 2014. Didn’t do much in the way of strengthening in the year following, and suffered for it. Since then I’ve got a small program that I follow, put together by a physio who is accredited by the Australian Physiotherapy & Pilates Institute (APPI). It basically involves core strengthening using modified Pilates movements. Made a huge difference in my mobility / life in general.

I say modified, because a number of Pilates movements/holds are not suitable for post-surgery and more severe back injury cases, so it is designed with these patients in mind. The PTs are first and foremost physiotherapists, so there’s nothing hocus-pocus about it.

I’m based in NE Scotland and there are a few APPI-registered physiotherapists up here, so am sure there are a fair few wherever you area in the UK, especially SE England if that’s where you are.

Had double microdiscectomy (L4/L5 & L5/S1) in 2014. Didn’t do much in the way of strengthening in the year following, and suffered for it. Since then I’ve got a small program that I follow, put together by a physio who is accredited by the Australian Physiotherapy & Pilates Institute (APPI). It basically involves core strengthening using modified Pilates movements. Made a huge difference in my mobility / life in general.

I say modified, because a number of Pilates movements/holds are not suitable for post-surgery and more severe back injury cases, so it is designed with these patients in mind. The PTs are first and foremost physiotherapists, so there’s nothing hocus-pocus about it.

I’m based in NE Scotland and there are a few APPI-registered physiotherapists up here, so am sure there are a fair few wherever you area in the UK, especially SE England if that’s where you are.

Thanks for that. There is a APPI registered physio not far from home so I will have a look into it and get in touch with them.

Good to hear that you found it very beneficial to your recovery. It seems a real minefield out there regarding the best way forward in terms of recovery.

I have managed to avoid surgery, but suffered two prolapses. Following the second one I visited a private physio who worked hard to work with me on strengthening my core, treatment of general muscle weakness and totally addressed my life including introducing more swimming, sit-stand deals, breaking up long car journeys. I visited her for about 6 months at different periods. Since then I have a much better core base and can self manage with home physio and attend a weekly physio led Pilates class. I occasionally return to physio for a massage to manage soft tissue flare up and am prepared to take pain killers earlier so I can keep mobile. If you can afford it, a world class physio (the various ones I have seen work in international sport etc) are worth their weight in gold. It might also take a rethink of life as a whole too.

If you are NE or Yorkshire based I can recommend a couple of places.

Farmers walk or loaded carries, slowly building up the weight carried, always do these type of exercises with a neutral spine, she’s got to want to help herself to really benefit.
These need to be done three times a week, whether she’s in pain or not, needs to grit her teeth and get it done.
I’m not qualified in anything, but i do know how to get good core strength and it doesn’t include doing any crunches.

Core strengthening exercises.

Yoga and Pilates sorted me out. But it’s constant work, not a quick fix.

Seek out a physio that will work with you to tailor your exercises to you. Not a random fitness instructor or a physio that just pulls you about.

An important thing is to motivate her to do the exercises regularly, they’ve gotta become part of a daily routine. I am my own worst enemy sometimes where I lapse in my exercise frequency, and only get back to them to sort out the pain that inevitably makes a big comeback.

Regarding loaded carries, squats etc, these are some of the best core exercises one can do, but for someone post-surgery can create major issues. Microdiscectomies involve removal of disc tissue, meaning the adjacent vertebrae are often much closer together, leading to facet-joint arthritis. This is present at a low-ish level for most patients, but upper-body carrying exercises (which cause disc compression) can exascerbate things significantly.

In a nutshell, focus on physio-directed core strengthening such as the APPI programmes, along with mobilisation exercises. Hope she feels better. It’s a crappy hand to be dealt, but at least it can be managed with a bit of effort and discipline.

Obelix, fair point, but surely a suck it and see approach would be best, the problem with core strengthening with pilates and yoga type exercises is that is doesn’t significantly strengthen the connective tissue or impact on bone density.

Strong muscles propped up by a crumbling skeleton is not going to end well.

The key here is a gradual build up over a long period so the body gets chance to addapt.

Word of caution but doing the wrong exercises can cause more issues than you started with I would of thought.
In the past after suffering serious injuries on shoulder and back I was told that doing core work was out of the question until I had built up specific strength in targeted muscles as the wrong excercise could cause a imbalance and do more damage.

Personally I would get a second opinion from a different PT as I would be a bit skeptical if one told me they were at a loss.

In the circumstances I’d avoid doing core exercise without her reciving specialist direction. It would be too easy to generate further damage.

I agree about needing to support her to do the exercises she will be given every day. For me, I normally do mine watching the 10 pm news!

Twinw4ll, agreed, there’s definitely a need for impact-based activities to strengthen connective tissue and bone. The core strengthening poses/movements are just one part of what needs to be done.

Stuart McGill (Canadian professor specialising in spinal injury research) reckons that for those with moderate-severe disc injuries, brisk walking with an exaggerated arm swing is one of the best things one can do. It covers both core strengthening and provides a significant level of impact without putting too much compressive force on the discs.

Note that the above is for people coming from a fairly low starting point, as someone a year or two post-surgery and still struggling would be. Following this, progression towards loaded carries, squats, etc could be made, but only under supervision of a physio, and preferably one experienced with back rehab. In some cases such a progression would just not be appropriate.