Microdiscectomy Recovery (Please help!)

Hey,

I'm 22 years old male, 195 cm , 93 kg from Sweden. I injured myself really badly doing squat in gym and it showed to be a severe L4-L5 disc herniation which left me with no other option than surgery. I had no low back pain before surgery but a really bad sciatica pain which disappeared right after surgery and now it's been like 7 months and i wanna go back to gym. I know that i should contact a physical therapist but i live in a relatively small town in Sweden and I've already been in contact with 2 different physical therapists but i don't feel like i can trust them at all. I contacted my surgeon before visiting these physical therapists and he told me three things to keep in mind. 1) Not bending over and lifting off floor. 2) No sudden twist and rotation of lower back 3) No movement that compresses spine.
And guess what, both these physical therapist gave me sit-ups at the very start of the recovery, I am one of those persons who dig deep into everything so i started arguing with these therapists and they just told me that "this is the program we give to everyone after disc surgery". Sit-ups is so god damn hard on the back even for a normal person and you want me to do it after my back surgery? How can a program be used both for Anterior and Posterior cases?
These therapist only had one major program for everybody which is a god damn joke to me. They had seen in my MRI that i have a Posterior herniation which means that exercises like sit-ups are like poison for me but anyway, i'm now in this really tough situation that i don't have anybody else to go to for help so me helping myself is the only option left.
I know that i should do a lot of core/back exercises, specially for strength and stabilization. I've already tried to educate myself as much as i can about core/back exercises but i would really appreciate it if you could give me some tips about best exercises with someone with my conditions.
I am kinda tall so it's like twice as important for me to have a rock solid core/back to keep that good posture so i just wanna focus on that for a while to build a strong structure so i can build upon that later on.
Please help me if you can as i have not much option left.

Thank you

I had a microdiscectomy four years ago. I walked outta hospital, went for daily walks the first eight weeks and felt fully recovered by the end of eight weeks. I started lifting very little weight with high reps. I did crunches, planks and kayakers for an ab workout. Nine and half weeks after surgery I rode my mountain bike in Whistler and N Vancouver. I even crashed.

I think your therapist is right telling you to start ab workouts. You're young. Don't abuse your back by lifting heavy and you're good.

I am not a doctor, nor am I studying to be one. I have been climbing since 1999, and training seriously off and on since about 2001/02. In my pursuit, one of the things I have picked up is a nice routine for adding mass to the torso which does a thorough job of working the skeletal stabilizer muscles of the torso, which includes the upper back and shoulder stabilizers , the hinge and pelvic region stabilizers , and the spine related back muscles .

My original workout involved doing a standard plank with my feet resting on an exercise ball, and I would put my face to the ground like I was doing a walk-out, a pushup, and rocking plank (except I would do an extended pushup at the end of the rocking plank). I would place the exercise ball (though I think TRX rings would be easier to hold stable form) somewhere between my knees and the tops of my feet so that I could do 3-4 sets of 9-12 total counts (so the walkout, pushup, and rocking plank would each be a single count, thus going from a walkout through to a rocking plank once is a count of three).
I call this workout the “bodybuilder”, and I have seen it done with the hands placed in TRX or rings as well, which allows for more arm freedom and thus allows one to target different muscles through the chest and shoulders than my bodybuilder. Doing the bodybuilder or the ring versions of it (which can be done on the knees, feet, or with the feet elevated on a platform or exercise ball) are good for working the whole core and stabilizers through the upper back and shoulders as well as down the spine, and to a lesser extent they also work the pelvic and lower back stabilizers. For a more specific workout for the lower stabilizers I found THIS workout online, which will again target all the muscles along the spine.

One word of warning concerning this is that side to side stability and form in general is extremely important to maintain (thus the recommendation for TRX over an exercise ball,) especially for someone in your situation, otherwise you will end up working one side of the body more than the other. The remedies to this are to use equipment with a more limited range of motion (hence TRX) and to focus on any exercises which can be done independently for each side. It is also worth mentioning that in addition to climbing the protocol I have given will be a hypertrophy level exercise for most people, so it will bulk up the torso with an emphasis on the stabilizers, and the majority of the mass will be gained from the hips up through the lower pectorals (Not the man boobs!). As a result I have actually replaced this with a weight routine which does the same thing but with tighter control over what body parts get worked and to what extent, though I still think this is a useful exercise for beginners to training, or for weekend warriors who are looking for what is essentially a one stop shop kind of antagonist workout to do post climbing. It is a great workout that can provide adequate balance to a pretty serious climbing routine. The reason I recommend it to you is it is a great way to add some strength and mass to your torso, and it does not involve bending in the back. Another thing worth mentioning is that the bodybuilder or any comparable versions will be an HGH and testosterone trigger nearly on par with a deadlift. I think it is likely a milder trigger as compared to a deadlift, but only because past a certain point there is no way to do it at the equivalent of a single rep. On that note, while doing these exercise, maximally tighten all your muscles, so “overgrip” the workout.

One last recommendation is to add in some specific work on the rib cage muscles, namely the pectoral minor and serratus anterior. The reason for this is being able to hold the ribs tightly in isometries will go a LONG way toward removing the tension from your other core muscles as well as to spread the load placed on the spine to the rest of your core. I have found a great way to target those is using side lying internal and external rotation . Note that the side lying internal rotation requires laying on a bench or the edge of a bed or couch so you can hang the arm down to get the full range of motion.

To finish this post, I will add that a ratio of 10 drops of peppermint essential oil mixed into 10ml of carrier oil (jojoba, olive, canola, whatever, but jojoba is best) is a great simple remedy for any muscle cramps which can be applied directly to the affected area. 1-3 drops usually does the trick. Also, here are some great links I found while looking for links for this post:

-great podcast on Form

-great article on athletic functionality

Hey Borna,

I have L4/L5 and L5/S1 herniations, sort of on the fence with MD surgery at this point. I'm curious, did you have any numbness and/or weakness along with your sciatica pain? Did it also resolve after surgery? Did your surgeon use an annular repair method? (The barricaid for example)

In my research, this article seemed to be the most comprehensive, practical, and literature based program I found regarding lumbar disc herniation rehabilitation. It's directed at avoiding the need for surgery but from what my PT told me the post surgery rehab is nearly identical to that of trying to rehab a herniation without surgery.

From what I've read it seems like flexion of the L spine combined with axial rotation is the biggest culprit of LDH and the motion to avoid thereafter. Rotation alone didn't seem to correlate highly, while flexion alone did (though less than when combined with rotation). That's the gist of what I've gotten anyhow.

Hope it helps, good luck!

SteveZ wrote:... In my research, this article seemed to be the most comprehensive, practical, and literature based program I found regarding lumbar disc herniation rehabilitation. It's directed at avoiding the need for surgery but from what my PT told me the post surgery rehab is nearly identical to that of trying to rehab a herniation without surgery...

I'm a doctor, professor of medicine, owner of a completely destroyed L4 disc, and 8 weeks post micro-discectomy for emergency decompression of both the L4 and L5 roots (when that disc came apart, it did so with a vengeance, fragment pinning both roots). Working on trying to recover motor function and proprioception; the nerves took a bit of a beating. So, I have a pretty broad perspective on this situation. The advice SteveZ posted above is about the best you'll find. You may also wish to consider Schinhan M, Neubauer B, Pieber K, Gruber M, Kainberger F, Castellucci C, et al. Climbing Has a Positive Impact on Low Back Pain: A Prospective Randomized Controlled Trial. Clinical Journal of Sport Medicine. 2016 May;26(3):199–205. Note carefully that the patients in the Schinhan study were doing bouldering traverses close to the floor, not impact-loading jumping down from the problems.

Lee,

Sorry to hear about your disc and I hope you're recovering steadily!

With your experience, would you be willing to share your thoughts on annular closure methods/devices? Or any good research you know of. Good, bad, indifferent?

Thanks!