excercise after surgery

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dkb66
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October 19, 2011 at 3:35 am

Post count: 2

#5014

I had lumbar microdiskectomy on L5 and S1 two weeks ago today. I’m 45 yrs old and have been a weight lifter and a very active preson my entire life. In July I completed the P90X workout and was in the best shape ever or so I thought until I bent over a grabbed a barbell and I felt my back go out in a instant. Now after the surgery I’m doing great but when I ask my doctor about getting back to being in shape he replys I’m gonna have to change my way of life.He’s a 55yr doc and kinda old school. So my question is when can I start back or can I start back with weights.And do you feel that it’s safe to do push ups,pull ups and dips now? Thanks

Donald Corenman, MD, DC
Moderator

October 19, 2011 at 9:47 pm

Post count: 8660

#5021

I assume this is the first and only herniation at L5-S1. The cause of the herniation is a combination of genetics and activity. If you have read the website under lumbar disc herniation, you will understand that the tear in the disc doesn’t heal. That does not mean that you cannot return to sports including competition but you have to be smarter about it and accept some risks.

The website has a section “recovery information by surgery” and then “lumbar microdiscectomy”. Much information will be gleaned there.

Normally after a microdiscectomy, I have patients attend 6 weeks of physical therapy by well-trained therapists. These therapists have a protocol to watch body mechanics for faults and strengthening progress towards full recovery. You should be able to get back to the gym without restrictions. There are some caveats however.

I harp on prevention of BLT or bend, twist, lift at the same time as this position is the most hazardous for recurrent herniations and new annular tears. Also, weight born squats and weighted lunges create great shear stress on the lower lumbar discs and should be avoided.

Ask your surgeon if he or she would consider a referral to a well-trained physical therapist for a rehab program.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

dkb66
Member

October 20, 2011 at 8:06 am

Post count: 2

#5027

Thanks so much for your help I made a list of the things to ask my doctor when I go in tomorrow.Maybe they will have a good rehab program and I can get back on the road to being in shape and good health.

Vince77
Member

October 22, 2011 at 5:01 am

Post count: 3

#5034

Dr. Corenman,

After living with on-and-off again pain for a decade I had a microdiscectomy at L5-S1 in Feb. 2010. I took rehab slowly and strictly adhered to the recovery protocol (something I have rarely done in the past). I did not exercise, other than walk, for about 10 months as I know cartilagenous tissue does not have it’s own blood supply and takes longer to heal. I have also had a herniation (MRI confirmed) at the L4-L5 level for 11.5 years now. It was not operated on as the surgeon did not believe this level was causing my pain.

I have always been an extremely active person. I love my Crossfit workouts (I go very, very light on the weights) and picked up running post-op. After running sprints four days ago, I have some discomfort close to the surgical site and some minor nerve pain. Outside of an MRI to confirm, and if you are comfortable giving your opinion on something like this, what are the chances I reherniated my L5-S1? Or could it be the L4-L5 level? Or stretching of my scar tissue? What are the possible long term effects if I continue my exercise regimen?

I have been icing and taking NSAIDs since it starting hurting again. I made an appointment with my surgeon, but not until mid-November.

I apologize for the barrage of questions and am sincerely grateful for whatever responses you provide. I had my 20s taken away due to my back and am quite fearful of now having my 30s taken away as well.

Donald Corenman, MD, DC
Moderator

October 22, 2011 at 8:37 pm

Post count: 8660

#5035

Let’s start with why you had a microdisectomy after 10 years of pain. Where was your pain? Was it buttocks and thigh pain or was it lower back pain? The reason I ask is that buttocks, thigh and leg pain is typically caused by nerve root compression and lower back pain is typically caused by problems with the disc itself. What did the surgery do for you? Are you better, is the pain more intense, less intense or changed in quality? What are your current symptoms? Do you have more pain with standing and walking or with sitting?

No exercise for 10 months after surgery causes deconditioning of the cardiovascular system and muscles. If you were more active prior to the surgery, did you reduce activity secondary to recommendations?

I suspect that your surgery was at the L5-S1 level as you report a preexisting herniation at the L4-5 level that was not operated on. How big is this herniation, what side is it on and why did your surgeon indicate that it was not causing symptoms?

Please let me know about your current symptoms and we can look further into the potential causes.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Vince77
Member

October 23, 2011 at 1:45 am

Post count: 3

#5036

Thank you for the very quick response.

I had nerve pain from my hip all the way to my toes on the right side only. I never really had any low back pain. My surgery was great. I could exercise again and sit without pain. It did, however, take a while for the nerve to heal since I waited so long to get the surgery.

My current symptoms are low back pain and mild nerve pain on the right side to the calf, that is better with heat, not ice, NSAIDs, walking, and rest. Both the lumbar pain and nerve pain are gradually getting better 4 days after the initial onset. There really is not anymore pain sitting versus standing. It does seem that no matter what stretch I do I cannot find the stretch that targets my low back pain. I have stretched my glutes, psoas, hamstrings, quads, and, piriformis. I get nerve relief when I stretch these muscles, but not low back pain relief.

I selected my surgeon based on his experience, medical school, place of residency, and because he told me he operated on professional athletes who went back to their respective sports without problems. The only restrictions he placed on me were no weight bearing squats.

This is a synopsis of my post-op report:
PROCEDURE: Right L5-S1 laminotomy, medial facetectomy, and foraminotomy with microdiskectomy.
FINDINGS: Large right L5-S1 disk herniation and severe lateral recess stenosis. Large L5-S1 paracentral disk herniation eccentric to the right side causing right lateral recess stenosis and compression of the traversing S1 nerve root.

MRI Report:
L4-L5 6-7mm; Lateralizes more to the left and combines with facet arthropathy to create bilateral compression of the L5 nerve roots, left more than right. (You of course know much more than I do, but I am guessing since I did not present any pain on my left side he chose not to operate. However, a week after surgery I experienced numbness in both legs which was attributed to “disk settling” and nerve healing.)
L5-S1 8 mm
Mild degenerative sclerosis right SI joint.

Thank you very much for your time.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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