[I posted this on the Slowtwitch.com Triathlon Forum after I had back surgery in July 2020]
Preparing for a Microdiscectomy and Laminectomy – L5/S1 Lumbar Spine
I wanted to start a thread about “preparing for a microdiscectomy and laminectomy” in the hope it would help a lot of you who have made a decision to have the procedure. And I also wanted to give an overview of immediate life after microdiscectomy surgery based on the specific instructions I was given by my surgeon. And also give readers a list of the items I bought pre and post-op that helped in my recovery. Standard disclaimers, I am not a Doctor, don’t rely on anything I say as medical advice, do everything at your own risk etc, etc, blah, blah, blah…
- Treat your Pre-Hab as Seriously as your Re-Hab.
- Microdiscectomy Immediate Post-Op Life.
- Stuff I bought Pre and Post-Surgery to Help.
- Other Stuff that Helped.
- Current Status and Exercise Program – September 1, 2020.
Lots of readers are searching this forum in anticipation of having a microdiscectomy as well as those, like me, that have had the procedure and are looking for help in recovery. Lots of you are also trying to get some form of reassurance as to the path back and what your prospects are for training/racing again. So I’m assuming for the purposes of this post that you’ve made the decision to have a microdiscectomy/or are about to have one. “Misery” loves company but so does “hope”. That’s why this forum was a great inspiration for me as I debated the “surgery” or “no-surgery” question right up to the night before when I finally started freaking out about what I was getting myself in to. I wanted to be that guy who came out of surgery positioned to be stronger than before as well as better educated about how to manage my training at 57 years old in a way that was going to keep me pain-free and turning up at the start line.
I’ve suffered through back pain for 15 years in various forms and it always generally resolved itself after 2-3 months – but not this time. I herniated my L5/S1 a few years back while training for Spartan World Champs. It got better enough for me to do that race but it re-herniated 8-9 months ago after a long bike training session as part of my training for 70.3 IM in Hawaii. Basically a massively stressed and tired body that had been hours in flexion (TT position) combined with bending, twisting and lifting – the perfect prescription for a herniation. My left-side disc protrusion measured 7 mm in depth, 10 mm in length, and ~13 mm across its base with significant S1 root compression (post-op I was told that my surgeon removed ~20% of the disc which was basically clamping on my nerve root). It just kept getting worse despite three lots of epidurals and countless sessions with all manner of therapists.
So I had microdiscectomy surgery at the end of July, 2020.
I took this surgery very seriously. I see posts of people back spinning on their bikes 1-week later in flexion, or driving after a few days, or slouching on coaches in YouTube “recovery” videos – basically doing all manner of things that you are not meant to be doing post-op. I wanted to follow a very conservative plan which was 100% in line with the Doctor’s orders because I wanted my result to be 100% recovery. This was made all the harder because I was also 100% free of pain from the moment I woke up and that’s still the case today. I feel pretty normal but I’m not going to be tricked into believing I’m healed – it’s a long process and it takes commitment and patience (see below for my Doctor’s post-op instructions).
Anyway, I wanted to give some tips on my preparation for surgery as well as some of the items I purchased to help me post-op. These items are listed at the end of this post and it’s basically a list of those things that I purchased on Amazon leading up to surgery as well as other items, resources, and tools I’m using post-op to help me with my recovery. So I hope this helps anyone in a similar position.
Treat your Pre-Hab as Seriously as your Re-Hab.
Firstly, I treated my pre-hab as seriously as I’m treating my re-hab. I wanted to be in the best physical and mental shape possible before surgery in order to help with a successful result. I originally had 2-weeks to prepare but that was reduced to 1.5-weeks when an appointment opened up. So I used that time to:
- Lose weight. I had already lost weight over the previous month as I wanted to lean out more just to help with my back pain before I had decided to have surgery. I was already pretty lean but when I made the decision to have surgery I doubled down on my nutrition and lost another 4lbs during that last week. In the 3-weeks post-surgery I’ve lost another 7lbs all through just eating correctly. I’m pretty dialed in on this (read my book if you are interested – “Your New Prime” by Craig Cooper) so it wasn’t that hard for me. Obviously, the less load on your lumbar spine the better. And remember, you’re going to be incapacitated for a long time so you have to get your nutrition dialed in so as to avoid any weight gain post-op. The fact that I was walking pretty much immediately helped, as did my 3 x daily walks as prescribed by my Doctor. Eliminating all alcohol in those weeks leading up to surgery also had a massive impact on how I recovered after as well as my weight leading in to the procedure.
- Practice Virtual Surgery. I behaved like I had actually had the surgery and practiced “virtual surgery” – basically moving in a manner that was spine healthy in order to reduce the inflammation as much as possible. No biking or running – just walking, as well as traction-based strength work (dips, pull-ups, push-ups), and swimming and Foundation Training – no stretching.
- I tried to reduce inflammation as much as possible in the lead up weeks. I started taking a lot of CDB, upwards of 300-400ml a day. Honestly, I think it had zero effect and was a waste of money.
- I prepped myself for post-op by telling my staff not to bother me for a few days, developing behaviors like learning how to get in and out of bed by rolling (see below), sitting and standing properly using a hip-hinge and not bending in flexion, putting shoes and socks on lying down, and organizing stuff I would need post-op (see below).
- I also prepped mentally, focusing on the fact that this procedure would make me stronger and force me to look at all my movement patterns and training so as to make sure I wasn’t perpetuating the movements that injured me in the first place. It’s a myth that there is “non-specific back pain” as touted by many online and in the clinical world. There is a reason for everything. You need to identify that reason and make changes to avoid it going forward.
Microdiscectomy Immediate Post-Op Life.
Below is a snapshot of my Doctor’s orders. These are the instructions and procedures he gives to all his microdiscectomy patients. Note that my personal program after my 3-week follow up was different than the below as I had recovered so well (see: “Current Status” below). But the following is based on standard practices I was told to follow:
- I have to wear a back brace for 8 weeks post-op whenever I am standing or moving – but not when I am lying down. If I’m sitting up or reclining in bed however (not lying down) I also have to keep it on. The brace I was given at the hospital when I was discharged is called the “Aspen Horizon 627 LSO”. It’s super comfortable and supportive, and I think it serves 2 purposes – firstly to provide lumbar support when moving – but mostly for me it provides a constant reminder to brace my core and surrounding musculature whenever I moved – and also to never put myself into flexion in any form. See below my recommendation in regards to Dr. Stuart McGill’s “Back Mechanics” book where you can learn about developing what he calls “stiffness” and “bracing”. These techniques will/should become a part of your life going forward as you learn more tools for better spine hygiene. By the way, of all the videos I watched online of patients experiences post-op I didn’t see one where it was recommended by their surgeon that they wear a back brace. I would highly recommend it so if your surgeon doesn’t offer it I would ask him/her why not.
- I was told to alternate my body position from sitting, lying and standing every 10-20 minutes during the day. I was allowed to lie down for longer periods of time as tolerated. I have to avoid sitting/reclining more than 20 minutes at a time for the first 6 weeks after surgery. I was told to take frequent short walks immediately post-operatively on firm FLAT surfaces – 5 to 10 minutes walks, 3-4 times a day and increasing length as tolerated, but not exceeding 15 minutes until their first post op visit. I was walking on my treadmill on the afternoon of my surgery and I am still doing 3 walks a day outside – 20-30 minutes each time – at what is my normal fast walking pace – and I am feeling great. In fact, it’s the highlight of my day!
- You have to avoid all bending, stooping and twisting for the first six weeks following surgery. No lifting anything greater than 10 pounds for the first 6 weeks. No stretching of your legs or any exercise except for walking until you’re directed to do so by your surgeon. You have to avoid doing any type of activity that involves pushing or pulling for the first six weeks. You are also not allowed to go in a pool, Jacuzzi or the ocean for 2 weeks post-op. This is for 2 reasons – to avoid the incision being infected (Jacuzzi, ocean, and pool bacteria), and also to avoid additional inflammation from heat. You can shower anytime but no baths until 2-weeks after surgery (for the obvious reason that a bath loads your lumbar spine in flexion).
- You’re not allowed to take any anti-inflammatory medicine including Aspirin, Naprosyn or Ibuprofen for the first 6 weeks following surgery. I was allowed to take Tylenol and the other prescribed pain medication I was given on discharge. I was given Percocet (for pain) and Valium (to help sleep). I took Percocet for one night only and that’s it. No Valium. If you have to take Percocet (Oxycontin) you will need to also take a stool softener like Colace. Percocet is heavy stuff. I can see why it’s such a problem for so many.
- You need to be conscious of any potential infection at the incision site including redness, swelling, warmth, bleeding or oozing. My incision was covered with a sterile super glue seal after surgery which peels off after 2-3 weeks. Don’t touch this or encourage it to peel off – it will do so on its own. My covering of my incision lasted 3-weeks. When the Doctor took it off I honestly couldn’t even see the scar. It’s like a 1” hairline. Nearly invisible.
- I had to constantly ice the area of the incision for 20 minutes per hour, 6-8 times per day for the first 2 weeks following surgery then as needed for the next six weeks. My surgeon advised doing this while lying down with pillows (or a bolster) under my legs to take the pressure off of the lower back (see “Stuff I bought” below). Unless I’m in the shower I was also told to avoid all heat. My routine is basically whenever I’m not walking I’m either lying down or just “up and about” in my house on phone calls or whatever. And I’m icing 2x an hour through most of the day and immediately after one of my walks.
- I was initially advised that physical therapy appointments could begin after the 6-week follow-up visit and would be scheduled for 2-3 times per week for 4-8 weeks (note: as you will read below I was subsequently told I could start PT immediately after my 3 week follow up consultation). You absolutely have to do your research here. There is so much disinformation on the Internet as to post-op recovery PT. Your PT must have a history of lumbar spine rehabilitation for microdiscectomies and I would absolutely recommend in the strongest terms that before you start physio you read the works of Dr. Stuart McGill in the following order: “Back Mechanics”, “Ultimate Back Fitness and Performance”, and finally, “The Gift of Injury”. Take the time to understand the mechanics of your injury and how to avoid the patterns of movement that got you in the position you are in today. Hands-down these are “must reads” before you start any PT program. Base your recovery on proper science – not blog posts or YouTube videos. Ask your PT what his/her program is for building back strength post microdiscectomy. Make sure they have a clear plan and clinical basis behind their program and not one that is just based on “needing to build up your core”.
- No driving for the first two weeks after surgery. After the first post-op visit I will apparently be told when I can drive. I can be a passenger in a car, however I have to avoid long car trips (anything over 30 minutes) for the first 6 weeks post-op. No travel by airplane until ~8 weeks post-op and only if cleared to do so (fat chance during COVID). If I do get on a plane, no lifting bags or anything into overhead lockers, and I should wear my back brace at all times.
- You are told you can start light work, such as office work, 2 weeks following surgery. I was back working the next day after my surgery (my work does not involve manual labor). Everyone will differ. If I was still on Percocet I imagine I would have struggled to think straight.
- Certain sporting activities such as tennis, golf, basketball and running are restricted for 12-weeks following surgery and only then if released to do so by your surgeon (these are the sports he listed on the instructions – as if I would go play tennis and golf!). Given my injuries, I was told that my path would probably be more like the following: released for PT after ~6 weeks, stationary bike riding after ~8-10 weeks, swimming after ~6 weeks (no breaststroke – only freestyle – and I’m going to be using a snorkel and a pool buoy to immobilize my legs for some time), no running for a year! (that one I’m going to have a big problem with – I honestly don’t think this will apply given the state of how I am feeling at the moment – I’m basically wanting to break into a jog every time I go out walking!). I’m hoping to return to strength training after about 3-months. Based on the program recommendations of Dr. McGill (see above books) I’ll have a 6-12 month progressive build focusing on very specific do’s and don’ts. Luckily the do’s include most of my favorite body-weight strength exercises – push-ups, pull-ups, dips, single leg lunges, and other exercises designed and scientifically proven to build strength without loading the lumbar spine (all based on McGill’s clinical studies). Again, it’s all in the books outlined above. The main thing is to take it slowly and to understand and avoid the movement patterns that got you injured in the first place. What’s the definition of insanity? – “same thing same result”. So you need to identify what is causing the breakdown in your back health and develop a plan to avoid those movement patterns while you strengthen your capacity to tolerate lumbar load in the future. The idea is to keep your spine healthy and as stress free as possible in those hours of the day that you are not exercising in order to allow your back to take on extra load when you do train. In effect, save it for training by treating it with respect all the other waking hours! How you brush your teeth, sit on the toilet, put your socks on, get in and out of a car. This stress on your back all adds up during the day and contributes in an incremental way to a stronger or weaker back depending on your movement patterns.
- Finally, although it was not part of Dr’s orders you have to learn to “log roll” in and out of bed before you have surgery and practice it until you master it. It seems simple but it takes a few times to master it. As soon as you get home you will need this skill. It’s the safest way to get in and out of bed and should become your standard procedure going forward. Here’s a link to learn.
Stuff I bought Pre and Post-Surgery to Help.
Here’s a list of stuff I purchased to help in my recovery and some other tips and tricks:
Walking stick. Yup, sounds mental, but it was a great help the first week if I needed something to help push me up – like off the toilet. I used this collapsible walking stick.
Leg bolster. I slept with this the first two weeks to keep my legs elevated and back straight. The Restorology Elevating Foam Leg Rest Pillow – Wedge Pillow
Chair bolster. I probably only sat down 4-5 times in the first 3 weeks post-op (apart from going to the toilet) but when I did I used this on my chair (the same one I always use in my car). The McKenzie Lumbar Roll.
Grabby tool. The best thing I bought and I’m still using it. I bought this one.
Colace stool softener. – Buy this before surgery. If you are taking Percocet or anything similar you will need it.
Extended shoehorn. I basically wear running shoes/Hoka’s all the time with stretch laces. So this helps you easily slip in to your shoes standing up with no bending. Here’s the one I bought.
Ice packs. These ones are awesome. I was on ice 2x every hour pretty much the first 2 weeks. I put this ice pack in a plastic trash bag (standard kitchen waste basket liner) and laid it on top of a towel on the bed and then laid on the trash bag covered pack. That way it had maximum ice-impact while not burning my skin, which has happened to me before while icing directly on skin.
Bed lumbar support. If you are spending a lot of time lying down you will need a lumbar support to stop your back flattening into the bed. This is the one I used. You position the top of the support directly under your lumbar spine.
Showering. I was allowed to shower the next day but a lot of Doctors don’t want you to shower for anything from 3-7 days after surgery. If that is the case you might want to buy some body wipes to stay fresh and wipe yourself down with. These are the ones I used.
Other Stuff that Helped.
I moved into a separate room from my wife so I could set up a re-hab chamber and have all my stuff around me and so I wouldn’t wake her at night. Some of the other things you might want to consider:
I had a large bedside table that was in easy reach so I didn’t have to always strain or bend to get to it. Make sure everything is within arms-length assuming you are lying on your back. So if you’re on the right side of the bed make sure you can reach everything on the right-hand side table with your right hand without moving or twisting.
Set up a power-strip for all your electronics and chargers on your side table. Also have room for a water bottle (I used a CamelBak with a sippy straw), and maybe a torch. I also had a separate pillow to put between my legs if I turned on my side while in bed. Get all this set up before surgery so it’s all ready when you get home.
Sleep was my hardest challenge. For the first 2-weeks I was pretty much taking Tylenol PM every night but nothing stronger. My Doctor said to take Valium (half dose every night, which he had given me when I was discharged from the surgery center) but I didn’t want to do that. Sleep is so important for healing so take whatever works for you if you are struggling to get a full 6-7 hours.
Current Status and Exercise Program – September 1, 2020.
I had my first follow up at 3-weeks. I was still pain free and felt pretty good. At the appointment I was told I could start physiotherapy 2x a week immediately which I was not expecting. I thought it was going to be at least 6-weeks before starting PT based on my post-op instructions – so that was awesome. I was also told I could start swimming (freestyle only) in 2-weeks (so that would be 5-weeks total post-op) but I had to wait until I saw him again in another 3-weeks before being allowed to do anything else like ride a stationary bike (KICKR/Zwift). If I’m cleared for biking at that time that would be 6-weeks total post-op before being able to do all of swim, bike, physio, light strength work – so there is hope and something to look forward to!
Other than that I’m super happy I had the surgery. I’ve started physio and am back in the pool (we have one in our neighborhood so I can walk to it as I told I still cannot drive). I’m doing ~500m of swimming 3x a week at the moment.
Here’s a summary of my basic physio and exercise program 5-weeks post-op:
Treadmill (3 x a day every day for 20-30mins).
From 3-Weeks Post-Op Added:
Twice a day, every day, the following (the first 3 exercises are known as the “McGill Big 3” as outlined in his books described above):
Bird dogs (6/4/2 each side descending set – 10 seconds each rep)
Side planks (6/4/2 each side descending set – 10 seconds each rep)
McGill curl-ups (6/4/2 descending set – 10 seconds each rep)
“Stir the pots” on Swiss ball (4 sets of 20-30seconds each creating figure 8’s with elbows)
Bear crawls (10 forwards, 10 backwards – 3 sets)
Farmer walks – single side w/ 25lb Kettlebell carry (50 meters each side)
TRX pull-ups (8/6/4/2 descending set)
TRX pull-ups (8/6/4/2 descending set)
From 5-Weeks Post-Op Added:
Lap swimming every second day with snorkel and pool buoy so as to avoid twisting – ~ 500m, and planning to slowly increase mileage every week (started 5-weeks post op).
That’s it for now.
I’ve also increased the handlebar height on my bike in preparation for getting back on the stationary trainer by wrapping these around the bar. This increases the height about 1.5inches so I don’t have to bend over in flexion so much.
I’m pretty confident I’ll be at or near as strong as I was before – but just in a different way. One thing is for certain, a lot of my movement patterns are being left in the past as I adapt to prioritizing my back and spinal health.
I’ll update as necessary. I hope this helps some of you.
[I subsequently updated that post to add]
10 weeks post-op.
In addition to all the above rehab and home exercises I’m now also doing physiotherapy 2 x a week w/ @Prosport in Costa Mesa, CA.
Also swimming 3x a week, up to 1000m. Mainly drills. No flip turns and push offs are at about 25% of usual force.
Did a video consult with Dr. Stuart McGill (ref: my post above) on specific rehab which pretty much follows what I set out in my post above. One difference was how I was going to build leg strength when (1) no running, (2) no weight load on lumbar spine, and (3) no walking hills (which is standard advice from your surgeon post-op). His suggestion is to do do “backward walking” to re-train and strengthen your legs. It does involve hills but the idea is you find a hill of about 100m and you walk backwards up it. Then you immediately walk down it. Then back up it in a normal forward manner. That’s basically it. So even though I still technically am walking one section up the hill I concentrate on not being in flexion or bent forward. And it’s actually the backwards part that is most challenging on your quads. It definitely works.
For cycling, after my consult last week w/ my surgeon he ok’d me for stationary bike (that would have been 9-weeks post-op) “but” I am independently following Dr. McGills prescription here that he gave me in advance of being allowed back on the bike by my surgeon. And that was to apply “progressive load” in 3 day cycles. Day 1 (first day back): do 3 minutes high cadence and very little resistance. Day 2: rest and see if you have any symptoms – do nothing. Day 3: repeat day 1 and cycle for 4-5 minutes but “only” if you have no symptoms. If you have symptoms then you are not ready. If no symptoms then you can continue with the exact same 3-day cycle and progressively build the cycle time on the saddle but only in very very small increments. And he means “small”. Like if your first day was 3 minutes then the next time should be 4-5 minutes. Then maybe 6 minutes. Don’t be in a hurry. Monitor your symptoms first and foremost.