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Back Problems Message Board

Back Problems Board Index

Obviously all of us are different and what works for one will not necessarily work for another, but I am going to tell you a bit about my experiences with having the same levels fused, hoping that something might prove useful to you.

Quick background: I was originally fused at L4-L5 but it didn't take care of my leg pain and I wasn't able to stand or walk for more than about a short block. At the time of that surgery, 1 opinion out of the 8 I got said I needed a 3 level fusion and he reserved the right to do a 5 level if that's what was needed once he got in there.

Everyone else told me one level was sufficient, so, needless to say, as a newbie to any surgery and to back problems, I went with what was the least invasive.

For 18 months, no one could figure out why I was still in pain because my MRI and x-rays all made my spine look perfect. No nerve compression was apparent. I had a number of diagnostic nerve blocks and my physiatrist who did the injections kept insisting my spine above the fusion was unstable. Finally we were able to convince the surgeons that this was the case, although people thought my L5-S1 was the "pain generator."

When my surgeon finally got in there, he was surprised to find that my facet joints at L3 were worn away to little nubs. This was allowing my spine to move every which way, in ways nature had not intended. So my surgeon had to rebuild them in addition to doing the rest of the fusion surgery.

The amazing thing was that my nerve pain (which several doctors had thought would be and already was caused by permanent nerve damage) went away on the 4th day and I was off all pain meds after the 10th day post surgery.

However...and this is the part that might have some relevence to you, my rehab has been done at an excruciatingly slow pace. We all regarded this surgery as my last chance to get better -- after this it would be spinal cord neurostimulator.

Some people raised their eyebrows when they heard just how slowly my surgeon was ordering the things I could do in rehab. My PT (who has been employed by my surgeon for 20 years) was given strict orders to avoid anything that had the potential to inflame my sciatic nerve. I had my surgery the day after Memorial Day 2010, and when we went to the family cottage in August, I wasn't allowed to go in the lake, even to wade!

During the first year, I began and stopped PT two times. I would work with the PT for a couple weeks, then my body had accomplished what it could at that point without inflaming the sciatic nerve, so I would stop PT...and just do what I could do up to that point. I walked as that was the only thing I could do safely.

This past Nov. I began to swim and was given the go ahead to do most other activities (within reason, of course). I have a lifting restriction of 35 pounds which I imagine will be I don't want to blow out L2...and then L1, etc.

During the first year I had SI joint issues. The left SI joint would slip out of position, which allowed my pelvis to tip. This in turn pulled the piriformis muscle taut, which caused hip pain and sciatic pain, since the sciatic nerve runs directly underneath the piriformis, and is easily inflamed.

I was working with a really terrific guy who does acupuncture and bodywork. His specialty is working with ultra athletes, the tri-athletes, people who run the 100-mile races through the desert, or up the mountain. He keeps them in balance and in structural alignment so their bodies don't wear out. He was able to keep me in alignment but we were beginning to think that I might need some treatment for the SI joints. I just wanted to tell you that it took me over a year of very careful work to get the core and back muscles to the point that the SI joints were no longer stressed by the new job they had to do post fusion. During this time, I would just have to lay off an activity if it caused any stress to the SIJ.

I found that the only thing I could do to gain strength and not cause the piriformis/sciatic nerve/SI joint to become painful was walking. So, that's all I did...and in moderation, too. When something caused pain, I would back off and rest. It took a long time to get where I wanted...but it was the only thing that worked for me.

I truly believe that if I had been pushed in PT or pushed myself to try to do more and more, I would have ended up believing I needed a SI joint fusion.

There is a VERY fine line between doing just enough to be beneficial and doing a tad beyond that and causing irritation or nerve inflammation. Once the flare gets going, it can be so difficult to get it back under control...and if it becomes chronic, the nerve itself can become scarred.

If I were in your shoes, I would stop everything you are doing, curtail your activities and go back to a very gentle walking program only. If you have access to a pool, you can walk in the water. On land, walk on a flat, even surface and start your training program over. The first thing I would do would be to lay off ALL activity for a week. Then, at first I would walk for ten minutes three or four times per day. If this is tolerated, then you can add on a minute...and continue to build time and distance as your pain tolerates.

The idea is to back off all activity and rest to see if the acute hip pain goes away or lessens. Then very gradually add back in some activity with walking. The thing is you must also limit the amount of time spent sitting as it can cause more pain than being on your feet and moving. I try to remind myself to get up every half hour and walk around the house --just enough to stretch out the spinal nerves and to change position. Worst thing is sitting in one position beyond a half hour.

The adjacent segments will always take the brunt of any activity now -- you have a big chunk of the part of your spine that is supposed to be the most movable that is soon going to be one solid block -- so you will need to always be mindful of this.

Be patient and try to keep the faith. Hopefully your various issues will gradually resolve as you get farther out from the surgery.

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