PAIN FOLLOWING BACK SURGERY: COMMON REASONS WHY YOUR PAIN MAY BE LINGERING

Research has shown that one year following a low back surgery, 70-80% of patients can have a recurrence of low back pain, even if the surgery was successful and immediately got rid of a patient’s pain. Some practitioners may say that is life or patients will just have cascading joints in their back that need to be operated on afterwards. Perhaps that is the case. But as a physical therapist with the view that there are other structures in your body that surround or interact with your low back, I firmly believe there are reasons why your pain is lingering after a successful back surgery. Here are three common things to consider:

Glute Stability Is Just as Important as Core Stability

For many of you who have received physical therapy following a low back injury, the most common protocol in rehabilitation is to follow a standardized protocol sheet ofr exercises to strengthen your abdominals. Tightening your core and marching in place, dead bugs, supermanssupermans, bridges and planks are all very common exercises that are prescribed by your physical therapist. And yes, doing those exercises can make your abdominal and back muscles more engaged and yes it can help provide better support to your back, especially following an operation. 

But have you considered what other muscles in your body can help support your low back? In my experience one of the major muscles to consider are your gluteal or buttock muscles. Your butt muscles should be the largest muscles in your body. They can provide the most stability, not only to your hips but also to your pelvis. Having gluteal muscles that do not contract or stabilize properly can add increased forces to your pelvis and spine, which then must compensate for that lack of force. Not sure if your gluteal muscles are stable enough? Stand up and just contract one glute muscle versus the other. Do you feel like one or neither of them has a well-defined contraction? If you do not—especially if one side does not work well as the other–it should not be surprising that your back pain is on the same side. 

Nerves Move Too

Too many times, people as well as physicians assume that if the back surgery removed a herniated disc that is pressing on the nerve root coming out of your spine, that your nerve pain will just go away. Any resulting nerve symptoms or pain will just take time to heal. 

But the nerves that come out of your spine can also be a separate source of pain all by themselves, independent from a herniated disc that was pressing on it. No doubt a discectomy may be needed to get rid of any extraneous pressure on the nerve, but the lumbar nerve roots need to also be addressed. And just like the elbow that feels stiff after a cast is removed, your sciatic nerve and lumbar nerve roots can also feel very stiff and sensitive to move after a back surgery. So that residual numbness or achiness may no longer be coming from where the surgery took place, it may be the compounding effects of your nerves that need to be treated as well. 

In physical therapy, we utilize an assessment and progression of techniques called neurodynamics that can help decrease the irritability of painful nerves as well as get them moving more fluidly so they can elongate and move in a way that meets our daily activities. 

The Hip Bone Is Connected to the…

I view the body and the different joints that dictate the way your body moves as a series of spring coils that link and synchronously work together to allow your body to do what it needs to do. In an ideal situation most spring coils would have relatively the same amount of tension, so each coil helps contribute to an efficient sequence.

However, in many cases in ongoing back problems, we find that the spring coil that conceptually makes up your spine and lower back is commonly being asked to stretch out more as compensation for other coils not working well enough. So, for example, if your hip was stiff and did not bend as well as it should to squat or rotate to grab something from the ground, then it should be easy to deduct that a coil or joint just above or below it will have to stretch out or work more to allow for the continued motion to happen. 

Even with a back surgery that reduces your pain, you may experience continued back pain because you are still bending and twisting excessively at the spine due to the fact that your hips or another part of your body are not working correctly. 

I would encourage you to work with a physical therapist that can not only get your low back moving better but can also work with the rest of your body so that all of the major joints function more efficiently, thereby alleviating the pressure on your low back.  

All in all, my point is that back surgeries can be very effective and are much needed, but I also encourage you to think about how your entire body works and how it may affect the longer lasting results of your surgery.