Lumbar Disc Surgery: Recovery From L5,S1 Microdiscectomy Surgery

Microdiscectomy is one of the most common forms of back surgery to help people with symptoms from disc herniations in the L5,S1 and L4, L5 regions of the lower back. But all too often the rehabilitation guidance that is offered is lackluster, and the explanation of what’s happened, and importantly, what’s NOT happened, is poor. We get comments all the time on our social channels from individuals who’ve had this surgery but been left to their own devices worried and unsure on how to move forwards. The hope is that this week we can help give you a bit of confidence and strategy to move forwards after this back surgery, after all, it is not a decision that we take lightly.

The damage is not the herniation

The most important thing to realise if you’ve had a microdiscectomy to L5, S1 is that the herniated material that might be irritating the nerve roots is A problem, but it is not THE problem. It is in fact the injury to the annular fibres that has resulted in them not being able to contain the nucleus within its rightful place that is THE problem. Microdiscectomy surgery therefore is removing the herniated material in a minimally invasive fashion, but it does not heal the damage that is still present at the site of herniation. Meaning the damage to your L5,S1 annulus fibrosus, and the inevitable involvement of the other ligaments of this spinal segment, remains a factor in the weakness and vulnerability of the low back. 

This form of minimally invasive spinal surgery therefore, removes the herniated material, which can often result in some quite impressive changes in symptoms, but does not heal the damage.

Damage to the integrity of the lumbar spine

What remains now is an injured segment of your spine, the L5, S1, the last mobile region of our spine. And so the same stability issues, and vulnerabilities remain. However, because the herniation has been removed, you will frequently find that the “pain” or “symptoms” you experienced before the operation are much less severe. This can be a double edged sword because the pain is often preventing you from bending, twisting, running and doing many other things that directly strain and provoke those tissues of the annulus fibrosus that are slowly trying to heal.

Opportunity for healing

The important thing that should be discussed, is that post operation, you now have the opportunity for healing to take place, in the absence of the inconvenience of the debilitation that was a daily feature of the herniated disc. And believe it or not discs are not unlike other ligaments in our body, they do heal, the annulus fibrosus of your L5, S1 segment will go through the healing processes required if you give it time. We discussed the concept of healing your herniated disc in a recent podcast but suffice to say it is not only possible but it should be expected.

The issue that we need to be aware of, when comparing your post microdiscectomy disc, with other ligaments, is that your spine is more or less always under load. And so education and guidance are vital as we do not have a second spine to use while this one heals, in the same way we can leverage our other leg or arm. 

Problems with post operation guidance

Of course this section does not apply to everyone and there are plenty of examples of great surgeons giving great post op care. But those patients aren’t going to be reading this! All too often the care is not good, and guidance, like, “don’t do too much” over the next 4-6 weeks or “don’t lift anything” until you go for Physio in 4-6 weeks time. Worse still very often the physio or physical therapy appointments are even more delayed than that! 

The simple fact of the matter is that the guidance does not reflect the reality that patients live in the real world, you’re going home, you’ve got to dress, live, maybe you’ve got young children, pets, deliveries, the washing to do. You’re going to do your best but, quite honestly, you’re going to be doing things again, much sooner than the 4-6 weeks period. Even the trip home from the hospital is going to involve numerous complex and strenuous movements. Getting in and out of the car, sitting on the disc for many minutes on the way home, the list goes on. Then there is the simple but graphic example of going to the bathroom. You’re going to be doing all of these things and herein lies the challenge. 

Rehab guidance that meets you where you are

Rehab can be dialled to the ability level of the individual, and really this should always be the case. The simple fact that you got out of your hospital bed, minutes to hours after spinal surgery indicates that you have been permitted to do the squatting movement. You might have had to do this with the assistance of a frame or nurse, but it was done. Was it done well? Who knows… 

Spinal stability that’s real

This reality of immediate exposure to life following the microdiscectomy needs to be acknowledged, which is why some elements of spinal stability work should be considered as soon as possible. Just sitting around, walking around, or lying around all day in the days and weeks following surgery is not guidance. Instead working on simple movements such as practicing the ability to engage the core, a preliminary movement for a dead bug, is something that can steadily be worked on. Practicing the squatting motion carefully recording yourself on the phone, maybe holding onto a doorway for support and assistance, makes sense. Why? Because you’re already sitting on the side of the bed, or on the toilet seat. Both movements are not done with 100% focus, care, or appreciation for the limitations in your range of motion as it pertains to spinal stability. And so you may as well practice something that will have benefits that leak into those specific movements that you are ALREADY DOING. 

This is why we speak about exercises like those discussed in the Core 5 for spinal health episode of the podcast.  These are movements that you can conservatively practice at any level of ease or difficulty, making sure to practice repetitions that are “aggravation free” with “correct choreography” to start to create an environment of competence around an injured region of the body. 

Stability protects your disc

Building this skill can happen relatively quickly at low levels of intensity, and the benefit of this improved coordination is that it decreases the likelihood of unnecessary aggravations of the post operation L5/S1 segment of your spine.  You’re providing more support for a region to reduce the risk of unnecessary interruptions to the healing process that is trying to take place at this level of your spine.

Let’s face it, it was when you moved one way or another and your spine bent, twisted or otherwise moved that you’re disc herniation occurred, flared up, or worsened. It is the lack of control for the spine that allows a minor bulge to gradually worsen with each passing irritation. It is simply put, that the ability to brace, stabilise or otherwise support the region between your rib cage and pelvic ring, that is at the heart of success in recovery from a herniated disc. 

The fact that we’ve removed a bit of floating disc during the microdiscectomy changes very little in this regard. 

The sheer safety of rebuilding stability

As if it was not already self-evident, there is little you can do in the days and weeks that follow your L5, S1 microdiscectomy surgery that is going to be less strenuous than careful and controlled stability movements that are appropriate for your current level of skill. Considering this, it is very perplexing that there is not more emphasis on this by the surgical teams. When we practice, lying down on the bed, and gently recruiting the mid-section musculature to provide a gentle engagement, or we stand holding onto a door frame and marginally bend our knees with this same recruitment, we see just how comically simple these movements are. 

When performed with respect and instruction, you can start to gain an appreciation for your current level of ability, or lack thereof. Steadily over the days and weeks with this incredibly safe, stability first approach, you can start to improve your ability to swiftly recruit these muscles to provide support for the spine as you go about your day. Creating an ever-compounding positive feedback loop to further protection, which allows for healing to continue, uninterrupted, and more resilience to build in the immediate aftermath of the operation. 

Be vigilant for mistakes that could set you back

Of course you could make mistakes during such a process, but you could also make a mistake coming down the stairs, strain too hard on the toilet, or get out of the chair too fast. All of these things are substantially more likely than if you are respectfully going about proper spine stability rehabilitation. The more we talk about it with members and on social media, the more it becomes self-evident that this should really be a must for those coming out of a minor back surgery. We discussed the more ideal scenario of beginning this kind of work BEFORE the procedure in an older podcast to help those of you who are faced with the prospects of back surgery: A Guide To Back Surgery. 

Some of the tools that can really help you get some of these movements correct include your smartphone, for recording yourself, a full length mirror for visual feedback in the moment and the “tape test” a great tool to help you better appreciate the failure or success in maintaining a neutral spine during movements like the squat, hip hinge, or even daily movements around the house. You can check out two helpful videos that will show you how to use the Tape Test to safeguard your low back after surgery.

Final thoughts on recovery from lumbar microdiscectomy surgery

I think it is fair to want to be cautious with what patients are given in the window immediately after surgery, but this inability to provide meaningful support comes from the lack of acknowledgement that patients do not go home and live in a vacuum and that unlike other injuries, there is no ability to provide the perfect environment for the tissues to go through a healing process. And even if we could do this, the cost of loss of muscle bulk and support would be too much to bear. 

As a result of understanding the reality patients are met with after they leave the hospital bed, it would be cruel to not give more comprehensive guidance for someone who just wants to never have to go through that again. While we’ve not gone into detail too heavily on exactly the exercises to cover here, hopefully the principled discussion has at least made you feel a little more confident about broaching the topic with your surgical team and starting to work towards learning the vital skills of spine stability sooner rather than later.  In doing so, you’ll find your recovery process post operation smoother, if not accelerated as you steadily build your rehabilitation in alignment with your progress. 

If you need more structure or support through this process we have a number of resources to help you, number one, the freely available masterclass, an 80 minute workshop that you can follow, covering about 30 minutes of theory and 50 minutes of practical. We have lots of tutorial and demonstration videos available across the website. Finally for those who just want to get on with it and want support along the way, membership to the Back In Shape Program would be the most effective pathway forward and you can learn more about that on the relevant areas of the website.