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Cycling with Spondylolisthesis
One of the manifestations of the condition is excessive lordosis (curvature of the spine) - this shifts the tilt of your pelvis and waist, causes almost complete atrophy of the gluteus muscles and results in shortening and extreme tightness of the hamstrings. And your centre of gravity goes off somewhere that can't be found. For me, there were a few concessions that I needed to make to my bikes to accommodate my spondylolisthesis - thank goodness for Cycle Fit. It was most around finding frames with the right geometry - track frames were actually a great choice - and making sure that the bikes were setup to avoid excessive back and hamstring stress. With all of that knowledge and and info taken into consideration on my bike setups, I was able to enjoy years of trouble free riding.
What I learned was
1) If you have any back issues at all get a professional bike fitting done. Do it.
Things go downhill
I started to experience more back issues starting about a year ago. I had to pull out of a bike ride to Brighton with prancer and matt-ha halfway through as my back refused to cooperate after a long hill, small niggles wouldn't go away, I didn't feel like doing long rides, and my more infrequent rides home were marked with numbness in my feet so I was tinkering with my seatpost and pedals a lot. Finally in January I had a "back attack" - when a simple movement triggered something in my lower back that put me at about 9 on the pain scale. I was still doing the odd bit of riding but not much. I stopped riding all together in February and my back deteriorated more and more to where my movement was very deliberate and 4g of Co-dydramol was needed to just get me through the day.
The MRI in March looked like this.
My discs between the S1-L5 and L5-L4 were completely worn out - the years of extra stress had been too much for them to last beyond my 39 years. The red bits show where the discs were protruding and you can see how far forward the L5 has slipped.
I found a fantastic surgeon who was able to explain everything to me. The discs were protruding backward into the spinal column and pressing on the root nerves which were already under stress from the L5 moving forward. The gap where the root nerves normally exit out of the back was being squeezed down and putting lots of pressure on the root nerves. This explained the numbness and the partial loss of neurological function in my feet. Nerves can handle some of the pressure but they cannot hold our forever; when nerves are gone, they are gone. Given the location of the nerves being squeezed, there were lots of parts of me in danger; my long term mobility, bladder and bowel function and sexual function were all at risk. After some very seriously long talks with the surgeon talking about risks, alternatives, risks to the alternatives, and the alternatives to risk, we agreed that the best course of action for my long term health was surgery.
What I learned was
1) Understand and weigh up the risks
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Posterior Lumbar Interbody Fusion (PLIF) Surgery
About a month ago I had PLIF surgery on my back. This video will help explain the detail that follows. http://www.spine-health.com/video/posterior-lumbar-interbody-fusion-plif-video
I had a complete laminectomy on my L5 and the discs between S1-L5 and between L5-L4 were then removed. The the bone remnants from the lamina were then put into the medical equivalent of coffee grinder and blitzed to create a goo of pulverised bone which was packed into and around cages that were used to replace the discs. The insertion and placing of the pedicle screws comes next and once the screws were in place then they were able to insert the titanium rods which pulls everything back into alignment.
The amazing thing is that the titanium rods threaded through the pedicle screws are made in theatre during the surgery. As they only decide where to best place the screws during the surgery, the shape of the rods has to be hand crafted by the surgeon. Sounds easy but this is 3-4mm thick surgical grade titanium - the hand cutters used to get the correct length are basically 6 foot long bolt cutters. It requires some serious skill to bend and shape the bars to the right contour and get the balance right between the perfect shape for the spine and the best surgical outcome. He said my L5 could have come back another 2mm but the additional stress massively increased the risk of pulverising all of the material around all 6 pedicle screws. If that had happened it would have been disastrous so he went for the better outcome rather than the perfect one.
My back now looks like this.
What I learned was
1) The skill required to do this work should not be underestimated
2) Good judgement is priceless. -
Post surgery and recovery from PLIF
My L5 was moved back about 1cm and about 3mm to the right to get it back into place. That doesn't sound much but it is a huge amount when that translates up the length of my spine towards my head - people swear I'm about an inch taller.
The only real issue I had post surgery was heavily diminished sensation in my right leg below the knee. The entire area was very numb with enough sensation in the heel and big toe to allow for walking. The surgeon said that this was a result of the stretching of the root nerves as part of the new spine position. One of the root nerves was essentially too short and it's new position put it under strain; that is something that root nerves really, really don't like so it shut down to adjust.
I am slowly regaining sensation in the leg. The process is very much like having winter numbed feet and then walking into a super warm room. The process of warming up and regaining sensation is what my leg is going through - only not in 5 minutes - spread out over weeks. I'm just past the painful chillblains stage of things but there's still a lot of numbness in the calf and middle three toes. I'm OK around around the house but I still need a crutch if I'm going out anywhere. It's improving but the process is slow and I've been told it will take anywhere from 6 weeks to 3 months for things to return to normal. This is all part of the healing process and the surgeon has been excellent at explaining what's going on.
Things I have learned
1) More patience than I had hoped to need
Cycling after PLIF Surgery
This is really the huge unknown at the moment - I am certain that I will be back on two wheels, but I don't know when. I'm really in the easy phase at the moment - the first 6 weeks post surgery is all about the making sure that the bones fuse and I end up with a nice solid base. Then the hard work starts. The surgery has given me an entirely new core skeletal structure. This means that all of the ligaments and muscles at my core were built up over years to support something that no longer exists. I need to re-learn how to stand and hold myself upright - there's 25+ years of muscle memory to be undone so that will take some time. I mentioned earlier about the short hamstrings and the atrophied gluteus muscles, those hamstrings need to be lengthened I need to build up gluteus muscles. Plus, all my bikes are set up for the old me; the one with the heavily curved spine, the need for a shorter reach and the tight hamstrings. I have no idea if any of my bikes are going to be suitable for me when it's time for me to put on my Sidis.
I'd be grateful if anyone has any insight or experience working rehab with PLIF patients. It would be good to know what to expect otherwise I'll document things as I go along.
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hope you get some useful knowledge sharing out of this C. it looks a good start to the thread by yourself.
glad you're confident of an eventual return to the bike. don't jump the gun. good also to hear you have confidence in your surgeon. best wishes, S
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Good luck with the healing. It should all get a lot better over time and you'll be back on the bike, possibly after another cyclefit pretty quickly. don't worry about doing any damage to your back. The hardware will keep it all stable and if you do break the surgeon will fix you again.
This is Toni's spine
http://www.flickr.com/photos/62533471@N00/3629436357/in/set-72157619673664833/
http://www.flickr.com/photos/62533471@N00/3630250488/in/set-72157619673664833/
http://www.flickr.com/photos/62533471@N00/5057894639/in/set-72157619673664833/She rides when she can, though she's not a strong rider by any means, she was able to ride the Skyride a couple of years and the vast majority of the Tweed Run last year.
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My Stepdad had a similar surgery around a year and a half ago. He had to have one of the discs removed as it had prolapsed and was causing
him lots of pain and loss of feeling in parts of his body. I think he had L5 removed too.
He is on the forum if you wanna drop him a pm about it. http://www.lfgss.com/member15041.html
He was back riding after around 8 weeks. Anyway hope you heal up quick -
with respect to remodeling your hams/glutes and general muscular world I would personally recommend Sean of http://www.kmilondon.com. I saw him after some major abdominal surgery as I fought to get back to viable levels of fitness.
He had to remodel my hams as I tore them in my left leg very badly 5 years ago - this caused major change in the rest of my body. I ended up doing a full KMI course.
Spine changed, legs changed, posture totally changed. amazing.James is seeing him atm and will undoubtedly be able to say something about him.
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Great thread, Chris, and great posts explaining the surgery. I look forward to the updates!
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Hey Aroogah, that's an excellent write-up. Most of my own back issues are pretty specific as I was born with a quit rare condition and my history won't be relevant to most people here, but I had a bunch of spinal fusions/surgery which meant that I was fused down to L3 and eventually that causes similar problems to yous. Due to the pressure of my spine on the three remaining discs in my back, I ended up with the L3-L4 disc completely worn away (it herniated then degenerated away over time), the facet joint at the back broke and the entire fused spine slipped backwards off L4, causing a form of spondylolisthesis.
I had an XLIF procedure which is basically the same as your PLIF only done as a minimally invasive surgery going through an existing anterior surgical scar on my side in order to get the disc spacer in to restore vertebral height. They then went in through the midline of my spine (again, using an existing scar) to place the pedicle screws and rods. This extended my fusion down to L4, pulled my spinal column upright again (I'd been leaning backwards) and restored my posture as well as decompressing the nerves that had been getting squashed due to the lack of vertebral height. When I woke up from the surgery I was in far less pain that I had been right before it, it was amazing.
I have photos of them doing the surgery - I asked for these because I love stuff like this and wish there was more detail on them but they're quite cool anyway (plus bonus BQ with bedpans on his head, for your delectation):
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An update to this is very much overdue. I resisted the temptation to update this frequently for a couple of different reasons. One, it's been a really busy and tough year and job/career changes time along with general life stuff has meant time has been a major constraint. Two, I wanted to complete the process so I could write about it with some perspective. I could have written about every week and covered every physical therapy session, but I wanted to document the overall process and be able to write about it as a forest thing, rather write about a series of individual trees.
This is what's the rest of the year has been like.
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Physiotherapy starts - Week 0 of physical therapy - 6 weeks post-surgery
Liz is my physiotherapist. Liz is a friendly, slightly pensive, bundle of energy of a type that can only be found in her home of Edinburgh. She's a Scottish Tigger with a philosophy degree. A former epee fencer who consistently represented her country on Team GB, she got into physiotherapy after her career was derailed by hip issues. She does competitive 10k runs and sprint triathlons for fun now. The first thing she does is to look at me sympathetically before taking away my crutch, giggling and then getting me to lift my shirt to get good look at the scar. She is duly impressed at how clean the line of it is.
My first visit is an initial assessment and quite simple: a history of my back and the progress since surgery plus a review of the notes that the surgeon sent through. We test basic neurological function of the leg and simple range of motion. That's the initial assessment done.
The conclusion is that I need lots of physio work and to get the plan right, "we" need some specialist help. I've known this woman for 45 minutes and she's already talking about "us" and "we." She's already committed. "Our" next session is scheduled with her colleague, Stephen.
Stephen is the resident back expert. A highly experienced physiotherapist with stints working with both international and professional rugby league teams, he has just completed a Master’s degree in Australia. His thesis was on techniques for managing post-operative pain for back-surgery patients.
Stephen and Liz take another assessment of me but this time focusing on my mobility in more detail. It’s more complex this time. Beyond getting up and down out of chairs, it's walking across the gym, knee drops off a step, various bending and stretching, and balance work. My drop foot is still getting in the way and I almost go over more than once. I can't bend at the waist without pain. It hurts getting into and out of chairs. Standing around is painful. Doing much of anything is unpleasant. It all jurst hurts.
Part of the assessment involves getting me to lie down on the floor but once there I can't get up. I physically cannot get my body to move in the correct manner move my body in the correct order I feel a sudden empathy for the upside-down turtle. All the movement trying to get up has me wracked with pain. They have to teach me how to move to get up off the floor. It takes me five minutes. Five fucking minutes. More time than it used to take me to ride up Notting Hill in dense rush hour traffic. That's the moment it all sinks in. I may no longer be on the floor but I am down. I. Have. To. Get. Up.
I have to unlearn everything.
That's Stephen's verdict. There are a couple of factors working against me, he explains. The first is that I've spent the last 25+ years dealing with a heavily posterior tilted pelvis. All of my conscious and subconscious movement is based around compensating for that. The second is that I've been given some shitty advice in the hospital.
Immediately after surgery when they have to move you, you are taught to "brace" for any movement with your abdominals. It helps support your back. That's what they tell you. 8 weeks after surgery and after incorporating "bracing" into my subconscious movement, I'm told what a complete crock of shit that advice is. "Bracing" with your abdominals overloads the stress of all your movement into your spine and back. It makes things more painful. I should be using my pelvis to move, not the bracing.
I don't know how to move my pelvis. I had a Cuban GF many years ago who actually gave up trying to teach me to dance "you don't have the hips for it," she would complain. "I don't know how you can move so badly!" Neither did I at the time. I don't have the muscles or control in the first place: atrophied glutes and excessively tight hamstrings and hip flexors are consequences of spondyllolisthesis.
I’m starting this process with about 60% sensation below the knee in my right leg so we have lots of work to on the nerves as well. I came out of surgery with little to no sensation in my right leg at all. It was about 40% by the time I left the hospital and has improved slowly since going home. My calf had been in perma-cramp for about 2 week after the surgery and their concern was the condition of the peroneal nerve. It could have been damaged badly by the cramp or it was a neurological knock-on effect (peripheral neuropathy) from the surgery. Time will tell.
The plan is to have me learn a new way of moving & breathing, learning to engage muscle groups I’ve never had to use, before strengthening my core enough to start to really stretch out my woefully short hamstrings and hip flexors. We have to get all of this done whilst trying to stimulate the nerves in the right leg to get them working again.
Start small and simple. Time to start getting up.
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Physiotherapy - Weeks 1-3 of physical therapy - 7-9 weeks post-surgery
I am learning how to get up from the chair under the watchful gaze of Stephen and Liz. I am doing some exaggerated unfolding that makes me think of modern dance. I focus on my breathing. I focus on my hips. I bend slowly at the waist. I put my arms down to my feet and I push.
Pain explodes. Pain tells me I'm doing it wrong. Or right. I'll remember which one it is when the pain subsides.
Wrong. That was definitely “doing it wrong” pain. “Doing it right” also hurts. It just hurts less. Degrees of pain are important here. Breathing, timing, and pushing with the right muscles hurts less. I am slowly learning to defeat the chair.
The floor is a more daunting adversary. We spend 15 minutes just rolling from my left side to my right side. Lift left knee, right arm above my head, bring my left arm over to start the momentum to the right. Reverse all that and I end up on my back. “On to your left side” orders Liz. Moving the opposite limbs in the same way means I end up on my left side. “And roll to your back. Now roll over to your right. Good! Five more, each side. ” Our sessions together have turned into me taking direction for the role of ‘victim chalk outline model’ on a police drama.
The chair and the floor rolling is all part of the learning how to move. I still spend half my time bracing my core muscles in anticipation of the movement that will trigger any pain. Pain memory is incredibly strong, as I am learning. After the surgery, I came to in the recovery room in complete agony, in the truest sense of the word. They had screwed up my pain management, well, by not doing any. That was followed by back spasms originating from the site of the surgery. I could feel them starting but was unable to stop them. When they struck, it looked like someone had put about 10000 volts through me. The uncontrolled spasms continued for 2 days. Thereafter the spasms were triggered by movement. All my movement became; brace, move, spasm. After 3 weeks the spasms had mostly subsided but the pattern was ingrained. To me all movement was pain and as a result pain in movement had become a self-fulfilling prophesy.
My rolling is improving. I can now roll from my side over to my stomach. On my stomach I can lift with my arms to get on all fours. From all fours I can move to a kneeling position before standing up. It exhausts me but it works. I can get off the floor now. Roll on.
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Weeks 4-6 of physical therapy - 10-12 weeks post-surgery
I am now doing some light swimming every morning just to get my body moving again. I slowly do laps focusing on strokes that will require me to use my back and leg muscles muscles more and more. Light gentle stuff, but it is nice to be active again and out of the house. I am self-conscious of the angry red 6-inch scar that rises above the waistline of my trunks.
I notice an elderly couple that come in every morning for a swim. She does laps in the same lane as me while her husband works on his hydrotherapy routine that works on the side of his body that was ravaged by a very serious stroke. One length of the pool with his almost immobile arm and leg takes him an age. I swim five laps to his one. Tough bastard does length after length and he emerges exhausted with a smile on his face. He insists on climbing out of the water without his wife's help. I really admire this guy. It’s good to be around that level of persistence. I look forward to seeing him every day.
Sessions with Liz now incorporate balance work. I still roll around on the floor and I get up and down out of chairs but now I have the step, walking and the balance star. The step sees me (unsurprisingly) stepping up and down, right leg first, left leg first and then balancing on my toes on the step. I walk up and down around the gym on my toes, on my heels, slapping my foot down, swinging my leg around in circles, all kinds of strange variations. The balance star is a large asterisk made out of tape on the floor. I stand in the middle of it on one foot and touch the points with the other one. It’s odd but it fires off the autonomous nerve networks and it works. I’ve regained more of the functionality, if not the sensation, in my right leg. My drop foot is less pronounced, I have an ankle brace to keep me upright and I only use the crutch when I have to use public transport so people give me a seat.
I can drive again too which is useful as I’m back at work at 10 weeks after surgery. The swimming helps, the rolling around on the floor has its uses, and the balance work is great, but I need to be able to put in a full day at the office. I’m still on fistfuls of pain killers and anti-inflammatories but that’s not a complete coping strategy. We work on seating posture, seated stretching, how frequently to get up and move around, hip stretching, and where to put the rolled up towel behind my back.
I make it through the days but not for much longer.
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Weeks 7-11 of physical therapy – 13-17 weeks post-surgery
These are easy weeks for me mostly because I’m changing jobs and on gardening leave. It means I can focus on my physiotherapy which is important given that I have an impending 3-week long holiday involving transatlantic flights, 4 days river rafting and some 2000 miles of driving. For someone who spent 10 weeks at home, and in the midst of 30 days gardening leave, it may seem strange to feel the need for a holiday. I need to get out of the house. I need that goal. Levels of recuperative stir craziness are high.
Floor rolling is no longer on the agenda but breathing and movement patterns are. Some regression on my progress is helped with another session with Stephen pointing out some of the bad habits I’ve re-acquired. It changes the focus of the physio I do at home every day.
Strength and fitness are the new keys bits of activity. But it only serves to point out how out of shape I am. I am on a turbo trainer at home now for 20 minutes a day though. I’m back on a bike at least, although somewhat gingerly. Liz and I start working on my core strength but it’s hampered by my lack of flexibility. Lying on my back Liz cannot lift my legs higher than 10 degrees before the hamstrings lock down all further movement. Any further stretching fires off the pain reaction in my back so we keep it easy. We follow this with pelvis tilts and lots of pelvic lifts.
The general neurological weakness in my right leg extends to the hips as well. I do one legged pelvic tilts with my right leg and that hip is dropping. I can’t raise it as high as my left hip. I have to pay very close attention to this sort of thing – what feels like maximum effort on the right side is about 85% of what I actually need to be able to do.
The pelvic lifts are great for me, not simply for the core strength but because it forces me to learn to control my muscles better. Body awareness is improving and with the extra control I can recognise what needs to change so I don’t trigger a pain response. I am starting to feel more in control. That’s good because I’ve stopped all pain killers by this point, not even over the counter stuff. I can’t be popping pills forever so stopping it sooner rather than later seems to be a good idea. I stopped the morphine at the hospital a couple of days early as well for the same reason. I’ve wanted to get rid of all the crutches as soon as possible.
Liz is also starting to work on getting my right calf more involved again. Short sessions of deep tissue massage on the calf are loosening things up. I’m stretching my calves daily and strengthening them doing calf dips on a stair. My leg is starting to see the benefits and although I still can’t feel anything on the skin below the right knee, the drop foot is gone along with the ankle brace. My middle three toes are still pretty numb but the big toe and small toe are strong enough to keep me upright.
In a fit of “I’m feeling great!” I jump on my bike one sunny Sunday to go to LMNH on the day of the Taggy Cat. It’s a slow 28 mile round trip, on a nice spinny 62 gear inches, and my first time on a bike on a road for months. I stretch before going and avoid any inclines and most major roads. I make it to LMNH for a nice lunch and a beer while L&W runs the event. I catch up with Jacqui who’s there as well. The last 10 miles back home are slow but I manage to make it. I can’t walk properly for the ensuing 4 days because my calves are well and truly fucked. It’s a not so subtle reminder that it’s a little over three months since having my spine fused together. Apparently the constant back pain was not strong enough of a reminder.
My optimism gets a severe dressing down by my body. The size of the task looks more realistic again. Perspective restored.
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Weeks 12-13 of physical therapy – 18-19 weeks post-surgery
The physio work has started to morph into actual gym work now. My schedule means that my physio sessions take place at a very exclusive gym in Notting Hill. A gym full of super fit, wealthy, fund managing, Type A personalities and their super fit cosmetically enhanced girlfriends. None of them pay attention to me as they pound out mile after mile on their treadmills. Liz’s bubbly personality always shatters the ‘Serious Gym silence’ that hangs over the place and can even crack smiles on the most serious cases of “I’m working out and it is serious business” face. People seem to naturally make space for us in the gym.
We spend time at one of the actual gym machines, the one that can be used for triceps work. I kneel, one knee forward, and use both arms to pull the weights diagonally all the way down and resist with my core. I unbalance myself the first time. Liz reduces the weight and that helps. We check posture and form in the many available mirrors. The corrections come hard and fast. “Straighten your hips. Resist more. More upright. Good. No. Too far. You’re tilting to one side. Don’t lean. Like this.” And so it goes.
I break into a smirk every time she says “Don’t Lean.” I couldn’t explain it to her if I tried.
I am introduced to the fit ball. I’ve had one at home for a while for my own sessions but we start to use it differently now. At home I used it for stretching and elevated-leg pelvic tilts but at the gym now we’re using it as a platform for reverse crunches. Like with the pelvic tilts the weakness on the right site comes to the fore so what I think is level is actually sloped down to the right. It’s another thing to add to the long list of things to watch out for.
It’s not just a huge challenge for me. Working with me has been a significant professional challenge for Liz. The vast majority of her work is of the 2-4 week variety, short term patients. I am one for the duration and she loves the challenge. She’s in constant contact with Stephen asking him for advice and tips and even goes off on her own looking for own techniques. For example, one challenge is that there are very few prescribed exercises for people with a posterior tilted pelvis. It’s really uncommon so there’s not much out there. Quite cleverly Liz takes a counter-intuitive approach and chooses exercises that she would absolutely avoid if she was working with someone with an anterior tilted pelvis. It seems to be working. I’m starting to get to grips with the new normal when standing up.
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Weeks 14-16 of physical therapy – 20-22 weeks post-surgery
Woo hoo!!! Holiday! I deal OK with a long transatlantic flight and with the rental car. I do some physio every morning to stretch along with some strength work to keep things ticking over. The rafting trip is a family reunion, the first time anyone has seen me since the surgery. I’m not allowed to do anything. I can’t help load or unload the boats. Or carry anything. I can’t paddle or use an inflatable kayak to run the rapids. I do however get to spend time as a passenger in a boat with my cousin’s wife and their two year older daughter. It’s a huge upside as far as I’m concerned.
I’m getting painful lightning bolt style neurological storms in my right foot now: sharp, cold, stabbing pains strike me several times a day and last for 5-10 minutes at a time. Small subtle changes after the attacks make them feel like an improvement. It does feel like the nerves are reconnecting. No pain, no gain.
The rest of the holiday is lots of time in cars which is less good for my back. I arrive back in the UK slightly worse off than when I left. Rental car seats with minimal adjustment, strange hotel beds and economy airplane seats have taken their toll.
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Weeks 17-19 of physical therapy – 23-25 weeks post-surgery
The first couple of weeks back are about getting me back on track. Lots of massage and gentle spinal manipulation are in order along with a return to some of our earlier work on movement, positioning and strength. We also start to tackle the stretching as well with some vigour. It takes a while but we start to get some forward momentum again.
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Weeks 20-24 of physical therapy – 26-30 weeks post-surgery
Progress is good ahead of my 6 months follow up with my surgeon. He displays the mentality typical of a top notch surgeon. I am fixed. I am no longer a medical challenge so he is considerably less engaged in our discussion than previously. I understand that.
He is pleased though with my state of health. All told I am about 85% back to normal in my foot which is good progress. I only need another 8 weeks of physio, after that we have reached the point of diminishing returns. I am also told that after another 6 months that’s it: whatever diminished sensation I have after that is permanent and will never improve. The best use of my time from now on is to focus on hamstrings and hip flexors. That will give me the best long term clinical outcome.
I also get some new X-rays.
I take this back to Liz and we draw up a new plan of action. The vast majority of our physio sessions to date have been once, occasionally twice a week, for an hour at a time. If we only focus on stretching now then twice a week for 30 minutes is the best approach.
Our first stretching session is painful. Liz properly pushes the boundaries on my hamstrings but it is amazingly effective. Within 15 minutes she can get my legs almost to 70 degrees and the bent knee hamstring stretches are pulling my hips up off the table. The only recourse to that is to use shiatsu/pressure point along the hip flexors and move my legs at the same time to get things stretched. It’s like that moment when you’re trying to undo at a particularly stubborn knot in your shoe laces and then suddenly you get that first small amount of give.
2 weeks later Liz can get I can get my legs up to 90 degrees, but it still takes work to get them there. Instead of starting at 10 degrees of flex, I’m starting with about 40 degrees. Everything remains phenomenally tight but we are starting to see more profound levels of change.
We now finish each session with 5 minutes of back manipulation to loosen the joint just above the site of the fusion. Loosening the joint helps to keep my back mobile and gives me a greater range of core mobility. This helps to reinforce the flexibility we gain in my hips and legs for as long as possible.
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Weeks 25-28 of physical therapy – 31-34 weeks post-surgery
32 weeks, to the day, after my surgery and I am back on my bike commuting into work. It’s a good day to do so as the weather has turned cool and most of the fair weather cyclists have opted for public transport. I leave as early as I can to give me as much time as possible. Everything else on two wheels overtakes me but I don’t care. I take up primary position and am more alert than usual but London drivers seem to give me enough space. There’s glass, other road debris and shitty road surfaces. The “woof” noise of a bus overtaking me at speed and moped fumes in the ASLs. My well-worn bag holding my work clothes is slung across my shoulder. I have a hot shower waiting for me at the gym. I soak them in. I have missed them.
One hour and fifteen minutes is my time to the office. The same commute used to take me 45 minutes. My legs feel good. My back feels good, sore but good. The ride home takes the same time. I give myself 2 clear days of recovery before getting on the bike again.
I’m still slow but at least I am cycling to physio now which helps. Liz has taken another continuing education course. She’s done 4-5 of them already in our 6 months together. She’s taken this one with me in mind. It’s not the first time our sessions together have influenced her thinking on courses. Muscular Fascia manipulation is something I have mentioned to her more than once and it’s entirely as a result of DJ’s & alien’s comments about their experiences. That’s subject of the course she’s taken. She’s eager to put it to use.
It’s the most painful stretching. It burns. Things feel like they are tearing. I am normally able to talk and banter with Liz when she’s stretching me but I can only focus on breathing and pain control. The area where she works feels like she’s magically found a smoulderingly hot piece of metal embedded in me that, for some reason, I hadn’t noticed before. It makes my vision swim so I close my eyes. But it feels amazing when she’s done. There’s less resistance to moving my legs to 90 degrees and my pelvis seems to be in a more neutral position without the hamstrings and flexors fighting to pull it out of alignment.
She finishes by working the area around my scar. With major surgeries like mine there’s a phenomenon where pain threshold around the site of the surgery becomes so low that pain signals become constant. It’s the one constant I have to deal with is the pain around the scar. It’s muscular in nature and lots of things can trigger it. I’ve just been dealing with it as part of the healing process. When she’s done, I feel great. I ride to work and enjoy my first entire pain free day in probably 5 years.
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Cycling after back surgery
Posted by
@Aroogah
As cyclists we all have back niggles at some point but when they go beyond just a niggle into something serious, then there isn't a lot of good advice. I've recently spent a lot of time looking for information about getting back to cycling after back surgery, both on and off the forum, and ended up with not much to be honest.
I found most of the information out there falls into one of two categories; 1) very cursory information; as in "your doctor will advise you on how best to....." or 2) incomplete information; forum discussions or blogs that die out. It's intensely frustrating looking for specific information and only finding medical platitudes, 4 year old threads from various fora, and really rubbish blogs.
I can complain or I can do something. So I'm doing something.
This thread then is my attempt to change that by documenting my own experience with back surgery and trying to get back into cycling. I would hope that it would encourage others to discuss their own experiences and give a platform for people with questions who may be facing surgery. There are lots of people on the forum with back issues and lots of medically trained members, physios, massage therapists, etc who would be able to contribute as well.
This thread assumes some knowledge of back physiology and terminology - Google is your best bet if you get lost.
Here then is my experience of cycling, Spondylolisthesis and Posterior Lumbar Interbody Fusion (PLIF) surgery and some of the things I've learned along the way.
Background
I was diagnosed as having spondylolisthesis about 15 years ago after a prolonged period of sitting awkwardly caused me to temporarily lose all sensation below the waist. My Spondylolisthesis was diagnosed of the isthmic variety on my L5 (lowest lumbar) which has slid forward on the S1 (sacrum). At the time I was a casual mountain biker and told to stop riding by the chiropractor who diagnosed me. A visit with a very pro-surgery surgeon to discuss options ended up as a discussion all about surgery, when pressed hard he gave me some alternatives to consider. I chose the alternative (physio therapy - core strengthening - weight loss) rather than the surgery.
8 Years later after some back problems I went for an MRI scan to see if the condition had changed. I wanted to be sure that I had not progressed beyond Grade 1 Spondylolisthesis. The verdict of the scan was that I had put on weight which was aggravating my back and I needed to be exercising.
Doc: "Running is out of the question so cycling would be a good option for you to get back into shape. Just go easy at first."
Me: "But I was told years ago by my chiropractor that I couldn't; too hard on the back"
Doc: "Bollocks. You'll be fine."
So, after much swearing and cursing of my old chiropractor, I did.
What I learned was;
1) Always get a second opinion: My chiropractor was wrong about stopping riding, I could have kept riding at the time and a second opinion would have confirmed that. Gah!
2) Always ask for alternatives: Surgeons are going to push for surgery, there are always alternatives but you need to understand your complete range of options and associated risks