Tri-training Post Lumbar Microdisectomy

I am four weeks post-op of a L4-5 microdiscectomy. I'm able to swim a mile and walk three miles. I tried to get on my bike three weeks post op, lasted ten minutes, and have been paying for it ever since. A new MRI just shows inflammation but no re-herniation. PT will start next week.  

I need some encouragement.  When can I start biking? Running? Lifting? Any precautions?

Answer by Caitlyn Mooney, MD 
Member AMSSM

The spine is made out of multiple bones or vertebra and in between each vertebra are disks which are cushion-like structures.  Each disk has an outer ring and a softer inner portion. Sometimes with injury or aging the inner portion can bulge through the tougher outer ring and this is called a disk herniation. Herniations can range from causing no pain to extremely painful. Additionally the herniation can press on nerves creating nerve dysfunction which can result in pain that radiates to the areas that the nerve serves as well as weakness, paralysis, numbness, tingling, loss of sensation in the area of the affected nerve, or loss of reflexes.  In the lumbar or lower spine the sciatic nerve can be compressed causing irritation.  This results in lower back and buttocks pain as well as numbness, pain, weakness of the lower extremities.

Most of the time herniations can be treated with conservative care including anti-inflammatory medications, pain management, and physical therapy. In the case of severe pain, pain that is not improved with conservative therapy above as well as leg weakness, bowel/ bladder dysfunction, then surgery may be indicated. One surgical option is a microdiscectomy or micro decompression surgery. In this surgery a small piece of the bone or vertebra is removed to decrease the pressure the herniated disk places on the underlying nerve. The surgery may also provide more room for the underlying nerve to swell and heal.

Microdiscectomy is most successful in relieving pain in the legs that is caused by irritation of the nerve. It does not typically resolve back pain, as the underlying causes of the back pain including degenerative disease, arthritis, or poor core strength have not been corrected. The weakness and pain in the legs or feet typically resolves soon after surgery.   

Based on your question I am unsure of what is holding you back on the bike. Do you have recurrent back pain, leg pain, or weakness? I would defer to your own surgeon for when to return to these activities as surgeons have specific rehab protocols that they use. Additionally they should know of any concerns you have regarding your outcome. Your doctor along with your physical therapist can access your function and thus will be better able to tell you when it is ok to go back to certain activities. Post-operative management is often based on individual factors such as your individual range of motion, strength, and flexibility.  As there is not a significant amount of bone removal with this procedure and it requires no bony healing and does not alter the architecture of the spine, typically healing time is relatively short. Physical therapy is often the most important thing for recovery. Physical therapy is aimed at addressing strength, motion, flexibility, core conditioning, posture, and aerobic activity. It is important to address residual deficits, residual pain. Physical therapy also prevents re-injury.

Outcomes and efficacy with physical therapy after a microdiscetomy will vary based on your age and underlying medical conditions including such conditions as arthritis of the lumbar spine and what residual symptoms are limiting you from pursuing your activity.

Caitlyn Mooney, MD 
Primary Care Sports Medicine Fellow 
Case University Hospitals/ Rainbow Babies 
AMSSM Communications Committee Fellow Liaison