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You are here: Home » Physical Therapy » Do I Need Surgery to Fix My Back?

Do I Need Surgery to Fix My Back?

By Mike Uhrlaub

Hey everybody, this is Mike Uhrlaub with another episode of Power Your Life. This is a common question that I get all the time from my clients. For many people with back problems, that’s one of the first things you think about when you experienced an injury for the first time. You may realize you’re having trouble putting socks and shoes on in the morning or you may get a shooting pain when you try to lift your leg to put your pants on. Whatever the case is, you end up thinking of all types of concerns. Surgery is a valid concern because there are cases where you might need surgery and there’s other cases where you won’t need surgery at all.

Let’s Meet Matt

It’s a matter of knowing which one it is because this is a common concern that we all have. I wanted to share with you the experience that I had with a good friend of mine, Matt, who is my client now. Because I don’t want to violate HIPAA, Matt isn’t his real name. However, Matt has back pain. I want to give you a little bit of backstory about Matt and go from the beginning to now with his experience. Hopefully, this can help you.

I’ve known Matt for almost 30 years, and he’s been a very good friend of mine. Matt was a former power lifter. He still actively lifts and he’s still a big, strong guy, he did a lot of heavy lifting back in the day and we used to compete against each other in power lifting meets. Matt was extremely strong, and he could squat the world, in fact he could squat well over 700 pounds, bench press over 500 pounds, and deadlift over 700 pounds. However, over the years, that took the toll on Matt’s back, just like it did on mine.

Soreness and Back PainSkeleton holding back indicating pain - Surgery

He would get ahold of me from time to time and he’d have to come into the clinic. We would get him straightened out and he would be good. He would just get a little soreness in his back and it would feel like he was very tight, and he couldn’t get it stretched out.  We’d bring him in, and he would be good to go after three or four sessions. This would last him around six months to a year. Then, something different happened. Last year, he started having more pain in that right side of his lower back that bothered him when he was stooping.  It was mostly when he was trying to brush his teeth over the sink.

This motion was really killing him in the right side of his lower back. So, we started him on another round of therapy. However, this time was different because his body wasn’t responding to what we were doing before, and I knew something was up. After around the sixth session, he came to me and complained of a clicking coming from his SSI joint area. He mentioned that every time he lifted his leg, or he bent forward, there was a clicking. I checked him out and I could actually feel the clicking that was coming from back there.

What Was Wrong?

Nothing seemed to be out of alignment, and we were addressing all the right things, but he was still having that pain. I referred him to a back specialist and a spine surgeon. Initially, they decided not to do anything other than some injections and they basically told him to go back to therapy. So, he got a little bit better, but then right before Christmas time, he started getting pain in his right big toe, which was starting to go numb. That’s when I knew that he was not getting better. I stopped things with Matt and told him that he needed to go back to his surgeon.

He went back to a surgeon and they did an MRI. They found that his discs were very bad at the L5 and S1. Then, there was a cyst that had formed along the nerve root. Ultimately, it was decided that the best approach for him was to get it surgically fixed. He went in and had the surgery, which was an L5 S1 fusion. After the surgery, there was still a big cyst on the nerve, on that right side. This is what was causing the pain down the leg.

There wasn’t anything that anyone was going to be able to do to take that cyst away, other than to go in and take it out. Because of the shape of his discs and the vertebrae, they didn’t have a choice but to do a fusion. In Matt’s case, that was what needed to happen, but where it gets interesting is when Matt called me up about six weeks after surgery. He told me that his surgeon wasn’t recommending that he do any therapy.

Issues After Surgery

He was having some visits with the therapist at the clinic, but he said he wasn’t getting anything out of it, and they weren’t having him do much. I asked him what issues he was still having, and he mentioned he still had the numbness in his big toe and that he couldn’t lift his foot up if it was flat on the floor. The surgeon told him that this was just part of the inflammation around the nerve and that it will get better with time. Matt couldn’t understand why he was waiting if he was just going to come in and get that nerve firing again.

So, I told Matt that if you have a compression on a nerve root, it comes off like straw. It basically comes of off the spine and that travels down into the muscles. Then, the electrical impulses go through that nerve. It’s like trying to drink a milkshake through a straw, and you’ve clipped the straw. Anytime you activate that nerve, you’re going to increase the ability for it to heal. Matt’s surgeon telling him that he doesn’t recommend him doing therapy doesn’t make much sense.

This is What Frustrates Me

That is what frustrates me the most with our current medical system. In Matt’s case, the problem was the cyst needed to be removed off the nerve, so they fused the vertebrae together. Then, his doctors think they do not need to do anything further, which does not make sense because the problem is all of the imbalances, which is what placed the extra stress on his spine to cause the cyst to form and to wear out the disc. Those imbalances and those other issues are still in his body. Not to mention, he has a nerve that isn’t conducting the impulses enough. I told Matt that it was his choice. I said that he could come back in and start working on this, or he can listen to his doctor.

Be Proactive About Your Health

As a patient, you must be proactive with your own health to know what you need to do.  You can’t be passive and just sit and wait, because you may never get the ability to lift your foot back up. So, he came back in and we started working with him. Because he had a fusion, I had to be very careful and mindful of that surgery. You just can’t start going at it hard and trying to rehab his entire leg and body.

When we first started working with Matt again, he could not sit down and lift his foot up. He couldn’t break it off the ground. Now, he’s able to break it two inches up off the ground. He’s within about an inch of his other side. He is now walking better and he’s feeling better. He can’t bend forward too much because of that fusion and the healing that still has to happen. When we talked about the importance of the hips and getting the hips to open, the hips must be moving and healthy for your spine to be moving and be healthy.

Matt was wondering why nobody has told him this. That’s the other thing that frustrates me with the medical system; there is not enough information coming out. With Matt, he has one segment of his spine locked up and that segment is never going to move again. It’s fused together, but you still must be able to eventually bend forward, backward, twist, bend, and lift. You must be able to put your socks and shoes on.

The Domino EffectDominos - Surgery

All the added stress that your spine is going to take is now going to be spread upon four discs instead of five, which means there’s increased stress. Now, your hips are directly related to your spine. So, if your hips are not moving correctly, imagine how much more stress is going to be generated into the spine. That leads us to what we call “Domino Effect.” This is the chain of events when on level starts hurting, you get it fixed, and then a few months later, the level above that starts hurting. The cycle just continues to go on.

The message that I want you to take from this is if you do have surgery and that is the direction you must go, remember that the surgery just fixes that structure. It doesn’t fix the part that’s generating the pain. It does not fix everything that caused that to happen and it doesn’t fix the root cause. Matt mentioned to me that he had a younger friend named Jeff. Jeff had a fusion a few years back and now his back is getting bad again, which is making him look at getting another fusion.

This is exactly what I meant by the Domino Effect. In Jeff’s case, his problem was causing the wearing out of the discs. Those causes were never addressed because Jeff never went back to therapy because his doctor said he didn’t need it, which was a huge mistake. Surgery fixed his issues, but it doesn’t fix the reason that the issue started. It doesn’t fix the root cause.

It’s All About Balance

I like to explain this as the front end of the car. So, when your tires on the front end are worn out, you go to the tire store and you get a new set of tires. Now, if you get a new set of tires and you don’t realign that front end, you are going to wear those tires out again within one or two years. Immediately, your car is going to drive great, but over the course of time, you’re going to get an uneven wear. You may even get excessive wear to the point where some steel belts might start to poke through. Now, you’re right back to where you were, and you must get a new set of tires all because there wasn’t any alignment.

You would never think about getting a new set of tires that cost you anywhere from $700 to $1,000 instead of spending just $100 to align your front end. It doesn’t make sense. It’s the same thing with your body. With your body, you must address the imbalances. It’s these imbalances that cause that portion of the spine to wear out. These imbalances are occurring because of the unnatural forces that are being pushed onto your spine. This could be tight hip flexors, weak glutes, weak lower abdominals, etc.; these are all things that could place compression on the spine.

Nutritional Imbalances

There are also nutritional imbalances, which is very important. In Jeff’s case, some of the degeneration that he’s experiencing was because he was eating a standard American diet, which is very acidic. It promotes increased degeneration of the cartilage and the collagen in your body, because your body is more acidic. So, if you’re not balancing your nutrition, you’re putting yourself at a huge disadvantage. Then, there’s the mental imbalances. This is how you manage stress and how you balance your life. That has a huge impact on your overall health as well.

Whether you have surgery or not, you must fix what’s caused it. You’ve got to get in and you’ve got to see somebody. You need to have them analyze all these imbalances that are existing and then work step-by-step to correct those. You are going to be mistaken if you think you can just have surgery and be good to go. So, I tell my clients that sometimes surgery is necessary, and sometimes it is not. However, you should always be more conservative at first because you can always do surgery later if you need to.

If you do have surgery, then you must understand that it does not fix all those imbalances and all those issues in the body. Those must be addressed, or you’re going to be right back to square one. I want to leave you with a quote from Winston Churchill. It says, “Without courage, all other virtues lose their meaning.”

The Five Best Kept Secrets to Fast Back Pain Relief

If you would like to learn more about how to fix your back, just shoot me a message on Facebook. Ask for my new free eBook that’s called “The Five Best Kept Secrets to Fast Back Pain Relief.” I’m more than happy to send that to you. It has got a lot of great information in it.

Until then, keep moving forward.

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Filed Under: Physical Therapy Tagged With: back pain, balance, health, imbalances, Mindful, MRI, Proactive, Spine, SSI Joint, surgery

About Mike Uhrlaub

Head physical therapist and leader of Flex PT in Council Bluffs, Iowa. Mike's a unique kind of therapist that believes everyone should be treated like they are a VIP regardless of insurance or financial status.

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