Okay, 50 Plus cycling issues. Check. Threads about prostrate cancer, retirement, and 3-wheel bicycles. Check. May not like it, but this is the right place.

I'm 55-yo, ride about 2-3k miles a year, no big deal, but tend to ride hard and aggressive. Oh, also bike commute 2-3 times a week about 15-miles round trip.

So an MRI last week shows a disc protusion between L4-L5. This is white-knuckle, grit the teeth and grab the back of a chair sustained and continuous pain.

Steroids and Tramodol help, but I want this fixed and have no fear of surgery. No messing with chiropractic back rubs or more drugs, let's get this fixed.

Here's the question; people knowledgeable about neurosurgery, but no knowledge of cycling, are saying 4-6 weeks off the bike. Sound right?

How long has this been going on? Some back issues get better even if very painful right now. Surgery on back does not always make things better. Be careful before under going knife.

Get at least 2 and maybe 3 opinions about surgery. Surgical skills vary wildly. A friend ruined for life (now wears diapers). Web sites, check for complaints and suits on your state website, ask OR nurses who they would choose.

Do have fear of back surgery. I very, very carefully chose my surgeon for an L-4, L-5 fusion. Walked a mile in the next morning, out that day, rehab with walking 2-3 miles per day, on mtn bike in 18 days. I was 71 at the time.

Good luck.

Medical professionals are recommending physical therapy and activity almost immediately after most surgeries now, including total joint replacements. My mom, who's had total knee and shoulder replacements surgeries, and a good friend, who's had a hip replacement, were both up and out of the hospital bed within hours after surgery, and daily afterward. The immediate goal is to minimize the risk of pneumonia. Afterward, strengthening the joint and physical recovery.

So being back on the bike in 4-6 weeks or less sounds reasonable, assuming no complications. With a safe spinner/trainer at home you might be able to work out within a week or two.

Hospitals are also discharging patients much earlier nowadays, in part to protect patients from nosocomial infections (which is a good thing), and in part due to pressure from insurance companies (not always a good thing). Be sure you have a plan for followup physical therapy. If you're a self-starter, even in pain, your recovery will probably go well. But be honest about your tolerance for pain - most folks delude themselves about how much discomfort they can tolerate and still be self-starters. None of my immediate family members who had joint replacement or extensive spinal surgeries were cooperative with physical therapy and consequently never healed properly or got much good from the surgeries. As a result I personally followed through on my mom's physical therapies following knee and shoulder replacement surgeries. She doesn't do pain, at all, and can't even tolerate sniffles from allergies without insisting on a trip to the ER. She griped constantly but got through it without complications and, unlike my grandparents, her replacement joints don't pop loose from atrophy of muscle and connective tissues.

Two older friends who had hip replacement surgeries experienced the two possible extremes as a result of their attitudes toward recovery. One friend cooperated with the physical therapy and resumed playing tennis as soon as possible. She's slowed a bit at age 70, but is still remarkably active. Another friend wouldn't cooperate with physical therapy, developed pneumonia and died soon after.

Also, if you haven't had the full knockout regimen for surgery and the immediate followup treatment for pain before - anesthesia and morphine - do be aware that some folks have lingering aftereffects that can last weeks or months. Be sure to give permission to a family member or close friend who knows you very well, good and bad temperaments, who can advise medical personnel if it appears you're not acting like your usual self, and to take decisions on your behalf in case of emergency: hallucinations, cognitive difficulties lasting more than a day or two after surgery, mood swings, any unusual physical or mental disorientation.

I live in an apartment complex that caters specifically to folks over age 55 and many with disabilities. Many times over the years I've seen neighbors who were discharged too early and were still disoriented and either fell at home or wandered around lost in the building or around the neighborhood. So be sure you have someone available to check on you daily for the first week after surgery, both in the hospital and at home.

Regarding the surgery itself, I can't offer any suggestions. My observations of several folks who've had spinal surgeries only indicate there are too many complexities and individual differences to generalize. My grandparents both had spinal fusions in the 1970s and it didn't help much. Both suffered from chronic pain and limited mobility for their remaining 20-30 years. My mom had two kyphoplasties which did seem to help, but due to her very poor balance and gait she continued to experience falls and is now too old to be a candidate for surgery, so the only alternatives are local anti-inflammatories and pain meds. My dad got some relief from the anti-inflammatory injections in his 70s and was able to get back out of the wheelchair for his final couple of years of life.

I'm sure there are success stories with back surgery for folks aged 50 or older, but I would decline surgery for my back and neck injuries until I've exhausted every other possibility. I'll stick with anti-inflammatories and occasional pain meds. I've made some concessions to age and chronic neck/back pain by getting a bike with a heavily padded springy saddle, suspension fork, upright bars, and fatter tires than I used to ride.

I second the idea of getting multiple opinions, and considering non-surgical remedies before going under the knife. As for recovery time projections, that's something to discuss as a consideration when deciding if, when, and by who you have the surgery done.

This isn't something that you need to deal with immediately, so take your time and proceed when you feel comfortable with the decision. IMO- the very fact that you're here questioning the information the likely surgeon is giving you is a sign that you don't have an adequate level of trust in him.

I have spinal stenosis primarily in the L3 - L5 region. Fortunately my spine doc is a cyclist and he recommended surgery as a LAST option. He told me to get a better bike than my 2015 Cannondale SuperSix EVO 105. Traded it for a leftover 2014 Cannondale SuperSix EVO Hi-Mod team bike (couldn't pass up on the super price). Very comfortable. He said my Litespeed was a great bike for my back. He said leaning over stretches out the spine and relaxes it. He's right!!! He also suggested I get an inversion table. Both the bikes and the inversion table work wonders on my back.
BTW: I'm 71.

MRI evidence of bulging or herniated disks are not necessarily the cause of your problems. I have numerous friends and relatives who went straight to surgery as you propose (let's fix this now) who unfortunately got no relief for the original problems --and also had new pains and problems as a result of their surgery. I also have friends who got great results.
Some years ago Scientific American (quoting numbers from memory here) did a study comparing (1) people with MRI evidence of disc issues, and (2) people experiencing severe back pain. The study concluded minimal correlation between the two groups (I think they concluded 20% of population goes through life with reasonably extreme herniations, and 20% of the population experiences debilitating back pain, but the groups show very little correlation). They further suggested an observed ~75% success rate from back surgery --and, of the remaining 25%, a large percentage (I don't remember exact number), got worse. They also suggested 85% of population experience some significant back pain in the lifetime, and it almost always just goes away (again can't remember exact number but 90% rings a bell). Those all roughly match my experiences (35 years of various types of back pain that all came and went with no surgery).

A more recent study I've read suggested back problems with sciatic pain radiating to specific spots down the lower extremities had a higher success rate from surgery than those who had surgery for more localized (lower back) pain. Unfortunately my pain is mostly localized with not so much sciatica. No surgery for me.

I guess I should add - I did extensive physical therapy, acupuncture, inversion table and you name it prior to my surgery. It was not something I took lightly. I was to the point of not being able to stand up, and it was spondylolythesis - which is pretty bad - not just spondolylosis, plus I have stenosis - narrowing of the canal.

A good doc of my wife once said "We treat symptoms, not MRI's"

Ask PT's who does the best job. They know, if they will tell you.

And, yes, I am driven to do the physical therapy correctly AS PRESCRIBED and it pays off - really pays off. My wife the same with two knee replacements - she has full range, followed PT orders to the "T"

Can disc herniation cause that kind of pain? Absolutely.

Hopefully your surgeon recommended microdiscectomy - removal of the offending disc via minimally invasive approach.

If you have some arthritis there too, it'll cause bone growth where you don't want it and possibly impinge on the nerve roots. That's one of the things most people don't understand about arthritis (technically degenerative joint disease excluding rheumatoid arthritis) - DJD bone grows where you don't want it and causes problems when it gets into sensitive/painful nerve areas.

So typically a surgeon will do a laminectomy - scraping out the arch of the vertebra of excess bone growth - to allow free spinal movement without impinging on anything - at the time of discectomy if needed.

And here's where we get into one of the really fuzzy areas in science. Any time you do a laminectomy, you risk developing scar tissue just because of the surgery, the resulting insult to the structures involved, and the healing process involved. So just doing any invasive surgery carries the risk of scar tissue causing more problems than the original problem. There is even a condition called postlaminectomy syndrome where so much scar tissue has built up that the spine is really not very functional at this point, and there's not much science can do because further surgery to break up the scar tissue only makes it worse.

So I would be OK with microdiscectomy and +/- on laminectomy for the reasons mentioned above. Minimally invasive laminectomy is less injurious than open (i.e., wide incision) discectomy, but technically more difficult for the surgeon.

This is why a conservative approach is usually the best first option. Start right into surgery without exploring conservative options first, and you open yourself up to the possibility of the surgery doing more harm than good. Correct one problem but cause another.

A bit of first hand experience.

Some years back (age <50) I had debilitating hip pain to where I could barely walk. Went to an orthopedist, who took X-rays, pointed out potential issues and suggested surgery. According to him, there was no way to be 100% sure of the extent of the damage, and what kind of artificial hip would be best until/unless he opened it up and looked. That wasn't reassuring, so I sought a 2nd opinion, who confirmed that there was probably some damage, but didn't think it was all that bad --- yet. Suggested managing with pain meds and steroids, but because of his own doubts, he sent me to his guru, -- the head or orthopedics at a decent sized hospital.

So, I walk (limp) into his office, lay my X-rays on his desk, and before he looks at them he crumples a sheet of paper and tosses it across the room. He asks me if I'd do him a favor and retrieve it from the floor, which I do.

"Nothing wrong with your hip".
"But you haven't even looked at the X-rays or reports"
"didn't need to, I knew it when you walked in, and confirmed it when you picked up the ball"
"so what is the problem?"

He sent me for spinal X-rays, then reviewed them in front of me pointing out calcification and narrowing of the spinal channel. I asked what they did about that, and he said they open it up, and "roto-rooter" it out so there's enough room again. But, he said, he wasn't going to touch me. I was too young, fit and active to risk the surgery, and I was going to fix it myself. He sent me for physical therapy, and I was 90% better within a month or two, and h=just about 100% ever since, except for flareups, which I manage through exercises.

Point is I was lucky not to trust the 1st guy, and extra lucky to find an old timer who knew his crap, and was honest enough to pass up a chance for a fat bill.

My advice, take it slow, confirm everything, and try anything that doesn't involve cutting, saving that for a LAST RESORT if/when less aggressive approaches fail. There's no urgency here, and you can cut at any time, but you can't uncut once you do.

The only downside to this is living with the pain while you waste time delaying surgery that may turn out to be absolutely necessary, and may resolve the issue. Compare that to the real risks of surgery -- any surgery.

I also had narrowing of the spinal canal, but cervical, and due to an accident and bone spurs. They did not operate at first, "too young and healthy." They chose to operate after I woke up one morning and my left arm no longer worked. Luckily, they did a great job and I regained most of the use of my arm and hands.

if I was the OP, I would not be in a hurry. Get other opinions, try other things. I have read about what the research shows, and buldging discs can have many meanings. It would really suck to recover from a surgery only to find out it did not solve the problem!

I think that each case and person is likely different. I had a severely herniated disc with terrible sciatica about 7 years ago. It got to the point where I was barely able to walk, in extreme pain all the time, could not lie down to sleep and on serious pain meds without much help. I went for therapy, cortisone shots, and whatever else was available until my doc suggested that we had exhausted all options and that surgery was now the only real option.

Many people told me to be wary of surgery, so I was very reluctant, but felt I did not have much choice. I recall waking up in the recovery room and was ecstatic when I realized that for the first time in many weeks I was not in pain. It was the best thing I could have done and I am sorry I did not go sooner.

I would agree that it is best to be conservative and try other options and get more than one opinion. At the same time, sometimes surgery is the best option. The pain and other issues may let you know when it is the way to go. Good luck.

Please wait and take a conservative route.

10 years ago this month I slipped on ice and 2-3 days later I had real (9 to 10) pain in my back, hip and foot. The MRI showed a moderately herniated L4-L5 disc with a moderate to severe pinched nerve.

I went to a neuro surgeon who wanted to operate; but gave me 2 injections. After 3 or so weeks the pain got less each day.

I then went to PT and got 4 simple exercises and the PT said DO NOT have an operation until you have no other options and can no longer tolerate the pain.

I followed his advice and am doing great now. Yes if I lift wrong or do too much my back will hurt for a while.

I have ridden a lot of miles including many off road rides.

Good luck!
Wayne

Yep, been there 10 years ago myself. Ruptured a couple of discs and several other herniated. So bad I spent 4 days in the hospital unable to move from the pain. Did physical therapy, learned my body better, don't do anything stupid anymore and 10 years later I do fine and still no surgery. If it flares up I use ice on the back, sleep with pillows under my knees, etc. Sometimes the pain manifests itself in extreme pain inside my right hip joint but it's caused by the back. Nowdays, I can be in extreme pain one day but with proper care I'm back to normal the next. I bike thousands of miles a year and hike all day long in the mountains during the summer. I'd hold off on the surgery too if at all possible.

I feel your pain.

I'm 60yo, 30 years ago I ruptured l4/l5 doing multiple stupid things (also have scoliosis). I deserve what I got. Never stopped playing sports and being an idiot. Occasionally totally disabling pain/discomfort. In tears unable to get off the floor for hours. Trips to the ER. Right foot has been asleep for 15 years. Years ago met top two back surgeons at two major hospitals in Baltimore. Both were adamant about no surgery. If PT, massage, chiropractor, exercises work to get me walking and out of pain, then keep doing those things that keep you right. Then just modify whatever behavoiur that will get you in trouble.

I can bike 40 miles, but can't carry a case of beer up the steps in my house.

Good luck, relax, your back has been abused for 50 years, treat it nice for a few weeks and see how it responds.

When I first experienced my L4-L5 herniation I thought I was "done". The neurosurgeon I saw told me that I was not a likely candidate for surgery because my fitness level was high and I would most likely recover with out it. It took a a few months and a couple of rounds of epidurals but it turns out he was right. The neurosurgeon also recommended that I continue to exercise as best I could, which turns out to excellent advise. The pain makes you think very negatively but you can get through it. Keep in mind that doctors can't really heal you, but it's ONLY your own body that can heal itself.

I am also a mild proponent of localized injections to the spine area (yes those same ones that permanently damaged some folks when the meds were contaminated) that mix anesthesia and steroids. They not only offer immediate relief and possible long term relief (reduced inflammation), but also a huge diagnostic value. If you inject at the L4-L5 area and the pain doesn't subside much, that might not be the problem area. After 7 or 8 of those injections with diminishing relief we tried injections to the facet joint areas. Boom. Pain gone. I have various levels of herniations L3 through S1 but those appear to cause very minor problems that respond to conservative treatments. The "severe" pain localized to the lower back was a facet problem all along. All those doctors who pointed to the MRI and insisted surgery was the only option -- were wrong. Several rhizotomy procedures later I am much better --and SO glad I kept researching and kept trying non surgery options.
I am more active now and occasionally aggravating those lesser problems, but much happier.

My recommendations for reading about nonsurgical options would include the following authors. Pete Egoscue, Eric Goodman, Esther Gokhale, and Dr. John E. Sarno. Amazon will take you to their books and others. Due diligence, of course. Good luck!

All: I deeply appreciate all of the responses. On my way out the door in a few minutes for my steroid injection (With a needle as big as a pencil lead, right into my spine. I might ride up and down hills for 50-miles and hours on end in 100F Texas heat, but I don't do that kind of pain anymore! General anesthesia? You bet!). More later.

Sounds about right. PT before and after is a great idea. No surgery unless you can't get relief with PT.

Is this just trimming of the disc or a fusion that is being proposed? Fusion would probably be the longer of the two.

My wife had a C4-C5 fusion and was skiing in 6 weeks. Her pain was less 2 hours after surgery than 2 hours before - dramatic reduction in pain. Her pain symptoms were burning pain down her arm where she was on heavy Vicodin regime for weeks before the surgery. After surgery she was largely pain free from the nerve impingement but obviously sore from the surgery.

Treat aggressively, the longer you have the pain the longer it will take you to recover from the nerve inflammation (which can be an aggravating long time). The sooner you resovle it, the faster you will recover and the sooner you'll be back on the bike. The point here is that procrastinating now isn't going to get you back on the bike faster and if it hurts like you say it does, you're not going to decide go/no go based on time to get back on the bike. Docs I know who have had problems like this let it go days not weeks before they resolve surgically if no benefit from PT.

Good advice to get surgeon recommendations from your PT. Also, to look for in the surgeon is how many of these surgeries that that do. Minimum is probably 1 per month, but you should be able to find one who does at least one per week and if you're in a big city, probably a surgeon that only does that procedure. That is the guy to pick.

J.

Was this a sudden onset of symptoms, or sudden worsening of symptoms? Or has it been the same for a long time?

I have always had minor low back issues on and off, suddenly got worse about 2 months ago. Very extreme pain, MRI said disc compression on S1 nerve.

I did go talk to a surgeon. He read the MRI differently, said it was a disc fragment and that with PT, antiinflammatory medications, and time, there was an 80% chance it would resolve. If surgery was needed, he said, it is the least invasive kind of spinal surgery but still there are risks and sometimes the patient does come out of surgery worse than going in.

His take - which I appreciate from my own experience as a clinician - is that whenever possible it is good to try the less invasive, less risky treatment first. In my case, if the 6 months of conservative management doesn't work, he can still do his thing.

When this thing first hit me, the pain was so severe I could not imagine conservative treatment working. But actually, it has. I did PT twice a week for a month and still doing their exercises religiously every day. Being a lot more careful about how I sit, how I pick things up, and modified how I do some of my procedures at work. I've been pain free for several weeks now, swimming and cycling with no problems. Actually, the PT work with improved core and posture has made my swimming a tisch faster.

Who knows, I may need the surgery at some point, but I appreciate this surgeon's advice. Even if the risks are relatively rare, it's best to avoid them if possible.

In seeking multiple opinions, it's good to find surgeons who are very comfortable recommending non-surgical treatments or at least trials thereof. Some surgeons - some I have worked with - fall very strongly into the "if your only tool is a hammer, then everything you see is a nail" syndrome.

Do you mind telling what the 4 simple exercises where.

Think I would be looking at remedial action first, had my op over 30 years ago in my twenties.
Overall I was off work for seven months, on traction for 4 weeks and months of seeing a phyiso.
However my scan showed the disc pressing onto my spinal cord and causing damage plus i couldn't walk or care for myself.
For many years after the op I lost at least 2 weeks work a year with sciatica until an osteopath managed to finally cure a nerve
that kept getting locked.
I live a mainly pain free life however have lots of muscle scaring , stiffness an some loss of sensation in my left leg.

Yes the op gave me a mainly good life back which I enjoy limited sports like riding my bikes, I would think very carefully before rushing in, my surgeon operated because it was the last and only option.

Good luck and think carefully about your options, its not like having a tooth out the get rid of tooth ache.

Cheers Phil

1.) lying on my back raise one foot, Just off the floor, hold for 5 seconds lowering & repeat 10 times. try and not let my foot hit or stay on the floor.
2.) lying on my stomach raise one foot and the opposite arm raise both just above the floor and hold for 5 seconds and repeat 10 times.
3.) lying on my stomach with my hands next to my head raise my shoulders to where I am supporting my self with my elbows, hold for 10 seconds and repeat 5 times, I now do 10 times.
4.) lean down on one knee, keeping the other foot flat on the floor, lean back stretching my back keeping it straight, hold for 30 seconds and repeat 3 times, and do this with the opposite knee on the floor.

When my back gets stiff I also place both hands on my waist just above my hips and lean back and hold for 30 seconds.

Work on core strength and flexibility both help.

Wayne

Thanks Wayne