6 months post op

Nick is now 6months post op. He continues to progress well and is noticeably better than one month ago....

• Sitting is no longer a problem for him
• He now stands straight pretty much all the time and it is becoming more natural and less of an effort for him. When tired he does still need to concentrate on standing straight though as his back muscles are not yet fully strengthened
• Still has tight hamstring on his right side, resulting in him being noticeably still a little lopsided....

• He does physio stretches, movement work and core strengthening work every day at least once, usually twice
• His core is improving and beginning to engage properly, resulting in a better connection between his upper and lower back and his hips. As a consequence he has started to use his hips again when playing tennis.
• Tennis. Can now manage a couple of hours at a time and has played some competitive matches. He's discovered that, not surprisingly, his consistency is poor and he gets tired easily. He played in a National tournament in May and was a little demoralised to see how his peer group have progressed in his absence. However, being Nick, this has simply motivated him more to improve
• School. So far he has managed to sit through all his exams without issue and only has two left so we are hopeful that he will be alright
• Emotionally. Happier as he can now play tennis again, although being in the middle of his GCSEs means that he's not exactly ecstatic! Does get frustrated with his standard of tennis and lack of fitness and has come to realise that returning to his former standard will take a while.
• Outlook - we are anticipating him needing only a few more physio sessions, but more strength and conditioning and movement work as they will take a while to fully recover.

 

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10 weeks post-op: ups & downs

10 weeks post op and I have to admit that I'm not entirely sure where Nick is at. This week has had it's ups and downs, some improvements and some setbacks....

• Last week he managed three half days at school and then the half term break started. On the positive side, it felt like he was managing greater chunks of time at school, and by the end of the week he managed a double lesson without having to get up in the middle. On the other hand, he still needs to lie down at break, lunch and free periods and he didn't manage a full day.
• He had a school trip to the theatre one evening for his GCSE controlled assessment - 2 hours and 20 minutes including the interval. When he got home he seemed OK - certainly a lot better than I was expecting and he didn't want a painkiller. But the next morning he was absolutely exhausted and didn't make it into school until lunchtime. But at least he made it.
• Sitting - still a problem, but he hasn't done much in the last few days as he is taking the half-term break as an opportunity to rest as much as possible
• Posture - generally good except when in pain
• Straight leg raise, about 60 degrees on one side, 90 degrees on the other
• Exercise - not doing much. Doing his physio exercises (same as last week) but focusing on his pelvic tilts. He thinks that they are getting easier, but he's not sure. I'm doing a lot of hamstring stretches with him.
• Tennis. His physio said that he could try some gentle hitting, max 15 mins every 2 to 3 days. He hit against the wall in our garden yesterday and said that it felt OK. He was a little stiff in unexpected places afterwards, but the stiffness seems to have gone today so I suspect just a case of waking up some muscles.
• Sciatic pain - not routinely mentioning any. A little reoccurrence when stretching his hamstrings out fully.
• Buttock pain - seems to gone completely, at last.
• Bending forwards. No change and he is getting increasingly frustrated by this. I noticed that when he bends over with his knees bent then he is quite lopsided. When I took the photo below he swore to me that he was even, and didn't believe otherwise until I showed him the photo.

 

• Sports massage. Is loving them. And coped much better with school the day afterwards. Next one tomorrow.

Emotionally. Tricky this one! He sort of lost the plot a little over the last few days and ended up doing pretty much not much at all other than lying on the floor. In the end I lost my temper with him and that seems to have jolted him out of it and today he has been back to doing his exercise with gusto. And he has resumed his school work too. I felt pretty crap, but I knew that he needed it.

Overall, if I am being honest both Nick and I are a bit concerned that he has not improved more. We both keep being told that it will take a long time but sometimes I wonder if we are clutching at straws when we see an improvement. And I spend a lot of my time trying to stop myself worrying about it. But it's not easy! I keep deciding to book an appointment with our GP, but then I don't as I wonder whether we are just being impatient. I am beginning to try and find out where he should be at at 3 months post op as we are nearly there and 3 months seems like a long time.

 

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8 weeks post-op - tough times

This last week seems to have felt like really hard work, for both Nick and myself.

Nick has found it very tough trying to get back to school, constantly trying but not managing. And every time he does make it to a lesson he ends up with more work to do whilst having to recover from making the lesson in the first place. He admitted to me that he had considered stopping school completely, which is extraordinary for him because he has always been completely determined to complete his schooling.

He was in school for a full day yesterday, which we now realise was a bit too soon. He was absolutely shattered afterwards and consequently needed a lie-in the next morning.

He is also still worried that something is not right, or at least that he is not progressing as much as he should be. His physio was re-iterating to him yesterday that it will take time because his nerve was compressed for so long. Also, Nick was using how far forwards he could bend as an indicator of progress. The physio discouraged this, pointing out that other aspects may be improving (eg how long he can sit) so he shouldn't focus on just one indicator.

He's had the start of a couple of flare-ups, but each time we have managed to divert it by rest or Diazepam. Each time it has been sitting that has caused the problem.

People are now starting to ask when he'll be starting to play tennis again - well meant questions but for someone who struggles to sit yet alone run it doesn't really help being asked when he can play tennis!

His year group at school are going through various activities designed to help them plan university/career paths which is creating another cause of anxiety for him. Hardly surprisingly he can't contemplate careers when all he has ever wanted to do was to play tennis and that's something he can't do at the moment.

Overall, this is where he is at...

• Can sit for about an hour at a time before his upper back starts to ache and he feels stiff
• Generally standing and walking properly unless pain has kicked in, when he then tends to lean forwards
• Only once taken any pain meds this week, and that was after sitting for too long
• Still needing to lie down a lot
• Finds gentle stationary cycling helps to mobilise his back
• Muscles - generally he says his muscles feel looser... hamstrings slightly, glutes fine, calves slightly. New last night at the physio was that his QL is tight
• Tried a sports massage last night, focusing on his QLs, glutes and hamstrings. Also being taught to breathe better to help relax. Comment re sports massage - yes, seems to have helped
• Emotionally, fragile. Ups and downs. Sometimes very worried about it all, sometimes pretty calm
• Schooling - tricky but slowly managing to sit through some lessons. Took an iPad into school yesterday so that he could type lying down. Double lessons still a bit of a nightmare for him
• Some of his physio exercises trigger pain on occasions so he tends to mix and match what he does, avoiding those that are painful. No new exercises added this week to his 7 week routine

Each evening we plan out the next day. I then email school and his teachers to let them know when Nick is hoping to be in and I keep my fingers crossed that he'll wake up the next morning feeling ready for it. It does make it hard for me to get much done as I never know in advance when I will be needed to take/collect him to/from school but we have found that planning more than one day in advance just doesn't work.

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7 weeks post op

This last week has been spent focusing on two things...firstly getting Nick back into schooling, and secondly improving his strength and flexibility.

Schooling

Last week Nick sat most of his exams at home. As his lessons were being used to go over the exams we decided that it was better for him to stay at home and sit his before going back into school. So far he has managed all but one exam. We started with the shortest first and ended with the longest since he still finds it difficult to sit for long.

On Thursday he went into school for two lessons and on Friday he managed three. Then on Monday he managed a whole morning, although he had to come home earlier than planned as he had quite a lot of pain. The pain was effecting his posture so we decided it was time to rest rather than to push through the pain. A couple of ibuprofen and a three hour lie down and he was OK. He also saw his physio and she was happy that the pain was just temporary.

Today he managed a morning of school but he rested for two lessons (which were free lessons). He did however manage a double period without adverse effect.

So overall, managing some return to school. It's slow progress, but there is progress.

Strength and flexibility

Nick is still a little bit frustrated by his lack of flexibility. Some days are better than others. Generally he can reach half way down his calves. He says his calves are feeling a bit looser but hamstrings are still very tight. Glutes a bit looser.

He's also working on strength - see 7 weeks exercise tab - but we haven't really tested to see if there is any change.

Generally not much change from 6 weeks post op. Straight leg raise slightly better (50/55 degrees), possibly some buttock pain (he's not sure) and he can sit for longer. Can now sit on the floor with his legs out straight which he says he couldn't do before.

 

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6 weeks post-op review

Nick is now 6 weeks post-op, and today he saw his surgeon for his follow up appointment. He also saw his physio yesterday.

This is where Nick is at....

• Occasionally a little sciatic pain in his calf and thigh
• No lower back pain
• A little upper back ache when he sits for a long time (maybe stiffness?)
• Able to sit for about an hour at a time
• Bending forwards. Sometimes reaches about half way down his calf, sometimes he can only reach his knees. Update as writing this - Nick has just been able to reach three quarters down his calf!
• Sitting straight leg raise - to virtually horizontal
• Lying straight leg raise - about 50 degrees
• Very tight hamstrings, glutes and calf muscles
• Not taking any pain medication or muscle relaxants. Finishing off his course of anti-inflammatories
• Doing the 6 weeks post-op exercises which now includes some strengthening work, along with lots of stretching
• Not been able to go back to school yet as today was the first time he could sit for as long as an hour
• Managing to sit some of his mock exams at home
• Emotionally, prior to our visit to the surgeon he was a little worried about progress, however the surgeon has put his mind at rest

The surgeon was completely comfortable with Nick's progress. Specifically...

 

• he felt that Nick was likely to experience a little sciatic pain because the nerve is healing and was compressed for such a long time prior to his operation (about 15 months)
• Nick should not worry about experiencing occasional pain. If necessary he should take some painkillers, but unless the pain continues for as long as a week some pain is not a concern
• Nick will need to push through some pain in order to continue progressing
• Nick should try to keep as mobile as possible - to continue walking and doing his physio exercises
• Nick should try to return to school, probably on a gradual basis initially, to avoid getting left behind
• Nick needs to keep a long term view, and not just focus on each day at a time, as he will have good days and bad days - it’s the long term progress that is important

Overall, the surgeon was completely relaxed about Nick's progress, which I think was the main factor in re-assuring Nick. Nick was noticeably happier and more relaxed afterwards, which in itself was lovely to see.

And I have coined a new phrase - 'surgeons think in months, physios in weeks and patients in days'. I think this reflects the differing perspectives that each have and helps both Nick and me to remember to look beyond each day.

 

And I have added in his 6 weeks post-op exercises in a new tab.

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5 weeks post-op summary

Nick is now 5 weeks post-op. Generally he feels he is doing quite well, fairly positive about it all. Not taking any painkillers or muscle relaxants, just continuing his course of anti-inflammatories. This is where he is at....

 

• Stands tall and straight
• Sitting - haven't really tested recently. Can do about 30 minutes - will be trying a 45 minute session at school tomorrow
• Bending forwards. Can reach past his knees, about 2 inches.
• Describes a hamstring tightness as the reason for being unable to bend further (rather than sciatica)
• Sciatica - occasionally has a little sciatic pain in his calf
• Buttock pain/ache seems to have gone
• Doing the 4 weeks post-op exercise routine
• Finds swimming a bit tricky, can trigger mild sciatica
• Schoolwork. Doing some at home but finds he gets very tired. Doing most of it lying down. Hoping to do a GCSE at school on Friday
• Currently trying to plan how he can return to school, whilst still doing physio stretches and not over-doing it and causing a flare-up.

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4 weeks + 5 days post op. 1 step back, 2 steps forwards

One step back, two steps forward

Nick visited the physio again this evening. To his delight he seems to be better now than he was pre his flare-up. His straight leg raise is now about 50 degrees and he can reach about two inches below his knees. He has no sciatica, even when she raises his leg. He does have incredibly tight hamstrings and it is this tightness, rather than sciatic pain, that prevents him raising his leg further. We regard this as good news, because we know that we can loosen his hamstrings.

He has some additional exercises - see page '4 weeks (post flare-up) exercises' and is back to a little cycling and some swimming. He is beginning to think about how he will cope when he goes back to school which we are hoping he will do next week. So tomorrow I need to start talking to the school again about his return.

So, it looks like he took one step back but two steps forwards.

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3 weeks + 3 days

 

Yesterday was a bit of a washout for Nick's new routine. We started off well, but at 11 am there was a fatal accident outside our house and being the first on the scene it took me a few hours before I was free again. Both Nick and I found the whole incident very distressing and neither of us felt like doing exercises. Fortunately one of Nick's friends come over in the afternoon, which both cheered him up and distracted him from the police activity going on outside. Overall he only managed a few exercises and one short walk.

 

Today was much better. Nick carried out all of his new activities (see tab on 3 week post op exercises) except a swim. And to our delighted he was able to reach below his knees today for the first time! He did need to rest between activities and he says that he thinks the key is to be patient, but none the less this is, finally, a visible improvement. Yippee!!

 

I have added a page of his new exercises routine.

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3 weeks + 1 day post-op. Physio visit.

 

Nick went back to see the physio today. Generally happy with progress but did re-iterate that this will take some time. The main issues are twofold. Firstly his nerve is still tethered somewhere, which is why he still cannot get beyond about 40 degrees in the straight leg raise or bend forwards to touch his toes (with his knees straight). Secondly, a lot of his other muscles have tightened up, eg his hamstrings, glutes etc as a result of his limited movement for such a long time.

So, she is stepping up his activity levels. Nick felt ready for this too so is happy with the idea. The main extra activities are

• Cycling, but starting off with only a few minutes and gradually building up and avoiding hills or bumpy roads. Nick will start off indoors until he can manage a reasonable amount of time.
• Lunges, for 2-3 minutes
• Bridge with a stability ball, holding for 10 seconds, 10 times over
• Wobble board balance. Total of 20 minutes a day. Nick struggled just to stand still, but once he can manage that to try squats
• Standing hamstring stretches for 2-3 minutes at a time
• Sitting. To limit to 20 minutes, then walk, then resume sitting (rather than sitting until it hurts)
• Swimming. He can start swimming lengths if he wants to.

He is to continue his walking. For his existing '1 week post-op' stretches, to continue any which he feels are working for him. He's decided to continue the clam and the sit to stand.

Nick also tried out the cross trainer but found that it caused pain in his calf, plus we don't have access to one at home so we decided to leave it out.


Overall, the physio felt that Nick should be reducing the amount of time he spends lying down so we've decided that he should follow a rotation of the above to keep him moving. Not great news for his exam revision!


Will get a page up tomorrow summarising the three weeks post op routine with a few photos.


 

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3 weeks post-op

 

Nick is now 3 weeks post-op. Most of his day is still spent lying on the floor, interspersed with stretches (3 x day) and walks (3 x day) but overall this is where he is at....

• Slight pain in his calf. He's not sure whether this is sciatic or not and he is struggling to describe it. Not causing him a lot of concern though, and we are hoping it is just the nerve recovering.
• Tight muscle ache in his thigh - describes it as like a very tight muscle being slightly stretched
• Bending - may have been able to touch his knees today. Not checking regularly so not too sure. He feels there is some improvement.
• Walking - managing approx one mile (1.6 km) three times a day. Walks slightly stiffly but still hugely better than before the op. Getting rather board of the local area so occasionally we drive a few minutes to a different park.
• Sitting - can manage 35 minutes at a time but can feel himself tightening up and it might be inducing the calf pain. Has to concentrate on sitting straight. He is practicing sitting up at a table because he has exams to sit in a weeks time, and a return to school in three weeks time.
• Car journeys - has managed a couple of long journeys (about 2 hours) but each caused a fair amount of pain and/or stiffness so we wouldn't recommend car journeys at this stage.
• Sleeping - generally sleeping OK but sometimes feels too alert to sleep.
• Concentrating - difficulties concentrating for long, school work taking a lot longer than normal.
• No problems with the surgery wound but sometimes feels the need for some ice as it feels like it's bruised (no visible sign of bruising). Massaging vitamin E oil into it twice a day.
• Painkillers - not needing any at the moment.
• Hamstrings and glutes - still feel tight, not much change
• Physio/stretches - doing three sets a day. Feels ready for further physio and current stretches take less time to complete now.
• Emotionally - 'not worried but don't feel everything is fantastic yet'. Starting to talk about when and how he will be able to return to playing tennis.

 

 

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1 week post-op

Well, Nick is now one week post op. Where is he at?

- no sciatic pain (or numbness, tingling etc)

- can stand up straight again

- no surgery pain, or surgery complications, wound healing nicely

- very tight hamstrings and glutes

- can't bend forwards much, but can extend his back

- can walk about 1 km at a time, twice a day

- doing stretches three times a day

- applying ice after any of walk or stretches

- practicing sitting, but can only manage about 15 minutes at a time

- has seen his physio once, and will see again in 2 weeks (would have been one week but next week is Christmas)

- no longer taking any painkillers

- fairly happy with his progress, but needless to say there is still a lingering fear that problems aren't resolved yet

 

His daily routine is now stretch - walk - stretch - walk - stretch with sitting up for mealtimes. I've added a page showing the stretches he now doing, 1 week post op.

We also visited an Alexander Technique practitioner today. Not a huge success. He found it quite hard work, especially when sitting down and he's not convinced that he feels any better for it.

Just for the record, his walks today were 2 x 0.7 and 1 x 0.5, no painkillers

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3 days post op

10 am. Nick gets up saying that he feels good and had a reasonable nights sleep. Quick check of the wound (without moving the dressing) shows that all the bruising around the wound has gone. Does a set of physio exercises and reports a little pain in his thigh which he first felt on doing the full leg extension. We suspect it is his hamstring pulling a little.

1 pm. I had to get to Sainsburys and unfortunately, due to road works and heavy traffic didn't get back until 12.30 pm. Nick looking rather miserable and reporting some back pain to the left of his wound. Says he just wants to sleep. Put on some ice-spray which seems to help and he is now snoozing. He turned down the offer of paracetamol. Conclusion - it's pretty miserable being left on your own when in pain. It's also pouring down with rain and the prospect of a walk is not appealing.

1.30 pm. Well, we braved the rain and got soaked! Nick wanted to walk more but actually managed about 0.5 km which is similar to yesterday. Felt pretty tired afterwards, so we had lunch and then decided to watch a film. He lay on his back with a pillow under his bum and extra head support. Also took 2 x 500 mg paracetamol.

3.30 pm. Had a break from the film to do physio stretches. Reports a little pain, some in his leg. Looking a little more cheerful.

5 pm. Film finished and Nick wanted to go for a walk, so off we went. He comfortably managed 0.8 km and is pretty cheerful. Ice spray afterwards. Lying on his back seems to be the best position so far today.

7 pm. Final physio stretches for the day followed by ice spray. Says he has no pain :-)

10 pm. Nick has headed off to bed. He's turned down the offer of any paracetamol again, and says he has only very very little pain, possibly in his back. He is very pleased that we have found a comfortable way for him to lie on his back, and is wondering whether the leg pain was actually due to him lying on his side.

He has some friends coming round tomorrow to see him, which he is really looking forward to. He also wants to try having a shower - not a bad idea given that he hasn't had one for two days!

For my part, I reckon it's best not to leave him on his own for too long. It's not easy being in pain, and it's even worse if you are alone. I feel really sorry for those who have to cope with this on their own - it must be really tough.

Let's hope that his progress continues tomorrow.

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