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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4 months post-op update - feeling good!

Nick is now making good progress :-) He is....

• Doing a lot of strength work on his core and legs, under the weekly guidance of his physio
• Continuing a lot of stretching
• Playing tennis again, although so far only a maximum of one hour at a time
• Able to sit for reasonable lengths of time for his GCSE revision
• Standing straight most of the time
• Much more optimistic and positive
• Starting to plan his return to competitive tennis

Progress seems to be improving pretty quickly over the last few weeks. Each day he pushes himself just a little further and so far there have been no bad effects. He is slightly cautious still, which is not surprising really, but he is so happy to be able to play tennis again! So pretty good news overall.

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3 months post-op

Well, Nick is now 3 months post-op and somehow 3 months feels like a landmark. I should have written this update a few days ago, but it was his 16th birthday yesterday and I wanted him to enjoy his birthday rather than thinking about his back.

Bit of a sideline, but he wanted a tennis theme for his birthday cake to celebrate getting back on court. So not my best ever cake, but it does undeniably have a tennis theme...

And another shot from his birthday - sitting by the sofa enjoying some time with his brother. It is easy to forget that a few months ago he wouldn't have been able to sit like this...

Anyway, where is Nick at?

Generally, he is continuing as he was, making slow but steady progress. He is still a long long way from being back to normal though. We are due to see his consultant tomorrow. This was following Nick's physio's concerns that something may not be quite right as she feels he is not progressing as quickly as she would have hoped. I will update next week as to what his consultant says.

At the moment...

• Sitting. Able to sit reasonable lengths of time, but is invariably tired and a little sore if he sits for too long
• Exercise. Still continuing his physio exercises but also playing tennis for about 20 minutes twice a week. Feels quite achy afterwards, even though he does stretch before and after playing.
• Standing. When not tired and pain free, he can stand straight. Otherwise he tends to tilt his pelvis and looks quite awkward.
• Bending. Still struggling to bend forwards.
• Muscles. Generally he says they feel fine, at least for the obvious ones (hams, glutes, calves etc). Stretching them every day.
• School. Managing normal school days, though usually tired and achy at the end of the day. Generally manages to complete his homework in the evenings but sometimes too tired and achy to sit up to do it.
• Sciatic pain - none
• Emotionally. Feels 'alright', says he feels 'happy and sad'. Happy because he is playing some tennis, sad because he's not better and still has problems.

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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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9 weeks post op

Two main aspects to the last week...

1. Nick is gradually increasing how many lessons at school he can make in a day, and
2. Working on improving his pelvic mobility.

Our weekly summary.....

• Sitting. Can make it through a double lesson (1 hr 20 mins) but gets up in the middle to loosen his back. Doesn't enjoy the double periods and really they are still a struggle for him but he is managing them
• Standing. As before, stands well when not in pain but tilts his pelvis when in pain
• Finds lying down the only really effective way to alleviate pain. Still needs quite a lot of lying down time to recover. Is now lying on his front propped up on his elbows as part of his physio exercises which he seems to like
• Muscles - Nick says that they don't feel tight any more so it looks like all that stretching has finally paid off!
• Bending forwards. Still not great, about a quarter of the way down his shin but he is trying not to focus on this in favour of focusing on improvements elsewhere
• Physio exercises - see new 9 week post op tab. Now working on pelvic mobility
• Has asked for another sports massage as he found it really helped
• Emotionally - says 'Don't feel too bad', and he seems generally more cheerful

Schooling

Has managed three full days and one half day. He was ill with a 'mini-flu' type thing on the fifth day. So missing some classes and only just about keeping up but this is an improvement overall. The downside of the extra time at school is that he spends more time in pain, which results on poor posture, and it can be hard for him to do his physio exercises. He now gets up at 6 am to do a set before he leaves - not easy for a teenager!

Pelvic tilting

His physio felt that Nick needed to correct his posture, and in particular his tendency to tilt his pelvis when in pain. However, Nick finds it really hard to do pelvic tilts, so he is having to learn how to do them. See tab on 9 weeks post op exercises. Hard work getting him to do them often enough (they're just not cool for a teenage boy).

Nick is the taller one on the left. For this photo he is trying to stand straight but is still tilting his pelvis. The other boy is my older son, one year older than Nick - he does a lot of strength and conditioning work as he is rower so perhaps not a very fair comparison for Nick!

Emotionally

Nick seems much more calm and settled now. It's possible that being back at school helps to distract him from his back, plus he gets to see all his friends again which cheers him up. But he is really looking forward to the half term break next week so that he can rest more plus have more time to do his physio exercises more often.

 

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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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4 weeks post-op summary

This is Nick at 4 weeks post-op.
In the last few days has had what seems to be a flare-up. Still monitoring it closely and because of the flare-up he is now really cautious of over-doing it. Just prior to this flare-up he was doing really well...

Pre his flare-up....

• Could sit about 20 minutes then again if he had a brief walk in between
• Could reach just below his knees
• Could stand up straight and walk correctly
• No problems with surgery wound
• Was off painkillers and no need for ice/heat
• Some residual pain in his calf and buttock
• Doing the three weeks post op exercise routine, including some cycling

Post his flare-up....

• Taking anti-inflammatories and muscle relaxants
• Back to the 'basic physio stretches' only
• Walking about 1 km gently
• Sleeping a lot - probably because of the muscle relaxants
• Can still reach below his knees
• Can stand properly, although could manage this only once he started taking the muscle relaxants/anti-inflammatories. Before the meds and in peak flare-up he could no longer stand or sit
• We've ditched taking his exams for the moment until we are over this flare-up.

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4 weeks post op

So, Nick's now at 4 weeks post op. A few days ago I was anticipating a very different 'this is where he is at' type post than what you are getting! For the moment I am going to update during the day to see how this flare up is developing. Hopefully by the end of the day I will manage a proper 4 week summary.

 

10 am. We were up early to see Nick's GP. Not looking too bad, some pain but clearly very worried about it all. The doctor has helped us with a pain management plan for flare ups consisting of a 10 day course of anti-inflammatories (diclofenac), some muscle relaxants (diazepam) for the next few days and some painkillers (codydramol) to use when he needs. Also gave him some anti-bacterial cream and anti-fungal spray for his tummy button. We talked about longer term neuropathic medication but decided to manage this flare up first.

Nick currently curled up on the sofa with a hot water bottle on his back (says that feels really nice) waiting for meds to kick in. Says he is feeling a bit better than yesterday which is hopeful. We have decided to ditch doing his mock exams, although he will need to go into school tomorrow for a French GCSE listening paper which being a public exam has to be done at school. Hopefully meds will have started to take effect by then.

11 am. Nick fast asleep. Very pleased - probably the best thing for him at the moment.

1.15 pm. Nick's just had some lunch and is looking so much better. Before lunch he was a bit groggy but after a bite to eat he began to perk up. Joking, laughing and generally happier. Very little pain, and did some very basic and gentle exercises (from just post op days) without problem. Can stand straight again. However, he doesn't want to overdo it so is back on the futon resting.

School called to say that they have arranged for him to do his GCSE exams later so he doesn't have to go in tomorrow after all. The teacher in charge of exams has had a micro-discectomy himself so genuinely understands what Nick is going through. Very helpful! Fingers crossed that all will keep on improving.

6.30 pm. Nick is still feeling a whole lot better. Very little pain (not taken any more painkillers since this morning) and more cheerful. He's gone for a couple of short gentle walks and done more stretches as he is concerned that he doesn't get stiff lying down so much. Still likes to lie on the hot water bottle!

He's decided not to take any painkillers tonight, just the anti-inflammatories and muscle relaxants. The downside of taking a stack of meds in one go is that you can't tell which one is having the right effect, so the plan is to drop the painkillers first and see if he is still doing OK.

Fingers crossed - looking like this was just a flare up.

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3 weeks + 6 days - shitty day

We've had a pretty shitty day today....

1 am. Nick wakes me up. He's in a lot of pain (buttocks), very upset and can't sleep. Desperately worried about this new pain. Took 1 x 30 mg Dihydrocodeine which after a while kicked in and he managed to get to sleep. Before going to bed he couldn't stand up straight which had upset me - he looked like his pre-op days which was depressing.

10 am. Nick wakes up and not looking or feeling too bad. Walks into the kitchen standing properly and walking tall - huge relief. Perhaps last night was just a temporary glitch. Cancel the planned trip to hydro pool for swimming because his tummy button is looking very infected.

11 am. Starts his first mock GCSE. We've planned out the day with basically cycles of sit - walk - sit - walk - exercise - rest. Each sit is doing his exam paper with an expected finish time of 3 ish.

Buttock pain gets steadily worse and he gets stiffer and stiffer. By the third cycle when he gets back from the walk he collapses on the floor by the door. Virtually in tears, unable to lift himself up to sitting and certainly can't stand. Abandon exam paper, another Dihyrocodeine.

Crawls to living room and rests on futon. Can't find a pain-free position at all.

5 pm. Visit to physio. His lower back had shifted a bit and muscles gone into spasm. Strangely can bend forward but can't stand straight. Lots of massage on lower back and calf. Advised that this may just be a flare up, and to rest with a warm pad on back. Revert back to the 1 week post-op stretches only. If no improvement in next 24-48 hours to contact surgeon again.

So, at time of writing (7. 30 pm) feeling pretty miserable and uncertain what is going on.

10.15 pm update. Took a couple of paracetamol and now looking a bit happier. Just praying that he manages to sleep tonight.

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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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6 days post-op

Not much to report from the morning. Nick woke up late ish after a good nights sleep. Showered, breakfast, stretches and ice. Took top dressing off, leaving steri-strips in place. Nick settled down to do some school work (lying on his back) while I went off to the shops. He found he was a bit unproductive doing the school work but feels better for having started it.

1 pm. Managed a good walk, 1 km in total, to our local bakery for lunch. Ice afterwards and now settled down to watch a film as we are both feeling tired. Reporting no pain at the moment.

7 pm. Just back from seeing the physio. Physio is happy with progress and result of the operation. Straight leg raise is about 40 deg but can't reach his knees yet. One of the physios was disappointed that he couldn't reach his knees yet, but the other was fine about it. Hamstrings and glutes very tight but back muscles fine. Worked on releasing the hamstrings and starting to mobilise his hips and pelvis. Removed the first two exercises from the basic stretches and added three - pelvic tilts, the clam and sit to stand. Also advised to start increasing sitting time.

 

 

Sitting for the journey there (about 20 mins in a car) did cause Nick to stiffen up noticeably but the journey back didn't have the same effect. Ice pack on return. Reporting no pain.

10 pm. Nothing inparticular to report since seeing the physio. Nick has continued to rest on the futon, sat up for supper and did a few stretches. Not reporting any pain so it looks like another day with no painkillers!

 

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