Training after an L5/S1 injury (sciatica)

#1

I’ve spent most of December lying on my back staring at the ceiling wondering if I will ever ride a bike again. Now I can move again, my physio has encouraged me to ride my bike (I told my wife, this isn’t going to happen often, prescribed cycling) - indoors, not too strenuous. Such good news! Does anyone have any recommendations for good TR workouts which are low stress (apart from moving my FTP to 100). Also like to hear if anyone else has successfully recovered from a similar injury - what do you think made the difference not only to your ongoing recovery but also preventing the injury happening again?
This is the longest I have not ridden my bike…

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#2

Wow, welcome back. I can’t imagine going thru that.

Here are a few I found via the website, workouts and using the Recovery filter (listed by low to higher intensity):
Dans, Recess -5, Taku -1, Lazy Mountain -1, Recess -4, Recovery: 45M Easy Ride, Recess, Lazy Mountain, Pettit -1, Obelisk, Recovery: 1H Easy Ride

#3

Three weeks ago I was hit with sciatic-nerve pain type systems as well and been doing a ton of lying down and taking an anti-inflammatory. Initially I was still doing 4-hour rides but now I can’t stand the trainer for more than 20-minutes. I went to the doctor yesterday and from the x-rays it appears that all is well and it’s a muscle strain; was suggested I come back in 30-days if there is still pain.

#4

I had a a pretty bad L5-S1 injury and was off the bike for 2+ years. The most significant thing that I did was reconfigure my trainer bike so I sat more upright. I dropped the seat as far as I could comfortably and swapped my handle bars for some fixie style bullhorns that I angled up.
I gradually worked my way back to my original position. The key is a huge amount of patience. It takes a long time to heal.

I also strongly recommend “Back Mechanic” by Dr Stuart McGill. He is one the foremost experts on back injuries and that book helped my recovery immeasurably.

Let me know if you have any other questions.

Good luck
Craig McMillan

#5

Yep off the bike for close to a year L5-S1/L3-L4 ruptures.

For me we found spine stabilizer muscles were not engaged (think multifidus); muscle imbalance; general core weakness.

Time to heal the disc first. So little blood flow to that soft tissue it takes forever. After that, muscle balance and engagement is critical.

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#6

That sounds familiar. Some muscles are over engaged (still rock solid after a month of massage and rest) others not turning up for work on time. The “it takes a long time” message is a hard one to get used to.
If you are reading this and you don’t have a back injury (yet) then do some work on your posture (on and off the bike) and your core!

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Hi all! New user, just had L5/S1 surgery. Looking for ideas / plans to help recover & build
#7

Two time L5/S1 discetomy surgery patient checking in here.
First surgery 2011, second 2016.

I’ll break this down into a few components; bike fit, rehab, off-bike work, on-bike

Bike Fit:
I can’t get aero as a result of back issues. I can ride in the hoods for short periods but I need to be more upright. I went and got a professional fit down with a physio and we got me more upright with spacers under stem and a shorter stem. I ride more now on the hoods as well just to keep hip and back angles where they need to be to avoid discomfort on a longer ride. I also initially moved to a synapse to help with comfort and cutting down some of the road vibration, but a lot of the newer bikes manage this really well anyway.

Rehab;
Rule 1: Listen to your body
Rule 2: Listen to your doctors/medical professionals helping you.
Find professionals that you trust and are looking out for you, not simply trying to sell you something. I’ll assume in all of this that you have gotten to root cause (mine was ruptured, and then bulged disc). But if you dont know, get it figured out with imaging so that you dont make things worse.
Getting up and moving is the first step. Literally walking. Your back isn’t going to heal and recover lying down, so get mobile. Avoid bending, lifting and twisting combo movements. Use ice to manage inflammation and pain to best degree possible, NSAID as needed and anything stronger only if absolutely necessary. Opiods get prescribed way too easily and I can tell you from experience it does not take much for a chemical dependency to begin, plus they destroy your stomach. Make sure your sleeping situation is taken care of properly; if you can sleep on back do it, make sure mattress is supportive, and use pillow between knees to alleviate pressure if you are side sleeper. After a week or two of movement and proper sleep your symptoms like sciatica should start to feel better.

Off-bike work;
Mobility mobility mobility. Can’t stress this enough.
As cyclists we are quad dominant and have weak hip flexors. This doesn’t help for back issues. Get your glutes activating properly and it will make your life so much better. Start doing some proper form glute bridges on your back on the floor. work up to 3x60s holds. Make sure you’re stretching quads, hamstrings, calves and hip flexors. Build a daily routine where you do this when you get up for 5-10min and before you go to bed. This will take time, but over time you will start to see results. I could barely touch my shins a few years ago, now I can go palms on the floor.
When the timing is right and your medical team says it is OK, start lifting some weights. Back Squats and Deadlifts. Proper form only. No hero weights. Work with a trainer who knows how to cue and coach form. Perfect the form with a dowel before you start adding weight. Building weight gradually will help strengthen your posterior chain and help protect your back.
Work your core, ab roller and planks/side plank. This too will help protect and strengthen your core.
Clean up your diet - I was carrying around some extra weight as a result of pain and immobility. Weight is hard on the back, bad diet does nothing to help you recover. Feed your body properly.

On-Bike;
I left this until the end, but if you’re doing the above there should be no workouts that you can’t do. Longer rides initially will be harder and may lead to back or leg fatigure. Bike fit will help.
If it hurts don’t do it. I did taku on 50% 10 days after surgery just to get the legs turning over. I used TR exclusively for my recovery and to get back into racing shape. I really liked the traditional base plan on low volume. The efforts aren’t too hard and there is not a lot of sprint work, really helped get things back to an acceptable level while I worked on the other items above.

If you have questions feel free to ask more, I know all too well the issues of this and spent more time and money than I care to think about trying to address the issue, and tons of time doing medical research once I finally knew what was wrong with me. Hope things start to improve.

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Hi all! New user, just had L5/S1 surgery. Looking for ideas / plans to help recover & build
#8

Thanks @Rondal for taking the time to prepare that detailed reply, it is really very useful. I’m fortunate that the gym we have at work is manned by physios, plus the care I have had from Pea Green in Oxfordshire so far has been outstanding. I’m on the way to root cause, waiting for the interpretation of the MRI (nothing obvious, but the consultant is yet to give his opinion).
I am absolutely with you on the over-prescription of opioids, these seem to have little effect on me anyway in terms of effective pain relief, whereas ice works well.
If I had taken the off-bike work you recommend I am sure I would not be in the position I am now. I don’t think I have touched my toes from standing since I started cycling, however many years ago that was.

#9

…and if i had listened to all the people who told me as a kid to stretch properly I wouldn’t be a two-time surgery winner. It’s never too late to start. Don’t wait until tomorrow start today.

My “routine” that I have found working well for me when i get up and go to bed
3x60s on back on floor - body weight glute bridge
2x30s each side hip flexor
foam roll quads
3x20s downward dog into standing forward fold when done the 3x20s and focus on driving butt up and tension in the hamstrings.

You can do half of that while surfind instagram, takes like 7min all in and only tool you need is a good foam roller, which could be replaced by a softball.

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#10

I actually didn’t really get into cycling until after I had two surgeries for L5-S1 (discectomy, followed by fusion). I can’t really tell you what’s different afterward, but I can talk about what I do to ride now.

I agree with a lot of what @RONDAL said. I don’t have any specific advice about the rehab beyond those two rules - I am not your body nor a medical professional helping you. :stuck_out_tongue:

The big thing for me initially was going to a regular yoga class (once I was cleared to do so). At first I had terrible flexibility and mobility, and there were quite a few things I was told I shouldn’t even try (twisting, some bends, etc.). Progress is slow but you’ve got your whole life to get better, so the tiniest bit of progress this week adds up. There are lots of other options, you can make your own routine… but a group setting, a schedule, and an instructor (with whom you share your limitations and injury info) can make a huge difference in consistency, and consistency is hugely important for rehab.

And I think I mentioned this in another thread recently: I agree back squats and deadlifts, done well within your capabilities, will make a huge difference in long term comfort, mobility, and posture. Oh, yep, looks like I’m basically repeating myself! :laughing:

Post surgery, post rehab, after a few years of regular yoga practice (I’ve fallen off now, but have been more regular with strength training), and with a good fit, I actually feel great in an aero position. May or may not work (or matter) for you, but it’s not outside the realm of possibility.

#11

With the work i have done on flexibility since Feb 2016 surgery I am going in for a fit next month to see if we can start to get me into a less upright and more aero position. It has taken 18 months though to see the full results of daily stretching and mobility work so that i am now comfortable getting lower for extended periods of time. Glad to hear you are having success!

#12

Ah, yes. My fusion was about 6 years ago now. I started riding with an upright beach cruiser, then a hybrid, then a road bike, and it was 3 years post surgery that I first put aerobars on.

#13

@unstoppable I am in this exact same situation currently, so thank you for posting a thread about it. My symptoms began in mid-October and after a lot of PT doctor’s visits I was back to 90%… until Christmas that is. Due to some traveling and lack of supportive chairs I have regressed in a major way. I am back to not sleeping and major sciatic pain down my left leg.

It is encouraging to hear that people recover from this (albiet slowly). I think the most important thing, for me at least, is taking it one step at a time and having a positive outlook. I am young, so I have my whole life ahead of me to train and recover. Now I need to focus on being healthy and addressing the issues that led to this mess.

#14

Hi @tylerj - sorry to hear about the poor holiday break. I am blown away by the quality of advice on this forum, and in this thread in particular. I hope your own bed/chair/food sort your back out soon

#15

Hi there, I had a similar injury in the past in l4/l5 disk. I struggled for 9 years but now I have successfully managed my pain. I even go riding now as well. I tried a lot of different treatments but found that practicing yoga and strengthening my core was the most effective treatment. I write about my workout and experiences. I hope it helps!

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#16

Thanks to everyone who has posted here, it is so good to hear there is a route forward. I’ve now had a diagnosis (severely blown out disk, threatening some nerves more important than the sciatic) so I am in for surgery soon. I’ve been doing daily exercises on the floor mat, and can now lead some sort of normal life - or so I thought. As part of the post op surgery I have begun planning recuperation and part of the MD recommended plan is to ride a bike. Yay! So I’ve set up a turbo which is light enough to carry (for me, the Wahoo Kickr was not good), and I spent today fiddling around with it, connecting it to TR and so on.
With turbo set up, it has to be tested. Shocking. I realised I had lost power in my right leg, but this really came home to me when I could not even get on the bike - it was too high from the floor, I could not get my left leg high enough and not enough strength in the right to complete the swing on to the saddle. I had to get on a chair and then get on the bike. Once on there, all felt OK, but could only do 65W for 10 minutes or so until my foot went numb and my calf went dead, a sign to stop. Still, I did it :grinning: Next stop, raising the handlebars, then putting the lighter bike with the better power meter on so that I can look at left versus right power. Oh, and record it so that I can look at it later in the year and maintain my motivation to stretch and strengthen off the bike as well as on!!

#17

Sorry for interrupting, but how is it going? Hope everything is OK now!

Having suffered from sciatica last year, yet still recovering - I know how you feel. My issues were agitated by running or being seated for long periods of time. Biking on the trainer and swimming didn’t bother it nearly as much. But there were times the pain was so intense that I felt like screaming. Especially upon standing after getting out of a car seat.
My doctor has told me to carry on cycling gently, given me some Ibuprofen type pain killers and told me to report back in a month’s time. Sciatica still apparently comes and goes. But I seem to suffer more at night in bed lying horizontal. Sleeping with sciatica was tough in the beginning, but wrapping a rolled up towel around my waist seemed to help with that some.
Also exercise is very beneficial as it increases blood flow to the area and helps maintain sanity when you’re suffering and hating life at the moment. But be very careful what you do.
Wish you fast recovery!

#18

I went through something like this in 2012, Developed severe back pain while doing squats( no doubt poor form). Wasn’t riding at the time, so I stayed out of the gym and just put up with the pain. I noticed loss of muscle and weakness in my left leg. Subsequent MRI showed a ruptured disk with nerve impingement. Seen in consultation by a neurosurgeon, and came to the decision to not operate initially, but do physical therapy. Religiously did PT, pain gradually resolved, I have regained most if not all of the muscle in the left leg, and I am, after correct instruction back to squatting in the gym. No pain, but I am about 1 inch shorter than I used to be.

#19

I’ve had Sciatica and Pirformis issues off and on for about 2 years now. Likely the result of fracturing my hip. I’ve found it very important to maintain a flexibility and strength routine. I also, encourage others to engage a PT to get you moving in the right direction. I continue to see them ever 6-8 weeks as a recovery session (think of it as changing your car’s oil).
Getting a bike fit is very important too. However, it isn’t the fix all. I still need to be diligent to maintain proper form and not try and “smash” big gears because this can aggravate the nerve. Glad to hear there are others out there who battle with these issues.
Great contributions and hope you get well soon