Surgery or a long term rehab for back injuries?

sfiggins · April 25, 2017

There's a reason why they call it "practicing" medicine.

Hankshank · April 25, 2017

Peter Hanson said in an interview 2014 that he had the same injury as Tiger, took the rehab, He has been playing competitive for the last two years. He said that he considered surgery but was advised not to by his medicine man.

puttingmatt · April 25, 2017

Dont know what all the fuss is , its a private matter between patient and doctor, who are we to question any of it.

Shilgy · April 25, 2017

Are you or Peter sure that applies three years later?

No_Catchy_Nickname · April 26, 2017

Interesting. It doesn't surprise me that the US is different from the UK in this regard, and the UK may have changed now anyway; my information is over 20 years old.

I think it was the neurosurgeon who operated on me who said it, but I someone in the medical field say to me that orthopedic surgeons are great for sawing bones, but not much else!

TheKrushh · April 26, 2017

Super interesting topic. Like everyone says, incredibly case by case basis, probably more than most injuries. The really interesting thing is that EVERYONE says they "tried" rehab. To what degree did they try? How committed where they? Who was their provider? How many different providers did they see? did you really just got to 9 of the recommended 12 visits and not do anything at home and then head back to the doc?

The thing that worries me is guys like Tiger and Steve Kerr are going to see the absolute top people. They aren't going to the random in-network guy down the street. I don't like using Tiger as an example because of who he is and how he works. Steve Kerr is interesting to me because he should be the classic example of a success story. Generally healthy, not overweight, top doctors and evaluation, access to everything and one nick of the meninges and his whole life is ruined for the time being. Absolutely crazy that even in perfect scenarios these procedures can horrible.

lumberman2462 · April 26, 2017

I started with a bulging disc that would hit my sciatic nerve sporadically. That sent me initially to the doctor. Lots of pain meds and anti-inflammatories and eventually rehab. Exercises and whatnot. That didn't work.

Another MRI revealed my disc was herniated and that sent me to a whole new form of rehab which involved laying on this table in which the PT strapped a belt around my waist and another around my chest and table would stretch me out....literally. It was some real Marquis de Sade/Spanish Inquisition #*()$.

Oddly when the table had me stretched out I was momentarily out of pain....and when the pressure was taken off and I re-compressed. It was bad.

Finally they did me a favor and ruptured the disc on the table. Big fun there. Unfortunately I had to wait another 6 months for surgery because I was nursing two family members back from pretty serious health problems and I just couldn't spare the time.

jimb6golf · April 26, 2017

I have 4 bulging (or worse) disks in my lower back and several more in my upper back and have been in and out of the hospital due to tremendous sciatica and pain in the past. I've had it checked by multiple doctors and for some reason they can't operate on the worst of the bunch (too far in and too close to the spinal column or some such thing). The best thing was in recent years getting back into the gym with a focus on improving my core and it's made a pretty significant difference. I'm still in pain pretty much all the time but the completely debilitating pain isn't there as much and other than having trouble standing up straight at times it's manageable I guess. Golf doesn't exactly help but I'm not giving that up any time soon. My point is to try exercise first, along with controlling your diet, and to stay in better shape rather than having surgery. Sciatica isn't fun (it's horribly painful) but if I can work out and eat better, and take Aleve when needed, then I can deal with the daily pain for now.

bigred90gt · April 26, 2017

I personally tried the epidural steroid injections before my second surgery. About 3-4 weeks after my 3rd in the set, I was under the knife for surgery #2. The injections did absolutely nothing for me.

bigred90gt · April 26, 2017

While I won't say to NOT use an ortho for a spinal surgery, I personally wouldn't. I want a neurosurgeon whose specialty is spinal surgery. That's not to say that an ortho wouldn't do a great job, that is just my personal preference. With something as sensitive as the spinal cord and nerves, anyone that is going to be rooting around in mine is going to be a specialist in that.

MAndrews · April 26, 2017

I suffered a compression fracture at the L1 level about 5 years ago. Now I'm not a world class athlete, I'm getting old, and I'm overweight and not nearly active as I need to be. My Dr gave me a choice either surgery to stabilize the fractured area, think glue / cement, or let it heal, do some rehab, and live with it. For various reasons I chose the leave it alone path. It still gives me trouble from time to time but nothing that stretching, heat, and a muscle relaxer or two can't cure. I have had to have a cortisone shot a couple of times but that's been the worst of it. Did I do the right thing? I still don't know. What I do know is I hear a lot of horror stories from people that have had back surgeries. They're problems, for the most part, are different than mine so what they have to say may or may not be applicable to me and my situation and vice versa. I think everyone has to consider the options for their particular situation and evaluate from there. I can tell you that I would never let a Dr operate on my back without a second and possibly third opinion. Your mileage may vary....

ray9898 · April 26, 2017

Without knowing the intricate details of each individual case only a fool would make a blanket statement of which approach works best.

Shilgy · April 26, 2017

We have the only real answer. Thank you.

Forged4ever · April 26, 2017

Actually, that neurosurgeon was pretty spot on "back in the day," say until the early/mid 70's, when the pods started getting a bunch of toys(instrumentation) for hip/knee implants, external/internal rotation and endoscopic video systems for joint arthroscopies. Prior to this your "lesser" hands ended up in ortho, lol. When my dad, who Played football in college, filled out his surgical residency preference list, and they wanted three listed, he listed one, writing it three times: Renal Transplant/General Urology/General Surgery. Though those are in fact three separate specialties, in the late 60's a kidney transplant surgeon had to be residency trained in both GU and GS AND Board certified in both before he(back then there were no female transplant surgeons. From 1985-1998, my father trained 4 and he was a batch, lol. They had bigger stones than 90% of the guys I know, lol) did his transplant /fellowship and got his THIRD Board Certification.

Anyhoo, his med school advisor looked at his list and laughingly chirped "We'll see. I hope that you like setting fractures," lol. That's why a lot of your older "jock(see football/baseball Players)" are pods, lol. Needless to say, he stayed the course, haha. So your neurosurgeon was pretty spot on and in fact your pods in your neck of the woods developed sooner than ours over here cuz yours had about a 6-8 year jump due to the bureaucracy of the FDA being much more involved in what could go into an OR than your oversight organization. Today, it's safe to say that OB/GYM's have replaced pods as the "heavy" hands of the surgical community and they are further hurt, at least on our side of the pond due to the fact that the vast majority of the residency programs are "close looped" in that only an OB/GYN trains an OB/GYN, versus every other surgical specialist resident rotates through every single surgical specialty with the most intensive rotation outside of their chosen specialty being in General Surgery because of the bredth and depth of its importance to not only the other specialties but to the well being of the patient themselves. Most OB/GYN's have none of this, or very little and are dependent on a guy teaching them that was trained as they were and that's why when they do more than deliver babies, and do invasive procedures, they always have a guy like my dad or another GS on call cuz if shat hits the fan, the big dogs come off the porch, lil.

This leads me to another worthless though potentially important factoid for any of you guys that might, or more probable have a significant other who may one day go to a Plastics guy/gal(Plastic/Cosmetic Surgery is a specialty and actually the most lucrative one for a private practice based doc). The ABSOLUTE FIRST QUESTION that you/she wants to ask is if they are General Surgery trained. If they him and haw, or say no, head the fack out the door!!!

I cannot emphasize this enough!!!

I don't give a shat if they're workin on your gobble neck or her lips. If something goes south medically or surgically intraoperatively away from the surgical site, a General Surgeon trained Plastics guy/gal takes a breath them does what needs to be done to right the ship and on ya go.

A non-General Surgeon trained doc?

It's a crap shoot and I don't care how long they've been doin it or what their record is or how great they are-

When I got hit by the drunk driver in college and was under the knife for nine hours havin my face put back together like a jigsaw puzzle, I had two Plastics guys workin on me, one on my jaw and teeth and the other on my cheek and nose and apparently a I started losing way more blood than was goin in me, my BP bottomed out and everyone was in a tizzy, save for the guy who was working on my cheek/nose, and he took charge, including over the guy working on my teeth/jaw, as while he was a top Maxilo-Facial Plastics guy who drove down from the Cleveland Clinic as a favor to my dad to do the surgery, he was just a DDD who did a Plastics fellowship and while he was indeed renowned, he didn't have the GS training that is so critical and it's not just the theoretical knowledge as much as bein in the the environment of everything goin to shat in a heartbeat and crooked teeth or a gobble neck is the least of the worries, lol. Just do yourself/your wife a favor and ask the question. He wouldn't have been in the room if the other doc wasn't there.There are enough top shelf Plastics guys/Gals with the full surgical background and that's who ya want standing over you/your wife.

Sorry for the ramble, lol

What's knew ;)

Have a great season Bro?

All the Best,

RP

Lodestone · April 26, 2017

my episode last September:

back had been stiff (I've had "issues" for 30 years, so this was not much different). Got up to pi$$ at 1 AM and all of a sudden it felt like a flaming arrow shot into my right thigh bone. I couldn't get back upstairs to go to bed.

MRI showed herniated discs, and likely one glob of disc floating freely. Pain and numbness down my right leg. No patellar reflex in right knee. Could not walk without a cane (an 8 iron actually)... I was taking way more Hydrocodone than I was happy with...Pain Management Doc gave me a shot which helped a lot, and set me up with Physical Therapy.

First day in PT the young man (who I really thought was great) had me lie on my back and asked me to do ONE straight leg raise with right leg. I could not get it off the table.

I was certain I was headed for the blade, and frankly, kind of pissed to go through the mandatory 12 weeks of PT, figuring it was just going to delay the inevitable.

However after a month of PT I felt like I had a really good chance of avoiding surgery.

When the pain doc saw me 30 days after the shot, he was amazed I was walking without the 8 iron.

And he was amazed that I might avoid surgery, based upon his assessment of my symptoms and the MRI.

Which leads me to the nugget.

He said "the back docs all refer to the '90-90 rule'. Basically it says that 90% of the people get better in 90 days and nobody knows why, or who."

So,, I'm sure I'll have more bad days, but the surgeons can't guarantee me I won't, and no responsible surgeon would touch me now.

Not carrying my bag anymore, pushing the cart. But playing 9 holes 4-5 days/week, handicap is around 8...I'm happy. and very grateful.

I take an ibuprofen now and then, but haven't had a Hydrocodone since October.

It has worked so far for me, but I'm not a world class athlete wanting to get back into the fray. I can't fault a guy for making a different decision. Different stakes, different information.

playa · April 26, 2017

Surgery techniques have come a long way from even 30 years ago so some of the horror stories you read aren't relevant these days. Never had a bad back but had a real unstable knee growing up. Early 30s a piece of floating bone the size of my pinky tip dislodged from behind my kneecap (it had been sitting there calcifying for 20 years but not coming up on x rays). I had to get surgery to remove it. Went in for day surgery, had keyhole surgey to remove the piece, cleaned up around the joint and back home that night. No damage to muscle or soft tissue from invasive techniques like the old days. Two days later I was walking unaided, 9 days post op I caddied for a player in our Pennants team, 4 days after that I played 9 holes and was completely back to normal. I was lucky that the op was done by the best surgeon in Sydney, but modern sufgical techniques had a lot to do with the recovery time. Since the op I have had no pain after exercise like beforehand, and the knee has been stable and pain free. I used to wear a knee brace to play golf but haven't needed one again. There is no amount of rehab or exercise that could have helped my situation. Sometimes surgery is the only option.

Hankshank · April 26, 2017

Peter said it at the time, referring to the back issues he and Tiger had at the time. So nothing is said about the last back surgery now. But what if Tiger was given the options at the time, and went for the quick option and has been paying for it since?

Of course, Peter is not more a surgeon than me, I do not know about the source of info he had but that was what he said, back then.

Forged4ever · April 30, 2017

I was in IV's yesterday when a Bud and former Stiller OG dropped in to say hey as he was upstairs for PT. He Played 5 years for em, starting his last two and then his world caved in, or more accurately his back caved in. He broke down in his 6th fall camp, went on IR, and never Played another down, practice or game. He is 6'2" and Played at 290-293, and the reason that I include that extra 3lbs. is because he got fined $100 for every pound that he was over 293. He guesstimated that he paid about $4000-4500 in fines over his five years in the league, with weekly in-season weigh-ins every Tuesday, lmao. He says that he currently runs between 340-345lbs. I'd wager 360-370?

Oh yea, he just had his 7th surgery this past December and cannot walk without both canes, EVER! . Guyer(Tiger's surgeon) did his last two.

He's a year younger than me and if you offered me a clean exchange of my current health status for his, I'd pass and stay right where I am. He's as hard nosed as they come but the pained expression on his face when he lifts his legs up into the exam chair makes me cringe and I can't help but assist by lifting his tree trunks up for him.

Nahhh, no matter how bad ya have it, there is always someone who's got a rougher road to walk than you.

That's probably my Best mental therapy as I see that every day

Have a great week Gals & Gents?

My Best,

RP

williamsnrb · May 1, 2017

Great response, Richard (as usual).

edit: The below response was added to my reply to Richard. It was meant to be a separate post, but the quick reply combined them. The portion below is not in response to Richard - he knows I am completely on board with his position. :taunt:

I live in this world everyday and will expound a little. There are some conditions where neurosurgery is a godsend (oncology - for obvious reasons, stabilization of a traumatic spinal injury, pediatric disorders, cauda equina syndome, etc). In such cases, neurosurgery is absolutely indicated. However, the water gets very murky in cases of pain without neurological deficit. There is a condition termed 'failed back surgery syndrome' for this very reason. On the other hand, rehabilitation is not at all standardized. In cases of mild/moderate back pain, a person could be suffering from a number of different causes of said pain. In some cases, physical therapy may reveal results when no other approach did. For other cases, a chiropractor may be best when physical therapy yielded no results. Or massage. Or acupuncture. Or you name it. And musculoskeletal rehabilitation has grown leaps and bounds in the last, say, 10 years. Now, it seems that it does not matter so much what profession the practitioner is (chiropractor or PT) as much as what approach the practitioner is using (the fields are quickly merging, it seems). So some people say they failed conservative management and decided surgery was best. But which conservative management did they fail? Would another approach have been better for their specific condition?

Anyway, there are a lot of different options for rehabilitation, and I would personally opt for one of them prior to surgery so long as surgery was not absolutely indicated (as described above). However, pain is a powerful motivator and if a person experiences enough of it (either in quantity or quality), getting out of pain becomes the most important goal. That motivation leads to the perception that surgery is the best option and sometimes it works and sometimes it does not.

So, to reiterate posts before mine, it is case dependent (but have a competent rehabilitationist/and or surgeon help you determine which route is best for you based on specific etiology - not just 'pain').

williamsnrb · May 1, 2017

Ortho spine surgeons go through the same residency/fellowship requirements as neuros.

Lodestone · May 1, 2017

excellent post!

Lodestone · May 1, 2017

around here anyway, the ortho docs have moved away from backs and spines and handed that over to the neurosurgeons. The ortho guys seem happy and busy doing knees and shoulders where they can swap out complete parts. I have known several very good orthopedic surgeons, for decades, and they were more than eager to not have to go messing with people's backs. Too many unhappy results.

While the training may or may not be the same, (I can't say if it is or isn't, my guess would be that it is not), it's not just about the training. It's largely about what you spend most of your time doing, and studying AFTER your training. The neurosurgeons are spending a lot more of their time on backs, vs. a typical orthopedic who was also doing knees, shoulders, broken limbs etc etc...

bigred90gt · May 1, 2017

Again, as I said, I'm sure an ortho would do a fine job, but my preference is with someone who specializes in the neurological system when it comes to spinal injuries. I spent a year welding in a metal fab class I took, and occasionally weld on things around the house, but if I need something with any kind of structural integrity fabricated, I'm going to go to one of the many welders I know to have them do it. An AC repair guy knows basic electrical systems, but if I need my house re-wired, I'm calling an electrician. A bit of a stretch for comparison, but same concept.

My fiancé is a post anesthesia care nurse at a major hospital. She sees all kinds of surgeries performed by every kind of surgeon you can imagine, and she will tell you the same thing. If you have an injury that requires surgery, and there is a surgeon that specializes in that particular area, that is where you go. I also wouldn't take my Ford truck to a Chevy dealer for repairs. They're trained mechanics, but they specialize in something other than what I have.

Forged4ever · May 1, 2017

Yep, absolutely!!!

Great catch Bill as I missed this however as Bill stated, an Otho spine guy goes through the excact same spine training as a neuro with the exception that the pods usually steer clear of the cervical stuff. As I stated, and this is just me however if I needed my spine done(sacral through thoracic), well my God Father is Joey Maroon(neurosurgeon(google him if ya haven't heard of him) and he's invented a few procedures along the way, and he had Jon do his MIS LD) and I could go through the channels and basically see who em ever I wanted, ortho or neuro, and lumbar sacral and thoracic, I'd take Jon Levy, a pod here in town, all day every day, 7/365.

The Ford/Chevy analogy is not apples to apples with regards to pods/neuro and spine.

Listen to whomever is your "expert," whether they be a nurse or surgeon, whatever you're comfortable with.

I'm just giving my .03 worth :)

The bottom line is that if ya can, the rule of thumb that I give people is that you want to go to the medical docs and surgeons that the docs, surgeons and their families go to.

Excellent posts Bill!!

Have a great week Bro?

RP

BogeyHunter · May 1, 2017

I cant talk too much on whether to have surgery/rehab but I would absolutely opt for rehab first.

Phil has it right. The old timers have it right. Once, X factor became the swing to copy golfers started getting injured. Stack and Tilt is the perfect back killer. I had a student tell me that he tried Stack and Tilt after seeing the commercial and he couldnt walk for almost two days from the lower back pain. Its crazy how the modern golf swing is injuring Pro golfers. I mean why should players in their 20s have back problems? it makes zero sense until you see what the modern swing is doing to their lower back. The teaching needs to change. I am glad that youre talking about this.

I get into arguments about this all of the time with other teaching Pros. I say this because I used to be a PGA Pro. I actually started learning golf by using the Ernest Jones method from Arnie Frankel. I got down to scratch after about 6 months after learning how to play using that method. Then I started the PGA Apprentice program and learned all about the mechanics. I got worse. A lot worse. Anyway, back to the lower back, people should be swinging more like Phil. He lifts his front foot off the ground, moves his hips more inline with his shoulders to prevent stress to the lower back. He swings the club in as much of circular motion staying connected as possible. None of this creating torque on the lower back BS.

Brian Sparks on YT has a series called Easiest Swing in Golf. If you are a senior golfer suffering from back pain, I urge you to watch his series.

Anyhow, Ive ranted enough!

williamsnrb · May 1, 2017

I don't mean to be argumentative, but this is not true. Spine ortho's go through the same specialty training as neuro's in terms of spine. Ortho guys may actually have a better understanding of joint mechanics in the spine than neuro's, actually. Spine ortho's aren't working on knees and vice versa. With that being said, a good friend of mine is a neurosurgeon and if I needed any work done, I'm trusting his hands. However, ortho spine guys are generally just as capable in the spine as neuro's.

williamsnrb · May 1, 2017

But that's my point - ortho spine guys generally only do spine surgery. And they are specialty trained alongside neuro guys. It's not like the local ortho who operates on knees and shoulders is going to crack into your spine. That seems to be what you are implying. Using your analogy, it would be like a carpenter who trains as a welder (full training) alongside an electrician who trains as a welder (same training). Each person may have a different background (pros and cons), but at the end of the day, each is fully trained in welding (carpenter=ortho, electrician=neuro, welding=spine).

And even though fusions, laminectomies, microdiscectomies, etc. are near neural tissue, the bulk of the procedure involves much more bone and joint components than neural components. In that way, one could argue that ortho spine surgeons might be better equipped to tackle those.

Again, we are not talking about brain surgery (obviously a neurosurgeon's territory) or hip replacement surgery (obviously an ortho's territory). We are discussing spine surgery and both ortho's and neuro's can have identical training in this shared anatomical region.

williamsnrb · May 1, 2017

Great points, Richard. Dr. Maroon is WORLD CLASS. I do not know him personally, but I have heard his name come up in high circles. We have some great neuro options here in Memphis, TN - a few good friends. Take care, man! I hope you're doing well.

Nathan

rangersgoalie · May 2, 2017

I have a fast approaching decision on my shoulder coming up. I am finally out of pain, can sleep, shake hands, but can't swing a club.

Have two rotator cuff tears and a labrum, but am 55. and not too excited about a one year rehab, so working and PT

with a back, I'd multiply this by a lot, and do anything to not have surgery. Shoulders have a pretty predictable result compared to back surgeries

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