Ep 12: Surgery or exercise for back pain? A client’s perspective

Voiceover (00:02):

Welcome to the Confident Body, where experienced health professionals discuss how to get the most out of your body for the lifestyle you choose. We believe everyone can exercise and get the most out of life, regardless of your injuries or health issues. Now here’s your host, senior physiotherapist, Michael Dermansky.

Michael Dermansky (00:23):

Hi, everybody and welcome to the show that helps you become more confident in your body so you can keep doing things that you love. My name is Michael Dermansky. I’m the Senior Physiotherapist at MD Health and I’ve got a special guest for today, Judy Czuchnowski, she’s one of my clients. And the reason why I asked her on the show today because I want to talk about a specific topic today, particularly with back pain: exercise or surgery. And the answer sometimes is not one or the other. It’s sometimes both.

So welcome to the show, Judy, and it’s really nice to share your experiences with the audience today. And so let’s start with a very simple one today. Tell us a bit more about your story about how your back pain started and what you did about it at the start.

Judy (01:09):

I’ve actually had back pain for a long time since my 30s and I was told that it was arthritis and I used to do a lot of walking to help with that. And for a long time that wasn’t too bad, but then once I got a bit older, and I guess too, I was working full time so it got harder to do the exercise, it got worse and it got worse anyway. And so I got to a point about 12 years ago and I was just in absolute agony and went to a GP who had some diagnosis’s done and sent me off to a surgeon who basically said to me;

“Look, come back when you’ve got something to worry about. Tell me about it when you’ve got something to worry about.” In the meantime, they started me on Lyrica.

Judy (02:06):

And that’s what I was doing. But in addition to that, I went to a physio and started doing Pilates at that point, this was a long time ago now for Pilates and I enjoyed doing that. So I continued doing that for a while, quite a while. And in the end decided that I actually wasn’t getting any better.

I was only doing it once a week and it was more a set program. I had a set program. I was given it and you just picked it up at the front and did the exercise on your own. You were not supervised as such and I felt like I wasn’t really getting that much better. So I felt like I really needed to do more than that.

Judy (02:53):

And long story cut short, I ended up coming here where I’m now coming and I have been for two times a week, which is much better. And also I like the fact that it is more tailored to my particular problems and it really means that I have felt much better in myself. Having said that, the pain itself, I mean obviously never went away. And in fact I got to the point with the Lyrica where I took the maximum dose for probably a decade and I was still in pain. So I’m taking the maximum dose and I’m still in pain and I’m doing this as well.

So for a long time, I tried very hard to just continue doing that thinking, well, I’d been told that I just have to do this, I can’t just expect to have surgery. And I went to different GPs and none of them were particularly interested in talking about surgery with me.

Judy (04:04):

They were basically like, “Here’s your Lyrica.” And that was it. Some of them would say to me things like, “You really shouldn’t take Lyrica. It’s not a good drug to take.” But they wouldn’t give me an alternative and they didn’t say to me, “Look, this is how you need to get off Lyrica.” So there was no alternative as far as I could see.

So I just had to continue as I’ve been doing. And then I got to a point where I really realized that this was my life from now on. It was only going to get worse, which it did. And basically I had nothing to look forward to. I was like, “Well, what do I do?” I felt like I couldn’t go overseas again. I couldn’t do anything. I couldn’t stand because I was in pain. What kind of life is it?

Michael Dermansky (05:00):

And you felt this way whilst you were doing the clinical exercise and Pilates or this was before we did the tailor program.

Judy (05:09):

This has been all the way through.

Michael Dermansky (05:11):

All the way through. Okay.

Judy (05:12):

So yeah, even though I was coming here, and I mean by the way, I felt so much better. I mean, I couldn’t not do this and I couldn’t not take the Lyrica because I knew the alternative was that I’d kill myself. Yeah. I did try to come off the Lyrica, I took myself off, but slowly tried to wean myself. And even after a week, I just wanted to kill myself. Literally wanted to kill myself.

Michael Dermansky (05:38):

Lyrica, you have to do it… One week isn’t slow. It’s really fast.

Judy (05:43):

Oh no, I’d only weaned a little bit off. But even so, the pain was so bad. So I knew that unless there was an alternative there, I was completely stuck.

Michael Dermansky (05:56):

Right. So let’s just go back two steps as well. Yeah. So firstly, I mean you were doing a class-based version of exercise or independent based stuff as well where it wasn’t supervised. And the difference between that from my perspective is that it can’t be done specific to your needs. It’s too generic. It’s not tailored to what people’s needs are. And everyone’s needs are really physically different. And then you did that for a period of time. Once you started doing a more tailored program to you, despite the fact that pain was there, how did that affect your life?

Judy (06:33):

Oh look, I felt better in myself. Just in a psychological sense, I was much better. And also I noticed that my body itself… Well, I was clinically obese, I’m probably still clinically obese, but my body itself changed, the actual change because of the Pilates that I was doing. So it makes you feel better about yourself the fact that your bottom doesn’t look as bad as it did, things like that.

So yeah, look, I felt better in myself for doing it definitely. And I knew that I had to. I wanted to keep it up because I enjoyed it and I enjoyed too. And I still enjoy coming because there are other people here and you get to speak to them.

Michael Dermansky (07:22):

See, that’s an interesting point you say, I mean the fact that you are amongst other people and you’ve got back pain and yet you can do things in your life again with other people around. That’s a massive, that’s social element to it too. It’s not just nice to have, it’s actually a big part of the healing process too.

Judy (07:42):

It definitely is. It definitely. And I have to say where I was before, where I was going, most of the people in that physio practice were young people. And I was a lot younger in those days myself, but they were still young people. And so the physios also were young people and they were really more interested in talking to the young people there than some oldie like me who I’m not a sports person, I hate sport, I really hate sport. And so all the physios liked sport and they were talking to the young people who maybe had a sports injury or something. And so they were talking about sport or they were talking about things that they had in common and really just ignored me.

And so coming here, it’s a different group of people. There are older people, much older than me coming here, but there’s people younger too and you can still get along fine with them. It’s nice. It’s nice to be able to have that different group.

Michael Dermansky (08:43):

I mean, having that environment where you feel comfortable is a major part of it. I mean, going to something you said to me in the past is that you told us before that you felt like we were a partner in your health. So do you mind saying what that means to you? What does a partner in health mean to you as opposed to us just telling you what to do?

Judy (09:06):

So to me, I very much believe that it’s my body and I own my body. And if I am going to improve that, I’ve got to put the effort into it. And yes, I have to use experts to help me like yourselves, but I’ve got to put the effort in as well. You’re putting in your effort and your expertise, and then I’ve got to put my efforts and expertise as much as I can as well so that we are both partners in improving things. But I have a vested interest in it because it’s my body and I don’t want to be in pain.

Michael Dermansky (09:43):

See, that’s two huge things you talked about as well. Number one, the social aspect where you felt like somewhere you belonged and you felt like somewhere you felt included. They’re not random things that have an effect on how the way you feel and the fact that also that it’s your body. You took responsibility. So one of the major, major things that we need to work on with clients as well that we need to have them see is that it’s not just about us fixing them. We can’t do that. There’s nothing we can do to fix you unless you take the initiative to do the things that you need to do to make a difference. And having that mindset with you is massive in terms of getting an outcome.

And so those two aspects, the fact that somewhere you feel comfortable and somewhere where you take responsibility for your own health is huge. We’ll provide the guidance, but ultimately you have to do the work.

Judy (10:36):

Yeah, definitely.

Michael Dermansky (10:38):

So when was it not enough? So tell me about when you decided it wasn’t enough and the steps that you took. Because you did all the exercise, you’d gotten more active, you did more things in your life, which is great, but then it wasn’t enough.

Judy (10:53):

When I started to realize that it was getting more painful and I really felt more and more limited in what I could do and thinking this is my life for the rest of my… And I mean I’m not old and wanting to retire, I’m not retired yet. So I would’ve liked to retire and think, well, I’d go overseas or I’d do the gardening or I’d do whatever.

And whenever I could think of doing it was like, “I don’t even think I can do those things. What on earth am I going to do with myself? I can’t do anything that I want to do in the future. This is horrible.” And it’s only going to get worse because I knew it had been progressively getting worse. And actually the catalyst for it was during the lockdown, I had to ask for more Lyrica from the doctor, from the GP.

Judy (11:45):

And where I was going at that point, I didn’t really know them, just a clinic. And they said to me, “We can’t give you this dosage. I’m not allowed to give you this…” Well, they didn’t actually say that. They just said, “No, well, we can’t give you that.” And at that point, I was like, “What do you mean? I have to have this. If I don’t have this, what am I going to do?” And it hit me, I thought, oh no, what alternative do I have?

Once again, not given an alternative, just said, “No, we can’t give you this, we can’t give you the prescription.” So what do you do at that point? That’s terrible. I was desperate. So actually I asked if you remember if I could see a neurologist and you said to me to go and see another doctor who I went to and she was fantastic.

Judy (12:35):

She was really, really great, was happy to give me the prescription. And then I went to a pain management doctor through that and through that process and went there and ended up having, I think it’s like a nerve ablation. And that worked brilliantly. It was really good. I wasn’t in as much pain, still taking maximum Lyrica, but just not being in as much pain. Well, hey, I’d take that, that was good, but of course it wear off as I knew it would. And then the second time around, I tried it and it made not one bit of difference.

Michael Dermansky (13:15):

It was already cut the nerves in.

Judy (13:17):

And at that point it was like, you know what? I’ve got nowhere to go now. This is it. And so we’d already discussed it, the GP and I’d already discussed where I go from here and at this point she said to me, “Look, you need now to see a surgeon. You don’t have to have surgery but you need to discuss it at least with him as to what you might want to do, what are your options.” And that’s at that point it was like, “Okay, I’ll do that.” But I had put it off as long as I could really. But yes, at this point, it was like, yeah, look there are no alternatives for me at this point.

Michael Dermansky (13:57):

Without having the operation.

Judy (14:00):

Exactly. But I felt I’d given it my best shot by that time, which is what I did. I went to him and obviously had to have x-rays and MRIs and what have you. Went back and saw him and we discussed it and he said, “Well, look, here’s what I think needs to happen and it’s up to you. Do you want to go away and think about it and then come back to me and give me a call if you want to discuss it?” And I just said, “No, I don’t want to. When can you put me in? I want to go. I want do it.” As you say, I’d already thought it. I’d gone through this process. I didn’t need any extra time. And I realized too that every day is a day of pain. So that’s what happened. And quite quickly, thank goodness, I had the surgery.

Michael Dermansky (14:54):

So I mean, the interesting process because you didn’t just say, “Oh you know what? I’m going to operation because I want to fix the pain.” You did a lot of work before that too. You’d made your body stronger. You were on Lyrica. So you did the pain management as well. You tried a moderate approach with the ablation as well, which if it’s the right problem, that will work. It did the first time.

Because an ablation, it won’t work for everybody because it has to be a problem where that nerve is being compressed or irritated. If it’s not, you can have an ablation done and it just won’t work. And you, you’d worked on the strength and then by the time you saw the surgeon, he was going to do a decompression for a disc bulge. And so he knew what the problem was, he had the right operation for the right problem. And so what’s happened since then?

Judy (15:45):

Look, it’s been so much better, the day after the operation. I mean, yes, I was on pain medication but already they had me out of that bed. I did my log roll to get out of the bed.

Michael Dermansky (15:57):

That’s right. Yep.

Judy (15:58):

I had the physio come round. The nurses too were, “Come on, you’re doing that log roll, you’re getting up.” Going for that walk up and down the hallway, which I was most happily doing. And within three days, I was home again. And it’s been just walking ever since. So the surgeon said to me, “Well, you need to walk every single day for the rest of your life.” That’s okay and that’s what I’m doing as well as, and as he said, I’d done the prehab and he said, “Now obviously you’re going to do the rehab.”

Michael Dermansky (16:34):

Yes. Obviously you’re going to do the rehab, which is really… So both those things are really important. I overestimate how important those exercises are before any operation as well. I’ve lost count, I’ve really lost count how many times where people have had done all the work beforehand. They have the operation so that the procedure that needs to be done that we have don’t control over is done. But you’ve got all the muscle strength around it too. And then you did all that stuff, all the muscle strength was there. T

hey just have to take pressure off the nerves and the discs and then by that stage, you could go back and continue to work on making the area stronger. Not everyone does that. If they do the operation too early before they’ve done the strengthening work, we just see bad outcomes.

Judy (17:22):

Well, he said to me, he thought that I would be, and in fact the referring doctor had said to him that this patient is a very good patient. She’s a good candidate for this operation because I have done all the work.

Michael Dermansky (17:36):

You’ve done all the work. It’s such a big deal.

Judy (17:38):

And she knew that I would continue to do the work afterwards. And he said, “I know that you will do it.” And I have, obviously.

Michael Dermansky (17:46):

So you were told walking for the rest of your life and the reason why you do that because it’s area moving that because they would’ve done the operation, some of this, the space would be less around the discs. And so this joint, the faster it’s going to be closer together. And so one of the risks of this operation is also you get early, develop more arthritis in the long term because there’s just less space now.

So you need to the walking to be able to nourish that area because it gets more bloated and well, it gets more nutrients moving through those joints as well. And you need to do that manually now because it’s not going to be as easy naturally without you doing the work. So what did it look like afterwards? You did the walking, when did you start doing more of the rehabilitation process?

Judy (18:29):

I had to wait until the surgeon said I was allowed to. I think it was about a month afterwards. And so I went back to see him. He said, “Yes, you can go ahead now.” And that’s when I started up again.

Michael Dermansky (18:41):

Yep. And how’s it been since you’ve had the operation and are doing rehabilitation exercise as well? So how’s your life now changed compared to what you said it was like before?

Judy (18:58):

Oh, it’s not the same life. I mean, I’m not in pain. I mean people say to me, “How’s the pain now? Are you okay?” I go, “I’m great.” I don’t take the Lyrica, which is really my goal when beforehand I said to the surgeon, “My biggest goal is not to take Lyrica because I hate the stuff so much.” And he said, “I hate it too. I do not want you on it.”

Michael Dermansky (19:22):

It’s a lot of side effects and you cannot come off it quickly. There’s a hell of a lot of side effects if you come off quickly. So if anyone’s listening to this and then say, “I don’t want to be on Lyrica,” please, please work through with your doctor about that too, because it needs to be slowly weaned off. There’s a lot of side effects.

Judy (19:39):

Correct. Absolutely correct. That took me some time to do, but that’s fine. That’s okay to do that. But I was in a position where I could then do it because I wasn’t in the pain. I couldn’t do it before because I just had so much pain. So now I’m not taking the Lyrica, I don’t have the pain. It’s a whole lot better. And actually my neighbor across the street happened to see me and she said to me the other day, “You are like the old neighbor I used to have the one that had the spark in her eyes.” And I said, “Really?” She said, ‘Yeah, I’ve got the old neighbor back.” So I didn’t realize that I looked so… I don’t know whether I looked grumpy or whatever. I didn’t think I looked grumpy.

Michael Dermansky (20:27):

I mean it shows when you’re in pain like that too.

Judy (20:30):

Yeah. And I mean year after year after year, it’s just tiring actually.

Michael Dermansky (20:34):

Yeah, it is very tiring.

Judy (20:35):

It’s very tiring.

Michael Dermansky (20:37):

So couple of other quick questions as well. So in terms of after the operation, how long did it took you to get that state where you got the life you have now?

Judy (20:48):

Really I was going to say straight away.

Michael Dermansky (20:52):

Oh wow.

Judy (20:52):

Straight away I felt so much better. And as I say, I’ve been walking every day. At first, I was a bit dizzy and I didn’t feel like I wanted to walk out and it was very cold. It was the middle of winter so it was very cold. And I would walk inside. But if I could get my daughter or my husband to come with me, come them into coming with me, I’d have to go with them, walk around the block and things because I was a bit scared that I would fall. But now, I mean, for months now, I’ve been doing that myself. And I actually look forward to going out on my walk. So my life’s really changed completely.

Michael Dermansky (21:33):

That’s fantastic as well. So I guess the biggest question I wanted to bring up with this podcast as well is exercise or surgery, from your perspective, what’s the answer?

Judy (21:50):

I would say if surgery is correct, if surgery is correct, it’s both. Obviously it has to be worked out whether surgery is the correct way to go. I mean if you just have a bad back, it’s not necessarily right to have surgery. It might not be the answer. That’s first thing. And then exercise is crucial to that I think. But if surgery is the answer, you still need to do a whole lot of exercise beforehand as well as afterwards.

Michael Dermansky (22:21):

And see that’s the big thing as well, because we hear from our clients as well, “Oh, my last option is surgery.” It’s sometimes just part of the process. It’s not necessarily the final option or the beginning option. It’s like this is what the process is. And so for you, that might be the right thing. Now surgery is not for everyone. And for you it was very different because you had the right operation for the right problem.

They didn’t explore and say, “We’re doing this operation to get rid of your pain.” They do this operation because they had a mechanical problem they needed to change. And as a result of that, the pain went away. But you did all the work, you took responsibility for your back pain and did the work.

The social elements, it’s a massive part of it too. And then straight away afterwards you were doing your rehabilitation exercises and doing the right things about that too. You were very active about that too. Where we see these things fail, so people say, “Oh you know what? I need surgery,” and they stop doing exercises or they’re going for an operation where, well, we’re going to fix the back pain when they don’t know what the cause is. And that’s a disaster from every angle. And we see that these are the long term ones that really don’t get anywhere and it’s just, well, where do we start from the start?

Michael Dermansky (23:36):

So I guess the answer is that not to fear surgery, because it’s sometimes the right thing to do. So we see a very similar approach with hip replacements as well. When people have severe arthritis in the hips, it’s not like, “Oh, the final outcome’s surgery.” No, you might even have an operation now and again in 20 years or 15 year, depending on how long the processes last. But if you do the work beforehand, you’ve done all the strength work and improve the function as much as you can. And then the last thing in the step is to change the surface and then you continue the work afterwards.

So you actually have a better life from the operation rather than just, “I did the operation to reduce the pain.” The whole point is to have the better life. Otherwise there really is no point to the operation.

Judy (24:24):

No, there has to be a goal and the goal has to be you have a better life or I agree. I think that’s… And the surgeon said to me, he said of the physio and you make me look good.

Michael Dermansky (24:36):

And that’s our job. That is our job to make the surgery look good. But also really particularly for you to make sure you have a better life from the operations as well.

Judy (24:43):

Yes, exactly. Exactly right. And I do, I do have a much better life for it.

Michael Dermansky (24:49):

Finally, is there anything else you want to tell the listeners, any pieces of advice you want to finish up with, Judy?

Judy (24:55):

No. It’s just find something that you enjoy doing so you’ll do it. So when I go walking, I mean I listen to music. Somebody else might like to listen to birds song. You know what I mean? It’s whatever you like doing that will encourage you to do that exercise that you need to do, then find it and do it, I guess, I would say is the best thing to do.

Michael Dermansky (25:23):

Fantastic. And I would guess from me, the biggest thing I heard from your story is that you took responsibility from day one. This is your body. You have to be your partner in this as well. You’re not expecting anyone to come and fix your pain. You did the work that you needed to do to make a difference to this issue as well.

Judy (25:40):

That’s right. And I am better for it definitely.

Michael Dermansky (25:44):

Well, thank you very much for joining us, Judy. And then it was great information. It was really good to hear your perspective of the whole journey and letting people know not to fear the surgery when it’s appropriate.

Judy (25:57):

Exactly. And it didn’t hurt. I mean, really honestly, you’d think afterwards you could be in a lot of pain within the hospital. I really wasn’t.

Michael Dermansky (26:07):

That’s really, really good to hear.

Judy (26:08):

So don’t fear afterwards thinking, oh, I’ll be in terrible pain. No.

Michael Dermansky (26:13):

No. But it’s not the first protocol either. So if you haven’t done the work, you would be in mistake to go in for surgery first.

Judy (26:23):

Oh absolutely. Absolutely. You’d be mad.

Michael Dermansky (26:27):

Well, that’s the end of the podcast for today, but next time we’re going to be talking about exercise and pregnancy as well, when it’s appropriate and what’s safe about exercise and pregnancy. Again, we’ve seen this a lot over the years and people do exercise during their pregnancy. They get great outcomes for during pregnancy and afterwards as well. So that’s what to look forward to in our next podcast. Thank you very much for listening.

Voiceover (28:34):

Thank you for listening to The Confident Body. For practical articles to help you build a confident body, go to mdhealth.com.au/articles.