Strength Training After Laminectomy/Discectomy

I have done a cursory search for recommendations on strength training and traditional barbell training status post Laminectomy/discectomy and could not come up with anything specific through the forum. I’m sure you’ve addressed this subject before, considering the large amount of discussions I’ve seen on “Sciatica” but I cannot find anything specific. My questions refer to re-engaging strength training after the recovery period and what your recommendations for progressive loading are? Risk of re-herniation is 10% in the first year, with a higher than normal risk over 5 years, and normalizes thereafter. Is there a specific period of time you recommend staying away from barbell training? Would you limit strength progression, and therefore increases in weight? Would you stay away from certain lifts entirely? As a rule neurosurgeons generally recommend No DL, No Squats and No heavy Presses due to axial loading. By your experience can these safely be done? Have you experienced positive results with return to these training exercises?

Your thoughts are appreciated and certainly if these questions have been answered I’d love to read up on it, please point me in the right direction. It’s also worth the cost of effectively re-integrating these exercises, if you would prefer referring me for a consult, I would be happy to follow up with it.

So far as I know, there is no best practice post lumbar surgery. That goes for any lumbar surgery. There are typically restrictions based on the post-operative healing but after that time, a sensible return to loading can begin. Some lumbar surgeries may result in movement/exercise modification for comfort or limited mobility (i.e. fusions).

Therefore to tell someone they can never do squats, deadlift and presses doesn’t make sense. Getting on/off a toilet = squatting. Picking up groceries = deadlifting. Putting object into overhead cabinet = pressing. Yes these can be done and yes there are many positive results. There are countless professional athletes returning to sport after these procedures.

If you’re looking for some guidance on the process, a consult with the BBM crew wouldn’t be a bad idea.

I would be interested to hear where the increased risk of reherniation statistic comes from, and what constitutes a “higher than normal” risk. There are no contraindications to training supported by literature that I have ever seen directly related to laminectomy/discectomy. I would also question the avoidance of deadlifts, squats, etc because of axial loading. If we want to elicit an adaptation, the body has to be exposed to load. Overall, the indications for resistance training far outweigh the risks and the inclusion criteria for laminectomy/discectomy tend to be pretty small.

If you had this surgery, before being able to comment further, we would need to know more about your current case/symptoms and what your goals for returning to training are.

Really appreciate the response. Thank you for taking the time. My main hope is to get your feedback on the hope of returning to barbell training based on your experiences.

Mr. Miles in response to your question: The literature fully supports the risk of reherniation as the number 1 complication s/p discectomy/laminectomy. The numbers are varied as one study shows 2-18% rate of reherniation while another goes as high as 36% for herniations >6mm, but still higher. One such study linked below (among many). Anecdotally it also makes sense, as the procedure itself cuts out the herniated nucleus pulposus (np) without repairing the defect in annulus fibrosus. This essentially leaves a hole for the np to re-extrude through. That said, there are developmental annular closure devices, but are not yet considered standard of care and normally only used for large annular tears.

Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85-A: 102–108

Mr. Rupiper: I agree the functional movement of squatting, pressing and deadlifting are undeniable in everyday life. This undeniable fact is also what makes “functional fitness” such an appealing modality for training. I think the surgeon’s advice to stay away from these activities is more in terms of recreation or sport rather then finding novel ways to get off the toilet. As this will enhance compressive forces on the spine, the defective disc and increase risk of reherniation. I think you make a good point about return to sport. If athletes are able maintain participation in sport then they’re probably still in the gym squatting and deadlifting to stay trained. James Harrison played professionally for several years after this surgery. I would think he squats and deadlifts.

All this is to say there’s still hope of returning to these activities. It also sounds like you all have experienced lifters returning to barbell training with reasonable success after this procedure?

Again really appreciate the feedback.

With regards to your comments about recreation and sport. You have to start with the basics. Get through the ADL’s, then you can move on to higher loads

Given the appropriate stress and recovery there is no reason why you can’t progress in a sensible manner. it shouldn’t be a surprise a surgery such as this will make achieving peak performance difficult (realistic even?). I think a more appropriate question would be what are you looking for? If it is to be a powerlifter, then you will need to DL, squat and press. If its to do cleans and snatches, the same thing holds true. Obviously starting in a modified/scaled fashion and progressing as able would be sensible training.

If your goal is to be a healthy individual, reduce atrophy, etc, you don’t HAVE to do these movements. There are other options/movements and exercises you can choose.

I don’t doubt that reherniation is a concern, but this gets at the lack of strong correlation between imaging findings and symptoms. Carragee also published a study in 2005 looking at the predictors of low back pain disability and remission and found psychosocial risk factors had a much stronger correlation with symptoms than imaging.

​​​​​​Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain - PubMed

To your point, there does appear to be some variability of reporting of herniation in the literature but what I would cite is Lebow which showed a 23% reherniation with 13% of those being asymptomatic and 10% being symptomatic.

This is the say, even if something does occur, there is not a direct association with symptoms. If this is the case, looking for means with which to decrease the likelihood of symptoms is likely a better approach. If there is a correlation between psychosocial factors and likelihood of symptoms and you thoroughly enjoy training I would certainly advocate that the benefits far outweigh the risks so long as they are approached in a sensible manner as Matt alluded to. There is no reason why you should not get back in to training, but it should be in a graded manner. The base of rate of herniations goes up with age and there is a high likelihood that that rate is high within the BBM community which all actively trains. I have an L3 herniation with residual motor weakness and I am typing this in between sets of 5 at 475# deadlift. There was a time shortly after though where I started with an empty bar and it was an act of patient to get back to this point. It all comes down to what your current goals and the patience to get there.

It’s encouraging to hear there is a possibility of returning to these lifts with patience and time. I can live with that. Thank you all again.