By Dan Hellman
What do you do when you’re a very promising 18-year old golfer looking forward to making the Tour some day and are told that you need spinal-fusion surgery to repair a disc herniation? Well, first take a deep breath. Then get a second opinion and see if you can heal your back through physical therapy.
This happened to one of my favorite clients, a young man from Sri Lanka named Vinod Weerasinghe. Vinod is an exceptional golfer (he’s now 19) who had suffered a large L4-L5 disc herniation—that is, a rupture of the disc separating his fourth and fifth lumbar vertebrae. A surgeon had recommended fusion surgery for him, a last resort for just about anyone but truly a drastic step for someone so young. Fortunately, he and his parents were wary of surgery and rightfully concerned that it might effectively end his golfing career.
Choose PT before surgery.
I believe it is almost always best to try physical therapy before resorting to surgery, and more and more surgeons agree. Dr. Richard Guyer of the Texas Back Institute, with whom I have worked closely, routinely refers patients for physical therapy before considering surgery. Mind you, Dr. Guyer is an orthopedic surgeon who has pioneered some of the most advanced techniques in back surgery, including spinal fusion and disc replacement, and he is in demand worldwide. He is certainly not anti-surgery, but he won’t recommend surgery unless non-invasive treatments and therapies, like PT, are not effective. And surgery for disc herniation? Mayo Clinic says it usually isn’t necessary.
I was pleased that Vinod came to Florida so I could work with him. He is an engaging and enthusiastic young man and was willing to do the hard work of healing his back and becoming his own physical therapist. He made the long trip twice in 2019 from Sri Lanka to Fort Lauderdale, each time spending several days with me. Currently, Vinod does two hours of exercise a day, and it is mandatory for him to do several decompression exercises after every workout or practice of the golf swing.
With his disc now healed, he is hitting golf balls again, pain-free. As you can see, he needs to work hard at staying pain-free every day, but I’m sure he thinks it’s worth the trouble. I expect him to have a long and successful career in golf if that is what he chooses to do. But whether he turns pro or just plays good golf in his leisure time, he should be able to enjoy the game for many decades.
What is a herniated disc?
The spinal discs are rubbery cushions located in the space between the vertebrae. They act as shock absorbers in the spine, keeping the vertebrae from making contact with each other and preserving the space between them. They also hold the vertebrae together, much like the ligaments in other joints, and they act like cartilage, allowing the spine to have the mobility it needs. If the discs deteriorate, the nerves of the spine can become compressed between the vertebrae, causing intense pain.
When a disc is herniated, the rubbery exterior is torn, and the disc’s jellylike nucleus protrudes through the tear. A herniated disc can never be recaptured, but my specific physical therapy worked with Vinod for an important reason: If we can move the herniated material away from the nerve through exercises so that nothing touches the nerve, the back pain ceases to exist. If a disc protrusion is caught in time—that is, before it herniates–it can be completely recaptured and returned to normal. So paying attention to the pain in your back before it becomes unbearable is critical. I use a unique combination of movements, exercises and techniques with each patient or client, drawing especially from ELDOA, myofascial stretching and segmental strengthening.
Fusion Surgery Now, More Surgery Later
Had Vinod opted for fusion surgery without first developing the structures to protect his back, he would have run a greater risk of needing more surgery later on. This is one way orthopedic surgeons and physical therapists work together, and one way I have worked with Dr. Guyer. But beyond that, Vinod needed to learn how to care for his own body. In fact, we all do. After all, our bodies can’t lie to us. If your body is speaking to you through pain, then you must be doing something that doesn’t support its well-being.
I sympathized immediately with Vinod because I suffered an injury in high school that cut short my basketball playing days. I was a shooting guard and I loved basketball, but I was never the same after the injury. In my recovery, however, I developed a great respect for the trainers and physical therapists who worked to put me back together, and that led me into my calling and my career.
Choose PT for pain.
Vinod’s story is another lesson in the value of physical therapy, particularly physical therapy that is well designed and properly executed. There is no doubt that physical therapy takes time and effort. People often prefer a pill to mask the pain or surgery as a quicker solution. For some reason, people believe more in the surgeon’s scalpel than in their own body’s ability to heal through corrective treatments. But physical therapists have many techniques at their disposal today that do what surgery and pain killers can’t do: reorient the body to its natural state or find ways for the body to adjust naturally to a new reality.
Surgeons operate. That’s what they do. But the good ones, like my friend Richard Guyer, understand that surgery should be a last resort, not a first option. They are more interested in healing the patient than in performing the surgery. Vinod has a future in golf because he and his parents wanted a solution that would not cut that future short. I am thrilled and honored that they came my way.