Thanks for the opportunity to help you.
The indications of the surgery are;
1) Failure of the conservative treatment.
2) Progressive or severe / excruciating pain.
3) Increasing neurological signs and symptoms
4) Involvement of bladder and bowel.
Following investigations also would be required, if not yet done;
1) Nerve conduction velocity (NCV) study
2) Electromyography (EMG)
Following measures usually are advised for the conservative treatment;
1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:
a) Avoid activities which increase the pain.
b) Rest intermittently
c) Avoid bending at 90 degrees
d) Pushing and pulling should be avoided till pain subsides
f) Avoid prolonged sitting and standing
g) Avoid sitting or sleeping on floor
2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants
3) Local analgesic gels or sprays / ointment
4) Hot fomentation
5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.
6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.
7) Lumbosacral corset or support or brace
8) If obese or over weight, reduce weight for long term benefit.
9) Epidural steroid shots
10) Radio frequency ablation of the nerves in facet joints.
Surgery is usually last resort, when the above conservative measures fail or symptoms are progressively increasing. You may start the following exercises, meanwhile;
1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.
2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).
This is a slide show for the exercises (you can pick up your own set, which suits you);
You can consult following specialists (apart from your GP);
c) MD in Physical medicine and rehabilitation
Your knee and hip pain are due to concomitant conditions of osteoarthritis (degenerative / age related arthritis) and due to radiculopathy from the back. These may need hip and knee replacement if conservative measures as following have not helped;
1) Physical therapy; this is the mainstay of the management of the osteoarthritis. Stretching exercises, strengthening exercises, mild weight bearing exercises, swimming on the week-ends etc would be helpful. Going to pool on week-ends will further enhance the benefit. You need to incorporate the exercises in your routine as much as possible.
2) Deep electrotherapy; this entails going to physical therapy center and take care of specific issues which are more painful.
3) Glucosamine and chondroitin supplements
4) Diacerin too can be tried which suppose to regenerate the cartilage.
5) Local analgesic sprays
7) Consideration of hyaluronic acid injection in the joints which are more painful. Some physician may inject steroid too for the pain relief.
8) Warm shower in morning would open up the joints.
9) Capsaicin (Zostrix, ArthriCare) is an irritant derived from chili peppers that provide relief by depleting a chemical that transmits pain from nerve endings. Various strengths are available without prescription. (It causes a burning sensation thus one has to be careful while applying and should wear a disposable plastic glove).
10) Acupuncture; most popular forms of alternative or complementary medicine, particularly for pain relief.
11) Analgesic patches too are available for the pain relief.
If overweight is an issue; long term is achieved by weight reduction. High impact exercises should be avoided; like kneeling and bending.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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