Views And Reviews No Holds Barred

Margaret McCartney: When can I get back to running after my operation?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4299 (Published 02 October 2017) Cite this as: BMJ 2017;359:j4299
  1. Margaret McCartney, general practitioner
  1. Glasgow
  1. margaret{at}margaretmccartney.com

When should I start running after a microdiscectomy? In weeks 1 and 2, walking is challenging enough. Week 3: the last few rays of summery sunshine, and I regard other runners with frank jealousy. I want to go running, but I’m scared of undoing the benefits of surgery. As one protocol says, I have “patient anxiety regarding reherniation risks.”

But where does this anxiety come from? “Sports should be avoided for three months,” says my local leaflet. But sex can be resumed “fairly soon, provided that you avoid any strenuous activity and are lying on your back.” This is unexpected, and I wonder what the evidence is. What will it actually take to undo the surgeon’s good work?

The internet gives me other opinions. Were I having the same operation in west Hertfordshire I’d be advised to “take it easy” for the first six weeks but to then “increase your activity as comfort allows,” being back to baseline by 12 weeks (no mention of sex).1

Patients at Guy’s and St Thomas’ are advised that they can get back to “heavier work and sports after two to three months” (also no mention of sex).2 In Oxford, “Jogging is okay after 10 weeks.”3 At Royal Berkshire NHS Trust, “Jogging, running, and heavy lifting should be avoided until six months after the operation.”4 (If that weren’t bad enough, “you may resume sexual relations as long as you remain the passive partner for the first six weeks.”)

But all hail Queen Elizabeth Hospital, Birmingham, which has an extensive, sympathetic leaflet saying that “jogging can be started immediately.” Joy! But that’s under “low impact” exercise; the next paragraph, rather confusingly, contradicts this by saying that “high impact exercise is running, jumping or twisting, for example, jogging,” and that this shouldn’t be started until four weeks because “you need time for the disc to heal.”5

I get the feeling that no one actually knows the answer to running after spinal surgery. Are there randomised controlled trials? I’m not bothered about short term pain, only about increasing the chance of recurrence. There is a Cochrane review, comprising trials of low or very low quality evidence, which focuses on post-op rehabilitation and concludes that high intensity exercise programmes produce slightly less pain and disability.6 Great. Many trials in interventions of exercise say that people were encouraged to get back to “usual activities”—but they don’t specify what these are.7

I can find only one study that included jogging as an exercise, as opposed to physio led, strengthening-type exercises.89 It had only 52 patients in it, and just a third were women. Is that enough? Trials are under way to compare prescribed restrictions on movement (together with electronic monitoring) with “unrestricted activities.”10 Will they look at a subgroup of runners? In any case, the results won’t be in for a while.

Given that the evidence I’m looking for doesn’t seem to exist, can I be part of some kind of crowd generated trial myself? Alas, I see no trials on the UK Clinical Trials Gateway that can answer this, and the randomiseme.org project seems to have run out of money and disappeared.11

In the meantime, it would save an awful lot of time and money if information leaflets for standard procedures could be nationally standardised and locally tweaked, to represent the evidence and state the uncertainties. There’s no clear evidence of harm: the sun is out, my trainers are on.

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