It is common to leave the operating theatre with the anatomical problem dealt with and still not know what you can do, how far you can go, or why it still hurts.
Nobody usually explains that part. And it is that part that decides whether you get back the life you had.
Recognising yourself in one is enough. They are different situations, with different routes.
For the overwhelming majority of spinal problems, the literature recommends starting with conservative treatment — often before imaging and medication. Only a handful of very specific situations fall outside that rule.
But there are cases where there is no alternative: the situation really is surgical, or conservative treatment was tried and could not help. In those cases surgery is indicated, and it is the right decision.
If you have already had surgery, this is not a judgement on your decision. It is the opposite: it is the reason why what comes after surgery deserves as much care as the surgery itself.
"I had spinal surgery and I am not well" can mean two almost opposite things. Confusing them leads to treating the wrong person the wrong way.
Months have passed and the pain has not gone away as you expected, or it changed in character and settled in. This has a name of its own and a classification of its own — it is called chronic post-surgical pain, and it is defined as pain persisting beyond the healing process, at least three months after the operation.
Having a name matters more than it seems: it means it is not in your imagination, it is not a lack of willpower, and it is not necessarily a sign that the surgery went wrong.
You no longer have severe pain — sometimes a nagging, persistent ache, sometimes none — but you still avoid bending forwards, you do not pick up your grandchild or your child, you put off going back to the gym because you do not feel confident. You lost strength during the months of recovery, and nobody told you clearly how far you can go.
This is, in my experience, the more common of the two — and the one that most often ends up with no treatment at all, because "everything went well" at the follow-up appointment.
It is not motivation or willpower. It is progressive, specific work — and what gets done changes a good deal depending on how long it has been since the operation.
Which operation, at which level, how long ago, and with what restrictions. It is information that changes everything that follows, and that I will want to see in writing before laying a hand on you.
A scar that sticks to the layers underneath limits movement and is uncomfortable for years. Working on it early helps it stay more supple and reduces the risk of adhesions and of a raised scar.
Giving movement back to the spine and the hips within what is safe for your stage. Slowly, and always within the instructions you were given after the operation.
It is far easier to prevent fear of movement than to undo it two years later. That is why, from the first appointment, I explain to you what is happening and why.
Which operation, at which level, how long ago, and what was or was not done afterwards. Many people arrive here having never had any rehabilitation at all.
After months or years, the nerve has often lost its ability to glide between the surrounding tissues. That gets worked on specifically, and it usually pays off.
Fear of certain movements has a name — kinesiophobia — and it is treated by graded exposure: approaching the feared movement little by little, with control, until it stops representing a threat.
A long recovery costs a great deal of muscle, and it is that loss — not the operation — that usually limits what you can do today. It can be recovered, even years later.
Every operation has its own restrictions, its own timescales and its own particulars. A spinal fusion is not a microdiscectomy, and what is safe in one case may not be in another.
So I will want to know exactly what was done to you, at which level, how long ago, and what instructions you were given. If there is any relevant doubt about what you can or cannot do at this stage, I tell you to check with your surgeon before we go ahead — I do not guess.
The aim is not to work against the surgery. It is to make the most of it — to give you the physical capacity that the operation, on its own, does not give back.
If yours is not here, ask me directly.
Not necessarily, and that conclusion is unfair to you. There is an internationally recognised entity called chronic post-surgical pain — pain persisting beyond healing, at least three months after the operation. It is classified in the ICD-11 precisely because it is common enough to have a place of its own. Having pain does not mean the operation failed to correct what it set out to correct.
In many cases yes, with proper progression and adjustments to some movements. But it depends on what was done to you, at which level, and how long ago — and on the instructions your surgical team gave you. I will want to know all of that before answering, and if I am left with any relevant doubt I ask you to check with your surgeon. I do not guess on your behalf.
In Portugal you can go directly to a physiotherapist, without a referral. After an operation, however, I like to know what the surgical report and the instructions you were given say — not out of legal obligation, but because it changes what is safe to do and when.
That the decision is yours and your doctor's, not mine — but that it is worth understanding clearly what it is expected to achieve and what alternatives exist. One thing worth knowing: for low back pain with no identified structural cause, current evidence does not support spinal fusion, and a trial of 349 adults found no advantage of fusion over intensive rehabilitation in functional capacity. That does not apply to every case, but it is a legitimate question to ask whoever is proposing to operate.
Nothing on this page replaces an assessment by a healthcare professional. And there are situations that are not a matter for physiotherapy at all:
this calls for urgent medical care, the same day.
A medical appointment the same day, as soon as possible, with neurosurgery or spinal orthopaedics.
This is not a matter for physiotherapy, nor for any other healthcare professional.
And it is not a matter of waiting to see whether it improves. Here, time is what weighs most on the outcome: the sooner you are seen by a doctor, the better.
See every sign, by area, and what to do in each caseWhich operation, how long ago, and which movement you avoid. With that I can already tell you a good deal, and frankly.
Initial conversation free of charge. I always reply — and, most of the time, the same day.
Cashin AG et al. Review on non-specific low back pain. JAMA, 2026. — the proportion of non-specific low back pain and of radiculopathy/stenosis among those seeking care; degenerative changes on MRI in people without low back pain (74.4%) and with pain (77.8%); recommendations on the use of imaging; the effectiveness of exercise in chronic low back pain and of invasive treatments.
Schug SA et al., IASP task force. The IASP classification of chronic pain for ICD-11: chronic postsurgical and posttraumatic pain. 2019. — the definition of chronic post-surgical pain (persisting beyond healing, at least three months after the operation) and its formal classification, including underdiagnosis after spinal surgery.
Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811-816. — the prevalence of degenerative findings in people without symptoms, by age group.
A synthesis of the literature on pain myths and beliefs (Melzack 1999; Moseley 2003; Seki & Ouchi 2020) — the weak correlation between pain and structural changes on imaging, across several regions of the body.
Anything on this page that does not point to these references is my own clinical reading, marked as such throughout the text. No information here replaces an individual assessment.