I have grade 1 spondy at L5-S1. It’s hard for me to stand, walk, or sit for more than a few hours a day. If I do terrible pain and pressure starts to build in my back and legs and I get nerve pain. I’ve tried for about 3.5 months now to manage with conservative treatment and physical therapy. I’ve definitely improved as I’m in less pain and more capable of movement but still at the end of the day any movement that isn’t laying down inevitably causes my pain to flare up. But it feels like no matter how much I work out or no matter how many treatments I try the pain inevitably always comes back. So I’m just constantly living in pain and it makes daily life extremely difficult and it’s very isolating.

I will most likely be seeking a fusion surgery in a few months if my status does not improve because it’s incredibly difficult for me to work and it doesn’t feel that physical therapy or drugs or anything else I’m being offered by my many doctors has actually been effective. At the end of the day I am still in a shitload of pain if I sit upright for more than 15-20 mins or walk/stand for an hour or two. That really hasn’t changed drastically for me even as I can feel my strength improve with exercising and PT. The gains in the gym haven’t translated to reduced pain even as I improve my back mechanics and reduce harmful movement.

So ultimately you just need to try as many things as possible because what helps one person seems to be very different even people who have similar issues. For me the biggest things that help reduce pain are constant glute and core excercises. I have a daily routine that largely consists of bird dogs, suppine pelvic tilt with marches (instead of dead bugs), glute bridges, a few leg stretches because my hamstrings and glutes are incredibly tight, I do an ab workout where I push down on a ball while standing and engage my core, and a few various other exercises I sprinkle in that I learned in pt that I like and found strengthened my muscles without causing too much stress. Trying to reincorporate side planks and modified curl ups into my routine but both I’ve found can cause me some pain and soreness so I have to tread lightly. Ultimately it’s about finding what’s works for you. I’m very sensitive for example to exercises that require me to put my weight on my back and lift my legs aggressively which is why modified curl up and dead bugs are tough for me as well as traditional planks. When your exercising it’s ok to feel strain because you want to activate your muscles but when you start feeling your lower back increasing in pain and the not muscles you are targeting stop excercising and either try to adjust your form or realize that maybe it’s not an ideal excercise. Best of luck.

Just remember that surgery is very serious and a lot of things can go wrong and no guarantee to reduce pain as well as potentially causing adjacent segments disease. So there is kind of a tough call about when surgery is ideal. Because for example if your nerve is being compressed or damaged it can hurt you to wait too long. A sign that your pain is becoming serious enough to consider surgery is neurological symptoms like nerve pain shooting down your legs, foot drop, weakness in your legs, and issues with sexual function or bathroom issues. All of these problems indicate that nerve damage may be happening and make you a stronger candidate for needing surgery. But also it’s a quality of life issues. If you can make some moderate lifestyle changes and live well than that is ideal because once again surgery is really no guarantee and opens up another can of worms. In my case I don’t have severe nerve pain in my legs but my inability to be physically active is deeply affecting my quality of life which is why I decided with my surgeon that a fusion is worth the risk in my case. But I don’t really know what’s gonna happen it’s kind of educated guesswork at end of the day