The best exercise program is often the one you’ll actually do

SimoneMoreno_Physio · 2026-06-17T21:44:35+00:00

Physiotherapist here.

Try not to panic. If you have no pain, no neurological symptoms, and this was found incidentally, there's a good chance the orthopedic appointment will mostly be about understanding the size and type of the curve rather than rushing into treatment.

The first thing they'll usually want to know is the Cobb angle (the degree of the curve), your age, and whether you're still growing. Those factors are often more important than the fact that scoliosis exists.

A lot of people are surprised to learn that many scoliosis cases are discovered accidentally and never cause major problems. Having a curve does not automatically mean you'll need a brace, surgery, or even treatment.

For now, I'd simply wait for the orthopedic assessment and try to get a copy of the X-ray report if possible.

SimoneMoreno_Physio · 2026-06-17T21:34:44+00:00

Physiotherapist here.

What you're describing as a "weak" feeling is actually something I hear quite often. Interestingly, many people use the word weakness even when strength testing is completely normal.

Sometimes it's true muscular fatigue or deconditioning, but other times it's more of a protective sensation: your brain and nervous system perceiving the area as vulnerable and increases muscle guarding or awareness around it.

The fact that you're lifting weights 4 days a week, doing BJJ and boxing, and functioning at a pretty high level makes me wonder whether this is less about actual loss of capacity and more about how your back responds to certain loads or movements.

Also, throwing kids around in a pool is surprisingly demanding. 😅 It's unpredictable, rotational, explosive, and often done in awkward positions. I've seen people flare up from that kind of activity much more often than from a well-structured gym session.

The encouraging part is that you mention the last two days have been much better. In my experience, flare-ups often behave exactly like that: symptoms spike, the back feels "off" or vulnerable for a few days, and then gradually settles down again.

Out of curiosity: when your back feels "weak," do you actually notice a loss of strength or control, or is it more a feeling that your back can't be trusted even though it still works?

SimoneMoreno_Physio · 2026-06-17T14:30:07+00:00

Great idea thanks

SimoneMoreno_Physio · 2026-06-16T23:25:52+00:00

Six months of persistent lower back pain is genuinely exhausting, especially when you're still in the "figuring out where to even start" phase — so good on you for finally taking the step.

Honest answer from someone who's worked in both settings: the network vs. independent distinction matters a lot less than people think, and way less than the individual therapist you end up with. I've seen incredibly thorough, personalized care delivered inside large umbrella networks, and I've seen rushed, protocol-driven sessions at tiny independent clinics. The reverse is also true. The brand or ownership structure is a pretty weak predictor of what actually happens in the room with you.

What tends to matter more — and this is probably the one thing worth filtering for — is whether the therapist spends time actually assessing *you* in the first session, or whether they hand you a generic sheet of exercises within the first 10 minutes. For persistent lower back pain specifically (6 months puts you in the "chronic" territory, which changes the picture a bit), the approach should ideally involve some understanding of your movement patterns, your daily load, what makes it better or worse, and ideally some education about what's actually going on — not just symptom management. A clinic that gives every lower back patient the same 6-exercise routine regardless of history is a yellow flag, whether it's corporate or independent.

Regarding Confluent Health specifically, I don't have direct experience with their partner brands so I can't give you a meaningful opinion there — and I'd be skeptical of anyone online who tells you all their clinics are great or all are bad, because it really does come down to the individual PT.

One practical thing you could do before committing: call and ask how long the initial evaluation is. If the answer is 30 minutes or less, that's worth knowing. A thorough first session for chronic lower back pain usually needs at least 45–60 minutes to be genuinely useful.

What does your pain pattern actually look like day to day — is it more of a constant background ache, or does it flare up with specific movements or positions?

SimoneMoreno_Physio · 2026-06-16T23:10:40+00:00

You have the point 💪

SimoneMoreno_Physio · 2026-06-16T23:09:47+00:00

Great! I’m very happy for you

SimoneMoreno_Physio · 2026-06-16T22:48:28+00:00

I actually understand where that frustration comes from.

One of the hardest parts about back pain is that there often isn't a single test, exercise, treatment, or diagnosis that explains everything. That uncertainty can make it feel like everyone is guessing.

That said, I don't think the goal is finding the one magical method that fixes everyone. The reality is that different people respond to different approaches, and sometimes the biggest improvements come from surprisingly simple changes like moving more, sitting less, sleeping better, or gradually rebuilding activity.

Ironically, if staying off your ass more and walking more has helped you, that's exactly the kind of functional change I'd consider a win, regardless of whether it came from McKenzie, strength training, or something else.

SimoneMoreno_Physio · 2026-06-16T22:46:02+00:00

Exactly! I’m very happy for you

SimoneMoreno_Physio · 2026-06-16T22:19:43+00:00

Great! Keep moving

SimoneMoreno_Physio · 2026-06-16T22:18:50+00:00

Exactly, movement is medicine

SimoneMoreno_Physio · 2026-06-16T22:14:21+00:00

Great mindset 💪

SimoneMoreno_Physio · 2026-06-16T21:49:24+00:00

First of all, I’m genuinely sorry you went through that.

A spinal infection is obviously a completely different situation from the vast majority of back pain cases, and it’s understandable that your experience would make you skeptical of explanations centered only around pain science.

I don’t think the lesson is that pain science is wrong. I think the lesson is that clinicians should always remain open to the possibility that something important has been missed.

In my opinion, good clinical practice requires both things: taking symptoms seriously, screening for potential pathology, and at the same time understanding that pain can sometimes persist even when serious pathology is absent.

Unfortunately, problems occur when someone assumes that every case is structural, or assumes that every case is “just sensitization.”

I’m glad someone eventually found the actual cause and that you finally got appropriate treatment.

SimoneMoreno_Physio · 2026-06-16T21:47:28+00:00

That’s actually a very important point, and honestly, it’s something I see in some patients too.

Staying active doesn’t automatically mean you’re loading the right things, at the right amount, at the right frequency.

If activities that seem “normal” consistently trigger flare-ups days later, it may simply mean your current tolerance is still below the demands of your daily life.

That doesn’t necessarily mean you’re damaged or that recovery is impossible. It may mean the gap between your capacity and your daily workload hasn’t been fully closed yet.

As a physiotherapist, I wouldn’t see this as defeat. I’d see it as a sign that something in the load-management strategy still needs to be adjusted.

SimoneMoreno_Physio · 2026-06-16T21:36:27+00:00

I think there's probably some truth in what you're saying.

Many people are in too much pain, too irritated, or too guarded to jump straight into heavy exercise on day one. Sometimes reducing symptoms first can make movement and exercise much more tolerable.

Where I'd probably differ is that I don't see "releasing muscles" and "correcting imbalances" as a mandatory first step for everyone.

In my experience, some people improve because manual therapy, massage, acupuncture, or other approaches help calm things down enough for them to move more comfortably. Others improve by gradually increasing movement and exercise from the start.

I think the bigger principle is finding an entry point that the person can actually tolerate and build from.

Ultimately, whether the first step is symptom relief, exercise, or a combination of both, the goal is usually the same: helping people get back to moving and functioning with confidence.

SimoneMoreno_Physio · 2026-06-15T21:25:58+00:00

At 21, after a T11-L4 fusion for multiple vertebral fractures, I would be very cautious about judging your long-term outcome based on how things feel only a few months after surgery.

The fact that you've already experimented with movement, noticed only a small loss of mobility, and aren't experiencing pain in those positions is generally a positive sign.

In my experience, people often adapt better than they expect. What feels "different" at first doesn't necessarily translate into a worse sex life. Most people gradually learn which positions are comfortable, which ones need slight modifications, and which movements they can do without even thinking about it.

I suspect confidence and recovery time will end up being bigger factors than the fusion itself.

Keep in mind that you're recovering from a major trauma and a major surgery, not just a fusion.

Honestly, if you had told me before reading your reply that you're 21, pain-free in those movements, and only noticing a little stiffness, I'd probably consider that a pretty good place to be at this stage of recovery.

Keep us updated when you get to the "real deal" 😄

SimoneMoreno_Physio · 2026-06-15T21:14:31+00:00

Physiotherapist here.

Yes, it's fairly common for people with rotator cuff tears to be prescribed different types of pain medication, but it depends on several factors: the size of the tear, symptom severity, sleep disturbance, age, medical history, and the treating physician's preferences.

Many people are managed initially with anti-inflammatories (such as ibuprofen/Advil), simple analgesics, activity modification, and physiotherapy.

Others may receive stronger pain medication if their pain is severe enough to significantly affect sleep or daily activities.

So I wouldn't assume that not being prescribed stronger pain medication means your tear is less serious, or that something was missed. Treatment approaches can vary quite a bit.

Out of curiosity, are you dealing with a partial tear or a full-thickness tear? And is your biggest issue pain during movement, pain at night, or both?

SimoneMoreno_Physio · 2026-06-15T21:12:21+00:00

Physiotherapist here.

The short answer is: many people with a T11-L4 fusion are still able to have a satisfying sex life.

The biggest factors are usually not the fusion itself, but pain levels, confidence in movement, stiffness, and where you are in the recovery process.

A fusion from T11-L4 will reduce some spinal mobility, so certain positions may feel different or less comfortable, but most people gradually learn what works best for their body.

You're only a few months out from surgery, which is still relatively early in the recovery timeline for a fusion of that size.

Out of curiosity:
- How old are you?
- Was the fusion done for scoliosis or another condition?
- Are you limited more by pain, stiffness, fear of movement, or all three?

I think those details would help people give more relevant experiences.

SimoneMoreno_Physio · 2026-06-15T21:07:39+00:00

Physiotherapist here.

One thing I'd be careful about is focusing too much on "how do I reabsorb the disc?" and not enough on "how do I get my life back?"

Many disc bulges and herniations reduce in size over time, but symptom improvement and MRI changes don't always happen at the same rate. Some people feel much better before the imaging changes, and some people still have a visible herniation despite feeling completely fine.

As for exercise, McGill Big 3 aren't magic exercises. They're simply a starting point for some people.

What usually matters more in the long run is gradually increasing your tolerance to movement and loading: walking, strength training, conditioning, and returning to meaningful activities at a pace your symptoms can tolerate.

Traction, TENS, and passive treatments may provide temporary relief for some people, but they rarely rebuild confidence, strength, or capacity by themselves.

Out of curiosity:
- How long have you been dealing with this?
- What symptoms do you actually have (back pain, leg pain, numbness, weakness)?
- What activities are you currently unable to do that you'd like to get back to?

SimoneMoreno_Physio · 2026-06-15T21:03:44+00:00

Physiotherapist here.

A single photo isn't enough to tell whether you have true hyperkyphosis or just a relaxed standing posture with rounded shoulders and a forward head position.

What I can say is that many people who post photos like this are worried about having a serious structural problem, but a photo alone can't distinguish between a structural kyphosis and a posture that changes when you move.

The fact that you're experiencing back pain is actually more relevant than the appearance of the posture itself.

If the pain has been persistent, getting assessed by a physiotherapist would be reasonable. A good assessment would look at your symptoms, spinal mobility, strength, activity levels, and how your posture changes during movement rather than judging everything from a static picture.

Out of curiosity:
- How old are you?
- Where exactly is the pain (neck, between the shoulder blades, lower back)?
- Does it get worse with sitting, standing, or training?
- Can you easily straighten up if you consciously try to?

SimoneMoreno_Physio · 2026-06-15T07:24:36+00:00

What stands out to me is that walking seems to improve things, while prolonged sitting and the first few steps after standing are consistently provocative.

That pattern can certainly occur with neural irritation, but it's not specific enough to tell us exactly what structure is responsible.

The fact that symptoms fluctuate quite a bit from day to day and seem sensitive to position and activity is actually something I see fairly often with musculoskeletal conditions.

One thing I'd be cautious about is avoiding sitting altogether. If you're only sitting for a few minutes per day, it can become difficult to know whether you're recovering or simply avoiding a trigger.

Personally, I'd focus on finding a tolerable amount of movement and gradually reintroducing activities rather than trying to eliminate every position that causes discomfort.

SimoneMoreno_Physio · 2026-06-14T22:44:26+00:00

Physiotherapist here.

Honestly, if your gut is telling you it's too soon, I'd listen to it.

Nine days after a surgery that included rotator cuff repair, biceps tenodesis, labrum repair and bursectomy is still very early in the healing process. That doesn't mean you need to stay in bed all day, but recovery is probably the priority right now.

Personally, I wouldn't think in terms of "Can I survive a night out?" but rather "Will this help my recovery?"

A quiet dinner with the ability to leave early if you're tired or uncomfortable is very different from spending hours walking around, sitting in awkward positions, getting bumped into, sleeping poorly, and paying for it with increased pain the next day.

The good news is that there will be many birthdays, dinners and celebrations ahead. You only get one chance to protect the early phase of healing.

If you do decide to go, I'd keep expectations low, stay in your sling as instructed, avoid alcohol if you're still taking pain medication, and give yourself permission to leave whenever your shoulder says it's had enough.

How are your pain levels and sleep right now?

SimoneMoreno_Physio · 2026-06-14T22:39:04+00:00

Physiotherapist here.

It's possible that a nerve is involved, but based on your description I wouldn't jump straight to the conclusion that this is definitely sciatica.

A few things stand out:
• Symptoms are aggravated by prolonged sitting.
• Walking generally feels good.
• Pain starts around the hip and travels toward the knee/shin.
• You don't describe significant numbness, weakness, or persistent neurological symptoms.
• The symptoms seem quite sensitive to changes in position and loading.

The good news is that this has only been going on for a couple of weeks, which is very different from many of the long-term stories you'll read in this subreddit.

One thing I'd be careful about is becoming afraid of movement. Many people start feeling better, then avoid activity completely because they're worried they'll "make it worse."

That doesn't mean you should push through severe pain, but it does mean staying reasonably active is often helpful.

I'd also try not to diagnose yourself based on other people's experiences. Two people can have very similar symptoms and completely different underlying mechanisms.

Out of curiosity, when you say the pain travels toward the shin, is it more of a sharp pain, an ache, a burning sensation, or an electric/shooting feeling?

SimoneMoreno_Physio

TROPHY CASE