Training After Spinal Surgery & SI Joint Dysfunction

​​​Most trainers will turn you away. I've lived this.

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I had double microdiscectomy surgery at 18 years old. For the next 18 years, I managed chronic SI joint pain with bilateral radiofrequency nerve ablation twice a year. Every six months, a pain specialist burned the nerves transmitting pain signals from my sacroiliac joints — giving me 90% relief for about six months, then back to square one.

The pain management worked. But nobody ever asked why it kept coming back.

The answer wasn't in my SI joint. It was in a muscle called the multifidus — and nobody told me about it for nearly two decades.

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What Your Surgical Team Never Told You About the Multifidus

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The multifidus is the spine's internal stabilization system. Unlike your large erector spinae muscles that move your spine, the multifidus controls movement between individual vertebrae — the micro-stability that protects every disc, joint, and nerve root during movement and daily life.

Here's what the research consistently shows, and what most patients are never told:

After disc herniation or discectomy, the multifidus at the surgical level undergoes rapid, severe atrophy — within days of injury. Unlike other muscles that weaken slowly from disuse, the multifidus atrophies almost immediately through a neurological reflex response to pain and surgical trauma.

And it does not spontaneously recover. Studies show patients 10+ years post-discectomy with significant multifidus atrophy at the surgical level on MRI — despite being pain-free and fully active.

This is why your pain kept coming back.

The cycle looks like this:

• Discectomy alters spinal mechanics

• Multifidus atrophies at the surgical level

• SI joint absorbs the excess mechanical load the multifidus can no longer manage

• SI joint becomes chronically irritated

• RFA silences the pain — but the load problem continues

• Nerves regenerate, pain returns, repeat

The procedure treats the symptom. Nobody addressed the cause.

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What Actually Fixes It

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The multifidus can be rehabilitated even after years of atrophy. But it requires specific, targeted loading — not the exercises you'll find in a standard physical therapy protocol.

The problem with conventional rehabilitation:

Bird dogs — the McGill-prescribed multifidus exercise — are theoretically sound but practically ineffective for most patients. The movement is too easy to perform using compensatory patterns. Your hip flexors, superficial erectors, and global stabilizers take over immediately, and the multifidus never receives the signal it needs. Most patients do them for months and wonder why nothing changes.

What actually works:

The reverse hyperextension — performed at light load with straight legs and a deliberate hold at full hip extension — creates a loading environment where compensation is nearly impossible. The pendulum motion simultaneously decompresses the lumbar spine and forces genuine multifidus and glute-max co-contraction. Stuart McGill's research supports reverse hyperextension for post-surgical spines specifically for this reason.

The sequencing that changes everything:

Extension-based work before flexion-based work. Reverse hypers before cable crunches. This isn't arbitrary — for post-discectomy spines, performing decompressive extension work before loading the spine in flexion reduces pain and dramatically improves performance on the subsequent exercises.

My clients consistently report that their backs feel better after their first few sets of reverse hypers than before they started. That's not coincidence — that's the decompressive mechanism working exactly as it should.

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The McGill Backward Walking Protocol

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Dr. Stuart McGill specifically prescribes backward walking for post-discectomy and SI joint dysfunction patients. The reasoning is precise:

Forward walking loads the hip flexors, quads, and anterior chain — and delivers repetitive heel-strike compression directly through the lumbar spine and SI joint. Backward walking reverses every one of these patterns:

• Toe contact first eliminates heel-strike compression

• Every step is initiated by the glutes and hamstrings

• The neurological novelty of the movement forces genuine posterior chain recruitment — your brain has no ingrained compensation pattern for walking backward

• The SI joint is loaded in extension rather than flexion

I perform 20 minutes of backward walking at 15% incline daily. This isn't cardio. This is McGill-prescribed spinal rehabilitation running in the background of every training day.

For clients with your history, I build this into your program from day one.

Why Standard Personal Trainers Can't Help You

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Most trainers see a post-surgical spine and do one of two things: they either avoid loading the posterior chain entirely out of fear, or they load it aggressively without understanding the neurological inhibition patterns that develop after surgery and chronic pain.

Neurological inhibition is the piece nobody talks about:

After years of SI joint pain, your nervous system has been actively suppressing recruitment of the muscles that surround and stabilize the joint — the glutes, multifidus, lumbar erectors, and glute-ham tie-in. Your brain learned to protect the area by preventing those muscles from fully activating.

This means you can be physically strong in every other way and still have a clinically weak posterior chain at the specific muscles that matter. Standard exercise doesn't fix this because your nervous system routes around the deficit automatically using larger compensatory muscles.

Knowing which exercises bypass compensation, in what order, at what load, and at what point in your pain management cycle — that's the knowledge that makes the difference.

I've spent 18 years figuring this out on my own body. I apply it to every client who walks in with your history.

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Who This Program Is For

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You are the right client if you have:

• Herniated disc with or without surgical history

• Microdiscectomy or spinal fusion

• SI joint dysfunction — diagnosed or suspected

• Chronic lower back pain managed by injections, RFA, or medication

• Degenerative disc disease

• Sciatica

• Spinal stenosis

• A history of significant weight loss that has increased mechanical load vulnerability

You are especially the right client if:

• You've been told to "take it easy" forever and you're done accepting that

• You've tried physical therapy without lasting results

• Your pain returns on a predictable cycle despite treatment

• You want to build real strength, not just manage symptoms

• You've lost significant weight on GLP-1 medication and need to rebuild muscle without aggravating your spine

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The GLP-1 and Spinal Pain Connection

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If you've lost significant weight on semaglutide or tirzepatide, your spine is in a uniquely vulnerable period — and a uniquely opportunity-rich period simultaneously.

Every pound lost reduces mechanical compressive load on your lumbar discs and SI joint. My 83-pound weight loss was the single most impactful intervention for my back pain outside of surgery itself.

But rapid weight loss on GLP-1 medications carries a serious risk: without proper resistance training, up to 30% of the weight lost can come from muscle tissue. For a post-surgical spine, losing the muscular support system surrounding an already compromised structure is a serious problem.

The program I've built for GLP-1 clients specifically preserves and rebuilds the posterior chain muscle that protects your spine — while managing the reduced caloric environment and altered energy levels these medications create.

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What Training Here Actually Looks Like

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Session 1: Movement assessment focused on posterior chain recruitment patterns, compensation identification, and pain behavior mapping. I need to understand exactly where your nervous system is protecting before we load anything.

Weeks 1-4: Establishing the foundation. Reverse hyperextension progression, McGill backward walking protocol, glute activation sequencing, and core stability in the extension-before-flexion framework. Light load, high quality, building the neural recruitment patterns your body has been suppressing.

Months 2-3: Progressive loading as recruitment patterns solidify. Adding farmers carries, Romanian deadlifts, hip thrusts, and compound movements calibrated specifically to your surgical history and current pain cycle.

Ongoing: Periodized programming that accounts for where you are in your pain management cycle — more aggressive loading in the post-treatment window, conservative maintenance as the cycle turns. Your body tells us what it can tolerate and we listen.

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One Client. One Trainer. Complete Focus.

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Every session at Eppinger Fitness is private. No other clients. No distractions. You and me, building something your medical team said wasn't possible.

I am the only trainer at this facility. I work with a small number of clients by design — because the level of attention this work requires cannot be delivered in a group setting or delegated to a junior trainer.

The clients I work with on post-surgical and SI joint rehabilitation are some of the most motivated people I've trained. They've been told what they can't do for years. They come here to find out what they can.

#1 Rated Personal Trainer in the USA on Google — 2022 to Present

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Ready to Have a Different Conversation About Your Back?
 

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