Restore and Reform and Fortius Clinic
The renowned centre of orthopaedic excellence, Fortius Clinic, recently interviewed our co-founder Lucy Nifontova on her own recovery story. This is taken from their website.
Putting up with back pain
Lucy had suffered from persistent lower back pain since she was an adolescent. It continued well into her twenties and became something she ‘put up with’ believing that there wasn’t any other option. By the time she was 28, Lucy was working long hours at her desk as a wealth manager for a FTSE 100 company in the City and following a visit to a friend for the weekend, she realised that she
had to do something about her back pain. ‘I was helping look after my toddler godson, picking him up, running around and playing in the garden. By Sunday night my back had completely flared up and I couldn’t move. I wondered whether I would ever be able to have my own children and realised that I had to do something. I couldn’t put up with this any longer.’ Her GP referred her to see Mr Tom Ember, a Fortius Spinal Consultant who referred her for an MRI. With no obvious prolapse but degeneration at various levels in her spine, Tom recommended steroid injections to help diagnose Lucy’s issues and to break her cycle of pain so that she could commence a rehab programme.
‘I was very unhealthy at this point,’ says Lucy, ‘I was carrying excess weight, working very long hours, had a poor diet and was doing next to no exercise. I was seeing an osteopath, but not taking any active role in rehabilitating or looking after myself.’
The cause of Lucy’s lumbar pain was initially hard to pinpoint.
The cause of Lucy’s lumbar pain was initially hard to pinpoint. While MRI scans showed degeneration at L3/4, L4/5 and L5/S1, and a SPECT-CT scan confirmed there were no tumours, there was also no obvious generator of Lucy’s pain.
Over the following eighteen months, Lucy had a series of spinal injections which relieved her pain. It was very clearly explained to her that the analgesic effects of the injections would wear off after some months, and that she was being provided with a pain-free window of opportunity to enable her to fight her condition with rehab. Tom referred Lucy for physiotherapy to help strengthen her spine and the surrounding stabilising muscles. As she suffers from hypermobility, he also recommended Pilates based exercises.
Lucy started seeing physiotherapist Michelle Lewis to start an active rehabilitation programme and reformer Pilates. By the summer of 2016, Lucy was doing her exercises daily, regular physio and reformer Pilates sessions and preparing for her wedding, yet despite her dedication to her rehabilitation and being in the best physical condition of her life, the pain was worse than ever. Going back to see Tom, he confirmed that her condition had become exacerbated despite all of the hard work she was putting in. Having been very cautious of operating, it was now time to review her options as new imaging showed marked modic inflammatory changes at L4/5, identifying this disc as the main pain generator.
Was surgery an option?
Lucy asked Tom about surgical intervention. They discussed the possible benefit of a spinal fusion, as well as spinal denervation. The latter was ruled out because the steroid injections had become increasingly ineffective (with each round of injections the period of pain relief provided shortens) which meant that a denervation was likely to be of little benefit. Tom explained that if he were to fuse her spine, this would be done just at L4/5. He warned her that the recovery from fusion surgery would be tough, especially given the degeneration on her adjacent discs.
Lucy’s case was discussed at a spinal multidisciplinary team meeting who agreed with Tom that spinal fusion was the best course of action. She subsequently underwent a single level instrumented spinal fusion at London Bridge Hospital in 2016. Lucy’s experience at London Bridge was overwhelmingly positive, from the clinical nurse specialist she met prior to her surgery, to the anaesthetist and theatre team and the nurses who looked after her throughout her stay.
A long recovery
Lucy had four weeks off work to recover over Christmas, and had a phased return to work in January. However, by February she felt burnt out.
‘Despite doing the prescribed physiotherapy, I was taking the maximum dose of painkillers just to get through the day, which in turn were giving me awful side-effects. I found the commute from Putney to the City exhausting. I was struggling to sit for long periods at my desk. I still had swelling and felt defeminised by my anterior surgical scar, I hit a real low point. I’d been in pain for so long, and all I wanted was a break and to get away from London and focus on my health and my recovery.’
Lucy decided she needed a holiday in the sun and whilst away, she practised Pilates and swam daily. She was in frequent contact with her physio Michelle who was prescribing exercise programmes that she was able to do by the pool or in her room. Returning from her break, she saw Tom for her three month check-up who was really impressed with the progress she had made, commenting that somewhere along the way we had forgotten that convalescence was an important part of recovery!
Restoring to form
Lucy is now two years into her recovery from her spinal fusion surgery, and decided to leave her wealth management career behind her to pursue a career in healthcare. She has had a remarkably successful outcome from the surgery, and has a minimal amount of residual back pain. ‘I now have a quality of life that I never could have imagined before. The little things that others might take for granted, like being able to manage a tube journey standing, being able to wear high heels, I am able to carry a handbag for the first time in years instead of a backpack. Every day I am reminded of how lucky I have been. After decades of back pain I am virtually pain free because of my treatment.’
She was so inspired by the turnaround in her recovery following her holiday that she went on to start a recovery retreat company with her physiotherapist Michelle. Consulting Tom on the programme, Lucy and Michelle now run intensive rehabilitation holidays offering patients tailored physio-led programmes which incorporate physiotherapy, soft tissue therapy, scar treatment, mat and reformer Pilates and the all-important sunshine. They fly their team out from London to provide their clients with the rehab. Lucy has qualified as a reformer Pilates instructor with STOTT and is passionate about teaching patients ways in which they can move safely and manage their pain.
Two weeks before Lucy and Michelle departed to deliver their first rehab retreat, a woman called Sarah contacted them enquiring about Restore and Reform. She explained that she was 35 years old, and 7 weeks post twelve level spinal fusion for a scoliosis correction and that she was wanted to be able to immerse herself in a rehab programme and to press that reset button that Lucy had sought so desperately almost a year before.
“I couldn’t believe it when I found out that she had also been a patient of Tom’s and had also had a spinal fusion. It was the most wonderful validation of Restore and Reform. We have built this business specifically to help people like her. She made remarkable progress during her stay with us and returned to the UK a new woman.”
Onwards and upwards
Shortly after Lucy and Michelle returned from their first Restore and Reform retreat, they were contacted by Clare, a 33 year-old who was suffering from acute lower back pain. “She had never had the cause of her back pain diagnosed and from what she told us about her condition, something quite clearly wasn’t right.” Within two weeks she had seen Tom who performed an MRI. This showed a large L5/S1 disc prolapse and a week later she was having spinal injections to enable her to start a reconditioning programme. She went to Restore and Reform for a rehab retreat in July. Although in the very early stages of her recovery, she has responded extremely well to the combination of injections and the R&R rehab programme. Her confidence in her own body has improved enormously, and she is moving pain-free for the first time in years. “We have taught her that she doesn’t need to change her life to suit her back, but that she can change her back to suit her life.” It is incredibly likely that Clare will not need to have a surgery, as a result of her excellent response to a combination of the injections and her rehab programme. She is now symptom-free and her disc prolapse has significantly reduced.
“I feel extraordinarily privileged that we have been able to take an experience that defined me in a negative way for so many years and create something positive and game-changing for others.’”
Lucy Nifontova and Michelle Lewis are the founders of Restore and Reform, running regular programmes for recovery and reconditioning after surgery, from back pain, giving birth or cancer treatment.
Mr Tom Ember is a Consultant Orthopaedic Spinal Surgeon at Fortius Clinic, London Bridge Hospital, Guys’ and St Thomas’, and Great Ormond Street Hospital for Sick Children. You can make an appointment to see him by contacting firstname.lastname@example.org.
You can read the original article on Fortius Clinic’s website here.