I just keep riding. The big thing is pain control so you don’t change your position to “protect” your spine. Then comes rehab or therapy to keep the nerves moving through the stenosis. In so doing the weakness can be fixed. It is when the pain control ceases to work that decompression surgery is almost unavoidable.
It comes down to pain tolerance in the end.
I herniated my l4-l5 disc when I was 20.
More than 20 years later, I’m still riding.
I definitely am not the poster child for doing it right. My biggest problem was my doctors didn’t take my pain seriously at 20, told me I was too young for back pain and just needed Advil. 
I struggled on and off until I was in my late 20s and a doctor finally listened. But for many years I was riding with pain.
My biggest mistake was letting my back affect my riding. I developed a lot of bad habits trying to “protect” by back and being defensive.
If I had a time machine, I would at least make sure to be riding under the watchful eye of a understanding coach to call out the bad habits before they became habitual.
I also think you have to listen to your body and learn what aggravates the injury. I would do stupid things like try to jump big fences, ride green horses, go on long trail rides… then find myself crippled for weeks after. If I had just waited until my back was stronger and not pushed myself, I would have been a lot better off.
Knock on wood, I haven’t had any problems or flare ups in several years. But I’m also (generally) smart enough to gauge my strength and listen to my body when it hurts!
As rayers says pain control is key. I’d also add that not waiting until it gets so bad that you need surgery. I’ve been going to the same pain management doc for 18 years. Also, I started with routine exams with a surgeon, just in case. I recently noticed that my right leg had partial numbness and pins/needles. So I had an MRI done. The surgeon said the compression, compared to two years ago, was more but not surgical yet. So I make sure I do my stretching and inversion table. I also take acetaminophen and baclofen before a ride just to remove inflammation and make sure the back stays loose.
Also, I work to make sure my position is good. Also, as rayers says how much can you tolerate. With the persistent numbness and pins/needles, I’ve taken jumping out the equation.
For me, it’s been about finding ways to best manage it. I have to be very careful about the sort of horse I ride. I can’t ride paces that are too big, too choppy or too bouncy. I can sit a small spook but the bigger ones are too much now. I’ve been trying to find a horse for the past two years and finding one with paces I can manage has been a tough ask. I stretch and regularly use ice packs and heat packs. I do yoga and Pilates regularly and try and find the balance between strengthening my back without overdoing it. I never get on without using a mounting block. A lumbar back cushion is a huge help for driving and sitting.
Thank you so much for the advice, everyone!
My rheumatologist is going to get back to me, but my PCP messaged me and started me on Flexeril with my Rx NSAID (Relefan). She said there is more arthritis in my SI joints which might be contributing to the pain. I also did help haul 350 bales of hay, which my PCP told me to never do that again.
I’m supposed to start active lessons next summer, and even though I have a baby, she doesn’t do anything stupid. The worst she does is just stop, which doesn’t hurt my back.
Does anyone have any suggestions for position for riding? I find that I don’t hurt while riding; in fact, I feel so much better. I hurt the next day. I’m also not sure how much hauling hay hurt my back.
Again, thanks so much! 
My suggestion would be to take note of what horses/tack/activities leave you feeling worse. An example- for a long time, a lot of dressage saddles would bother my back. Also, if you aren’t already doing it, make sure to keep up NSAID therapy before/after your ride.
And don’t unload 350 bales of hay. 
Seriously, though— that’s part of the reason I took so long to heal. I had horse jobs all through my 20s so I was killing myself cleaning stalls, unloading hay, riding green horses, etc. So I could never heal because as soon as I wasn’t crippled I was back to abusing my back.
Seriously. That is about as bad for your back as anything. It is really hard to use proper body mechanics in lifting hay.
I have had two herniated discs. My first happened about a week after my friend and I went and picked up a load of hay out of the field. Bargain hay! Not only did my back crack, the hay which looked lovely on the outside had big pockets of foxtail hidden in it and we had to haul both horses to the vet to get foxtail awns pulled out of their gums and from under their tongues. So much for the bargain hay.
I started boarding my horse when I was in my 40’s and that immediately made my back happier when farting around with hay bales was no longer part of the equation. Find some high school football player to stack it…they love the weight lifting session.
You had better be doing some serious core strengthening and that would probably take care of the after ride soreness. My mantra for anything…if it hurts quit doing it. More exercise and try again. I have always been able to get back to riding pain free with my back that has given me problems since college.
My rheumatologist called and I have a referral to ortho. I might make a separate post about support for people with autoimmune diseases since I can’t really ride right now? I’m allowed to do “gentle exercises” until we figure out if I need surgery on my back and on my shoulder (I also tore my rotator cuff somehow). I’m exceedingly frustrated with myself and my body. 
This is an ongoing occurrence, though. I do appreciate my very, very patient pony.
I’m so sorry you are dealing with health issues on different fronts. It is no fun. I think the biggest thing that helped my back is walking (hence the gentle exercise recommendation). I’m not talking any super ambitious, difficult walking. Every day I walked at lunch for 20-30 min in a flat, paved neighborhood. It loosened up my back and my neck and allowed me to regain strength in my left leg.
What @Rothesay said - heat and ice are your friend.
Thank you so much for the tips! I’ve started my stretches again and I will incorporate walking again. I don’t even mind walking around the house now that it’s getting cold here.
How about some light swimming? Not sure how your rotator cuff would feel about it, but it will help keep you moving without strain any muscles. Even walking through the shallower areas is good exercise.
I do have an autoimmune condition, but I am not sure how much that impacts my back. I have ITP (related to my platelets). Does yours have more impacts with inflammation?
I have a reoccuring herniated disc at the L4/L5. I had surgery on it early last year as it was edging towards causing major damage and then reherniated the disc 4 weeks after the surgery. I got the disc back into place with PT and avoided a second surgery. I am now doing “facia manipulation” with a sports therapy doc (not through a massage therapist). It is very, very painful but effective. We’ve determined that my back problems stem from a jaw surgery I had back in high school. It’s been a slow journey. I am thinking of doing ice baths/heat treatment for the remaining inflammation I can’t seem to get rid of.
That is what my PT has been pushing me towards. We have a large hot tub at our REC center, and I’ve considered it.
My cousin has ITP, so I’m sort of familiar with it. And, yes, AS is inflammation in the spine and other big joints (I have it in my right knee). It’s a very weird condition and took me roughly thirty years to get diagnosed.
I’m so sorry about your back. It is really awful and painful. I meet with ortho today, so I’m curious what they are going to say.
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