Lumbar Spondylolisthesis – Another Cause of Lower Back Pain
Occasionally I see a young person in my office with a particular pattern of lower back pain. It could be a high school baseball player of 16 or a dancer of 22.
(If you’re older than that, keep reading – there’s useful information in here for you, too.)
Often, the problem begins after an athletic activity involving lots of backward bending – gymnastics, for instance. The pain is typically located in the center-line of the low back. It’s worse when adopting a sagging posture.
With this pattern of pain, I’m beginning to suspect that they may have lumbar spondylolisthesis.
Spondylolisthesis starts as a stress fracture of the vertebral arch. (The break itself is called spondylolysis.) The fracture occurs from overloading the spine in a back-bending motion. Sometimes it occurs from a one-time traumatic injury. But more often it’s a gradual deterioration of the bone from repetitive stress.
Once you have spondylolysis and the vertebral arch has lost its integrity, the front part of the vertebra (called the vertebral body) can glide forward relative to the vertebra beneath. Then you’ve got spondylolisthesis.
Spondylolisthesis doesn’t always hurt or cause other symptoms. That’s why a lot of people – up to 5% of adults are believed to have spondylolisthesis – may not even know they have it.
If the spinal stress fracture is detected soon after it starts, the treatment consists of wearing a brace for a number of weeks. The goal is to actually get the bone to knit back together.
But in an older person, it’s too late for that. Normal fracture healing is never going to occur. Instead, the treatment goal is to reduce pain, prevent further forward slipping of the vertebral body, and restore normal spinal function as much as possible.
Lumbar bracing can still be an important part of the treatment, as well as selective strengthening and range of motion exercises.
When the forward vertebral slippage gets severe, and the symptoms are unresponsive to conservative measures, surgery for spondylolisthesis becomes an option.
Exercising correctly is critical for treating spondylolisthesis. The principles of proper alignment and body use – which are important for everyone – are doubly and triply important for someone with spondylolisthesis.
Because the details of posture and exercise are so critical for someone with spondylolisthesis, I’m hesitant to include any specific exercise information in an article this brief. That’s why I’ve written a more extensive, fully illustrated report on spondylolisthesis which you can access here.
But here are a few important principles.
- You want to practice proper low back alignment when you’re standing. Eliminate any forward sagging of the pelvis. This is a simple idea but can be difficult to implement, since you may have a lifetime of postural imbalance and subconscious movement habits to undo. Hint: It doesn’t involve tucking the pelvis under.
- Give yourself plenty of rest/recovery time with the low back in a flexed position. That could mean lying on your back and hugging both knees toward the chest, curving the low back in the process. Another variant is the child’s pose in yoga.
- Like everyone, you want to develop proper abdominal muscle support for posture. The plank pose (and its variants) is my favorite exercise for this.
- You need to stretch the psoas muscle, one of the main hip flexors. But here’s what’s really tricky: you have to maintain the low back in a flexed position while you stretch the psoas. That rules out a lot of the commonly recommended hip flexor stretches. Contact Dr. Lavine for the details of the type of hip flexor stretching exercise he recommends.