Lumbar Spondylolisthesis – Another Cause of Low Back Pain.
Occasionally I see a young person in my office with a particular pattern of low 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. The details of correctly performing this important exercise, as well as much more information about spondylolisthesis, can be found in Dr. Lavine’s downloadable report Living Well With Spondylolisthesis.
MORE SPONDYLOLISTHESIS INFO
Access your copy of Dr. Lavine’s complete report, Living Well with Spondylolisthesis, including a fully illustrated exercise guide.
The exercise is great want to learn more.
Thank-you that was really great knowlege. I would like to know more about doin exercise?
Thank you so much for commenting on my blog post at http://www.fortheloveofcorbin.blogspot.co.nz. I really appreciate your input. Having read your comment and now this post, you have confirmed what has been running through my mind, that the finding of spondylolysis in my son is incidental. In your professional opinion or in your professional experience have you heard of any instances where spondyloysis has resulted in cramping type muscular pain in the thigh area? Can be in quads or hamstrings or both.
I don’t have experience with that exact situation. The spondylolysis and the cramping pain may be related to each other but I would also look for other causes of the cramping.
Thank you for your in-depth article “Living Well With Spondylolisthesis”. I have suffered with mine for more than twenty-five years, together with advancing spinal stenosis and osteoporoses, lots of pain, back braces, and pain patches. Over time I have received four RFA’s which initially helped a lot, but finally had to elect either fusion or interlaminar device along with decompression, and did the later one (Coflex). Because those of us with spondylolisthesis and spinal stenosis must avoid BLT (bending, lifting, twisting) to various extremes depending on our level of pain and displacement, my recent research focused on “what to avoid”, as a way of life and to preclude further incidents. As you know, there is not enough of this information out there and your article was highly informative. Hopefully, more complete information will find its way online and more P.T.’s and D.C.’s will better familiarize themselves with the varying degrees of this issue and fully understand that treatments, exercises and lifestyles must be adjusted to each individuals’ abilities and issues. Your comments are appreciated. Thank you.