Expert: Scott F. Gillman, DC, DACBSP - 7/22/2010

Question
Dear Dr Gillman,
I am in need of your expertise! I have had a spondylolisthesis at L5-S1 since I was about 12 (from gymnastics). Really no symptoms except for that first injury episode up until January of this year. I had been doing Crossfit for about a year and a half with only beneficial strengthening of my back, (a week spot for me)until this started. I think I have traced the onset to a Russian Squat routine- lots of heavy squats over about a 6 week period...
Symptoms started slowly, and since they never came on during workouts,and my coach said my form was good, I continued Crossfit- training for a competition. I had radiating pain down through my buttcks into my left big toe that intensified to the point of getting a cortisone injection with some relief. I continued working out avoiding heavy squats(trying to will it away I guess). For the last 6 weeks or so I have stopped Crossfit and backed down to simple core exercises and stretching. I am feeling better but haven't had a day without any symtoms yet, which is what I was hoping to accomplish before starting back to crossfit.  I've been experimenting with just a hint of increased activity - a few air squats or slow and controlled body weight exercises (pullups ,pushups)- and it's making my symptoms worse. I really want to get back to Crossfit and am getting fearful that I won't be able to. The only therapy I've gotten is acupuncture, and didn't know if chiropractors dealt with this. Would you reccommend Chiropractic? And do you think it's possible to return to crossfit in the near-ish future?

Answer
Hi Lucinda,

What you are experiencing is not uncommon.  If you were a gymnast, odds are you are quite flexible.  Your spondylolisthesis may not be the sole cause of your back pain, but it could be a mechanical weak link if you're doing a lot of heavy repetitive squats or Olympic lifts.   Acupuncture will not fix your problem.  I'm assuming you had an MRI and that led to cortisone in the form of Epidural Steroid Injection, true?  I'm also going to assume that you are in your late 20's or so (don't ask me why...just a guess).   It is very likely that you have a disc protrusion.  It is also possible that you have an unstable spondy', meaning that one bone is slipping around on top of the other one.   Whether you have an unstable joint or not, some people are vunlerable to the bone/joint stress from the repetitive lifting that programs like CrossFit require.  If so, the repetitive strain leads to  disc irritation, stress fractures,or the precurser to stress fracture: bone marrow edema.   MRI would be helpful, but not absolutely necessary if you feel okay.   As for chiropractic, I am curious as to why you'd ask if chiropractors deal with conditions like yours.   I'm not trying to be rude or anything, but I found it odd that you'd ask this.  What do you think chiropractors treat?   Please give me some more information, vis. if you had an MRI or not, and what sort of cortisone injection was done.   Otherwise, find a sports chiropractor (www.acbsp.com) and also ask if they have a Distraction or "Cox" table.  

Best'

Dr. G