QUESTION: Dear Dr. Gillman,
I have been diagnosed with spondylolisthesis roughly 9 months ago. The doctor never mentioned the grade to me but according to my PT he said it is grade 1. I could only go to physical therapy a handful of times so I've just been working with the exercises given to me.
That being said I am losing a lot of hope because there is still pain, there is still the tingling, and there seems to be a restriction in movement, or at least pain stopping me from reaching 100% movement... I'm not severely incapacitated but it is enough for me to stop all athletic activity until I get back to 100%.
Is there any hope for a 100% pain free full recovery? What do you recommend? Any exercises? What to avoid?
Thank you for your time,
a athlete hoping to do what he loves again
ANSWER: Hi Ricky,
I am assuming you are a high school or college athlete. Understand that many athletes with Spondy (spine) Listhesis (slipping of one vertebra out of place on the other) have no pain and often never know they have this condition. There are two ways to get this: 1) your bones are old and degenerated/arthritic, and the hypertrophy of the arthritic joints causes one bone to push off the other. Likely that's not your situation unless you are senior pro golfer or an aging soccer player. 2) "Lysis." Lysis means "disillusion or breaking apart." You can have lysis of the bridge of bone that connects the front (body) of your vertebra to the back (arch) of your vertebra. This portion of bone is called the "pars interarticularis." This can be from a crack/fracture of the Pars' from direct trauma, e.g. being clipped from behind, repetitive trauma, e.g. baseball batting, or from the delicate bones not being connected at birth, vis congenital. SpondyloLYsis, in it's new/acute stage, is painful just like any other stress fracture to a bone. It will hurt especially with weightbearing activities, and will feel better if you lay down or rest. Here is a nice link I found that describes all of this: http://www.neurosurgeryresident.net/Spin.%20Spinal%20Disorders/Spin17.%20Spondyl
If you only had an x-ray of your spine and not an MRI, you will be missing out knowing if you have a new/acute lysis or its precursor, a stress reaction to the bone. A simple "Stork Test" can tell you if the joint system is irritated or not. Athletes I've tested that have an acute pars' break or a notably inflamed par' area will yelp with pain when put into the stork position.
Assuming you do not have an acute pars fracture, I would suggest getting the combination of chiropractic joint manipulation to your spine and pelvis. Also, some folks get relief with distractive/decompressive maneuvers: http://www.drgillman.com/drgillman/pages/videos/3810.html
If you have an acute pars fracture have signs of stress fracture brewing in the pars, sometimes you have to wear a lumbar back brace (rigid plastic brace) just like you'd wear a cast on an broken arm. You could take the brace off periodically and still receive joint manipulation and soft tissue therapy, but the brace would stay on to prevent you from repetitively loading up the joints with activities. While some exercises would be okay, e.g. "opposite arm and leg - birddog - on a ball," others would be detrimental, e.g. "Superman" back extensions, Ab' Crunches, seated ab' twist (rotary torso machine), and double leg lifts.
If you test-out okay with a sports chiropractor (see: www.acbsp.com) and obtain treatment, but do not obtain substantial improvement over a four week period, then MRI would be the best way to evaluate what you have.
I hope this was helpful.
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QUESTION: Hi I just wanted to add more information that Low back pain and left leg pain in L4/5 dermatome with xray demonstrating retrolisthesis L4-5.
These are doctor notes. I did not know if this would change your recommendations of the actions to take and what not to take.
Thank you so much for your time.
Spondylolisthesis in a young athlete is different from retrolisthesis (often seen in older folks with degnerated discs); How old are you? Who diagnosed you with spondylolisthesis? How was it done? 'Just x-ray? Who said "retrolisthesis?" I think you just should find a good chiropractor who can do a thorough hands-on exam, determine what's going on, order the appropriate tests if needed, and/or provide the right kind of treatment.
Thanks for the 10's rating. 'Much appreciated.