The Runner’s Guide to Spondylolisthesis

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Spondylolisthesis + How it affects Runners

No one understands the joys of running better than a runner. There is a particular thrill and pleasure when your body moves and aligns the way you wish. Breathing, heart rate, muscles, and speed all working in unison to create a pathway between distance, space, and time.

Spondylolisthesis-The Runners-Complete-Guide

The joys of running are also forever balanced with the rest and recovery necessary from a sustained injury. The pain from spondylolisthesis will sideline anyone. Considerable developments have been made in sports medicine and kinesiology. These have improved our understanding of the biomechanics of the body. Overuse and impact injuries of the lower extremities are common in the runner’s world. Proper identification, treatment, and prevention are vital to keeping you healthy and enjoying the sport you love.

“’No pain, no gain’ does not mean that pain systematically equals gain. It’s easy to go hard. It’s hard to go smart.” Erwan Le Corre, founder of MovNat

It is very important to move past the focus of running, sports, and activity to concentrate on rest and recovery after a painful injury. Many runners experience spondylolisthesis and spondylolysis injuries over the duration of the time active. It is very common, accounting for more than 3 million cases in the United States. The mainstay of treatment is to stop and rest.

For an active person, this is not an easy prescription to swallow. Not everyone is the same, yet continued sports activity during an injury can over-stress and harm the body. The damage can be acute or potentially lead to worsening of symptoms and permanent, crippling, lifelong flare-ups or chronic pain.

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What is spondylolisthesis

what-is-Spondylolisthesis

Our spinal column or backbone is stacked with 33 bones called vertebrae. Spondylolisthesis (spondy) occurs when a vertebrae moves or slips. Derived from the Greek, spondylo for spine and listheis for slippage, the condition can be debilitating. The vertebra can slip forward, anterolisthesis, or slip backward, retrolisthesis causing mounting pressure on the nerves affecting the bones in the lower back generating pain.

Throughout your body is a highway system of nerves leading from the brain to all your organs. When you are injured this communication network sends electrical signals to the brain that are read as pain. Pain from spondylolisthesis depends on the graded degree of vertebral slippage.  For clarity, spondylolysis is a medical term used when a part of the vertebral bone, the pars interarticularis is broken, damaged, or defective.

what-is-Spondylolisthesis-Spinal-Vertebral-Column

There are seven vertebrae in the cervical region by the neck C1-C7, 12 in the thoracic area T1-12, five in the lumbar area L1-L5, five in the sacral area S1 to S5 and four in the coccyx tailbone area. This is important when diagnosing location and treatments, as painful deformity, narrowing, and nerve compression can occur. While spondylolisthesis can happen in any region, the most common are in the lower back of the lumbar spine.

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Symptoms of Spondylolisthesis

You may learn you have spondylolisthesis from an x-ray for another condition, as many people do not feel pain. Once a vertebra slips people have gone years without any symptoms and do not know they even have it.

Symptoms-of-Spondylolisthesis.

Symptoms run the gamut in discomfort range from none at all to, mild, moderate, and severe. The first sign starts with a light muscle strain along the lower back. Muscle spasms may be felt in the thigh hamstrings causing you to take smaller steps when walking or running. Pain, tingling, or numbness may be present down the buttock through the leg to the foot as the vertebra begins to press on the nerve.

Additional symptoms for you to watch for are:

  • Pain and sensitivity in the lower back or buttocks
  • Increasing pain intensity after exercise or on standing
  • Reduction in range of motion and flexibility
  • Ongoing pain, tingling, numbness, muscle weakness, stiffness, or tightness in thighs, legs, or hamstrings
  • Difficulty walking with a growing swayback, waddling motion or limp
  • Trouble with bladder or bowel control
  • Bulging, protruding abdomen

Long-term problems and difficulties include acute and chronic pain in the lower back and legs. If the condition advances, the nerves may be affected causing weakness in the legs. This can result in reduced movement, walking, running, and flexibility. With inactivity comes the potential for weight gain, osteoporosis from bone loss, and reductions in muscle strength and mass.

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Causes of Spondylolisthesis

Causes-of-Spondylolisthesis

There are many small bones and joints in the spinal column that can get out of alignment. Spondylolisthesis severity is related to the amount and intensity of physical activity and sports you participate in.

It is the most common source of back pain in 7-10-year-olds and teenagers as they begin to take part in sports and increase their physical activities. High-intensity sports such as weightlifting, football, and gymnastics tend to have a greater risk. As you move into adulthood, normal wear-and-tear will see degenerative spondylolisthesis progression. This usually occurs after 40 years of age.

Spondylolisthesis is grouped by their primary root cause. Be sure to meet and discuss any concerns with your health care provider before making any decisions.

The six groupings are:

  • birth defect
  • fractures
  • defect or fracture in the pars interarticularis
  • degeneration due to age or overuse
  • tumors or other chronic diseases
  • previous spinal surgery

Causes-of-Spondylolisthesis-Pars-Interarticularis

Type I:

Developmental congenital spondylolisthesis or dysplastic is inherited. You are born with the vertebral bone that tends to slip forward; therefore, increasing the risk of developing this condition. Common areas are in the lumbar spine, L-5, and sacrum S-1 area. Even though the condition is there since birth, many times it is not noticed until well into adolescence or adulthood.

Type II:

Acquired Isthmic spondylolisthesis is the most common type of defect with small, hairline, stress fractures of the bone. It is usually located in the part of the vertebra called the pars interarticularis. This is caused by recurring impact, strain, injury, and damage. It is further subdivided into Type A and Type B.

  • Type II A

consists of micro-fractures and complete fractures on the pars interarticularis bone. This is produced by overuse and overarching of the body as seen in gymnastics, football, and weightlifting. In addition, activities of daily living may cause stress on the spine such as lifting heavy objects.

  • Type II B

the par interarticularis bone does not fracture. Instead, the body lays down new bone as it heals. This causes the area to expand, stretch, and lengthen allowing the vertebra to slip.

Spondylolisthesis-Causes-1-2a-2b-2c

Type III:

Degenerative spondylolisthesis is age related and seen in people older than 50 years of age. It is usually located at the L-4 and L-5. Normal wear-and-tear causes the cartilage disc cushion to deteriorate. With this disintegration, your intervertebral discs hold less water and proteoglycan. These are both lubricants and cushioning agents that act as shock absorbers. As the discs thin, the bone facets are unable to control spinal mobility and movement. Sooner or later the vertebra slips.

Type IV:

Traumatic spondylolisthesis as the name implies is the result of a direct bone injury. This type is less common. The vertebrae bone is fractured splitting the front from the back. Examples include falling or from a car accident.

Type V:

Pathologic spondylolisthesis is the result of a tumor or chronic disease triggering an abnormality that weakens the bone. The vertebra becomes unstable and slides. This type of injury can be the result of Paget’s disease. In Paget’s disease, the bones weaken and trigger pain, fractures, and deformities. People also have a higher risk of developing arthritis. Other conditions, such as infections, osteoporosis, tuberculosis, giant cell tumors, and tumors that have metastasized or spread will weaken bones.

Spondylolisthesis-Causes-3-4-5

Type VI:

Iatrogenic post-surgical spondylolistheses is the result of spinal surgery that weakened the existing bone structures. This leads to persistent slippage and the worsening of the condition, even after spinal surgery.

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Risk factors for Spondylolisthesis

Spondylolisthesis-Risk-Factors

The likelihood of developing Spondylolisthesis increases with age and exposure to intense physical activities.  To sum it up, the two groups are risks you can prevent and risks you cannot. 

Risk factors include:

  • Family history of spinal conditions, tumors, disease, and bone disorders, such as rheumatoid arthritis, osteoporosis and osteomalacia. Seek medical attention and follow the treatment plan set up by your doctor to minimize long-term effects of cartilage degeneration.
  • Birth defect of the par interarticularis bone means that you are born with the condition. There are some lifestyle elements that you can do to minimize or prevent future pain and surgery.
  • Recurring trauma and injury will damage the bones, tissues and surrounding ligaments. In addition, there will be a slow and steady decline in overall spinal health with continued destruction from high-impact sports.
  • Overarching of lower back and lumbar regions will amplify damage to the spinal column by the application of intense pressure and force. The result is an increased danger of vertebral slippage.

Actively applying good spine health habits will go a long way in maintaining your optimal performance and health.

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How is Spondylolisthesis diagnosed?

What can you expect from your doctor? Initially, your doctor will conduct a physical and neurological exam. They will be looking for signs of tightness, muscle spasms, and difficulty walking.

You can expect the doctor to:

  1. Determine location and levels of pain
  2. Inquire about sports or other physical activities
  3. Complete flexion and extension movements of your limbs
  4. Test range of motion of joints, reflexes, and muscle strength
  5. Observe your posture and physical condition upon standing and walking
  6. Watch your gait and body movement
  7. Notice how your spine curves (spinal curvature) and alignment
  8. Feel your spine, muscles, and surrounding tissues to test specific areas of pain
  9. Order X-rays or CT or MRI scans to examine the bone and tissue composition

Diagnosing-Spondylolisthesis

If it is required to move forward, your family doctor or primary care provider will order an imaging diagnostic. A simple, lateral, side view X-ray radiograph is the best method to diagnose spondylolisthesis. Alternatively, your doctor may wish an oblique X-ray that views the vertebra at a back angle. For this perspective, the facet joints, pars interarticularis bone, and lamina can be seen.

There are two more viewpoints available. One is the flexion x-ray which is completed as you bend forward. The other is the extension x-ray taken as you bend backward. All of this information will show any fractures, hairline fissures, and vertebral slippage. It will be used to customize a treatment plan as personal as you are.

Spondylolisthesis severity is graded using a five-point scale. The least severe is grade one and the most severe are grade five. It is based on the angle and percentage of vertebra forward slide compared to the vertebra next door.

The radiologist makes this determination based on the following chart.

  • Grade I is a slip of up to 25%
  • Grade II is between 26%-50%
  • Grade III is between 51%-75%
  • Grade IV is between 76%-100%.
  • Grade V, or spondyloptosis, occurs when the vertebra has completely fallen off the next vertebra.

Spondylolisthesis-grades-1-2-3-4-5

If there are many other symptoms or damage, additional imaging diagnostics are ordered. The next level up which provides extensive detail and isolates the exact location of the injury is computed tomography (CT) scans or magnetic resonance imaging (MRI) scans. These tests will show compression of the nerve roots and stenosis. Spinal stenosis is when the bone canal narrows so that the nerve is under the bone or muscles and sparks pain.
To confirm this, the doctor can order a myelogram. After numbing the area, a dye is inserted around the nerves into the nerve sac. This image will clearly show the structural components of your spinal column, bones, and nerve pathways with any deviations and irregularities.

Spondylolisthesis-spine-mri

As most people do not have any symptoms or devastating pain, many people have these tests completed for other conditions when the spondylolisthesis is discovered. A radiologist will diagnose the condition and send a report to the primary care provider. If treatment is needed, you and your doctor will discuss the available options.
Other medical specialists including orthopedic surgeons, neurologists, internal medicine physicians, and rheumatologists can treat and make referrals for spondylolisthesis.

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Treatment for Spondylolisthesis

The prognosis of spondylolisthesis is excellent. There are multiple non-surgical and surgical treatment options that give relief from symptoms. Your treatment choice depends on the type, intensity, and range of symptoms.

The majority of people, about 80 percent of cases, will respond to a traditional conservative treatment plan. The likelihood of spondylolisthesis returning depends on the severity and intensity of the first, initial episode. You may never have another episode or if the bone presses against a nerve it will recur. If the traditional conservative treatment plan does not improve your symptoms the next option is surgery. Even if the case is severe, surgery is successful in providing symptom relief in 85 to 90 percent of people. Relief from pain and a potential cure do exist.

Each person and situation is unique. In general, spondylolisthesis is treated medically and does not need surgery, if your vertebra grading is a Grade I or Grade II. Surgery may be needed if the Grade is III or Grade IV and pain is unrelenting and slippage is present.

In deciding if a particular treatment plan is right for you, there are some things to take into consideration.

  • Age, weight, and other health conditions and diseases
  • The grading level of the slippage
  • Severity of symptoms
  • Effect on activities of daily living

Key methods in a traditional conservative treatment plan are to listen to your body’s symptoms. They involve rest, medication, massage, and gentle exercise. In this way, you may avoid surgery.

  • Take rest and recovery seriously. This means you need to avoid all activities that cause pain. This does not only include sports. Watch out and be aware of the things that you do daily, without even thinking about, such as bending and lifting. Take a break! You need to REST.
  • Ice cold packs temporarily relieve pain and reduce inflammation. The cooling sensation slows blood flow in the area and the pain impulses to the brain. Heat or hot packs relax the surrounding muscles. They bring more blood flow to area reducing the number of inflammatory substances.
  • Oral non-prescription analgesic medications are available over-the-counter and fall into two categories.

Spondylolisthesis-medication-treatment-nsaid-ibuprofen-naproxen

Get them here: (Motrin) | (Aleve)

1.Non-steroidal anti-inflammatory drugs (NSAID) work by reducing the substances that promote inflammation and pain. Examples are ibuprofen (Motrin®) or naproxen (Aleve® or Naprosyn®). They need to be taken with food. Aspirin can cause Reye syndrome, a rare and serious swelling of the brain and liver; therefore, it is not recommended for people under 20 years of age.

Some side effects include:

  • Nausea, vomiting
  • Constipation, diarrhea
  • Poor appetite
  • Headache, dizziness
  • Rash, drowsiness

Spondylolisthesis-medication-treatment-tylenol-acetaminophen

Get them here: (Tylenol)

2.Acetaminophen (Tylenol®) will reduce minor aches, pains, and fever. Do not exceed the maximum dose of 4,000 mg in 24 hours or take with alcohol as these increases the risk of liver damage or death.

Some side effects include:

  • Light-headedness
  • Nausea, vomiting
  • Stomach pain, constipation
  • Sweating, weakness, fainting
  • Itching, hives

As with any medication, read the labels, ask your pharmacist or health care provider any questions before taking. It is important to be safe.

  • Brace or back support can be used to promote time for healing. It stabilizes the area by reducing movement. Most importantly it serves as a gentle reminder that you are injured and to take it easy! Discuss this option with your health care provider as in some cases a brace may actually cause the muscles to weaken.

Spondylolisthesis-back-brace-wrap

Get them here: (Back Brace)

  • Physiotherapy and physical therapy rehabilitation will keep joints and muscle limber during healing. There are easy stretching and firming exercises that will increase your muscles range of motion. In addition, there are exercises you can do to stabilize and strengthen back and abdomen muscles to encourage recovery. Chinese and Indian Yoga, modified sit-ups, Cobra stretch exercises, and other stretches can offer a relaxing sensation and pain relief.

https://www.youtube.com/watch?v=vCWYsF3_9Ig
Spondylolisthesis Exercises & Stretches for Back Pain – Ask Doctor Jo

  • By slow gentle stretching, the back muscles, tissues, and nerves are used. General muscle strengthening exercises are swimming, Pilates, and yoga. Muscle and back safety include, pay attention to lifting with your knees, standing and sitting straight with good posture, bending slowly and correctly, and sleeping on a firm mattress. If you are overweight weight loss may help.

Spondylolisthesis-pilates

  •  Some people find relief with chiropractic manipulation treatments. Chiropractic adjustments can be used to treat back and neck pain. The goal is to restore alignment, reduce pain, and support the body’s normal capacity to heal. People have experienced improved range of motion the chiropractic.
  • Epidural cortisone injection requires scheduling with your doctor. The cortisone shot is injected in the area around the spine, inside the spinal canal. It may help to reduce the pain and inflammation.

As there are many to choose from, discuss all treatment options with your health care provider to find the ones that is the best fit for you and your pain level. One size does not fit all. Remember to always take deep breaths. Deep inhalations and exhalations give your body the oxygen it needs. Be patient it can take eight to 12 weeks. The goal is stronger, flexible muscles, better movement, and to return to full activity without future episodes.
If your condition does not improve over several months and the pain is not manageable, surgery is the next option.

  • Surgical procedures are used to create more space for the nerve roots. Check with your doctor to decide if you are a right candidate. The goals of surgical procedures are to stabilize the spinal column, relieve the pain, and improve your ability to function.

There are two primary types of surgeries. Sometimes it is necessary to have both.

1.Vertebra repair can involve removing scar tissue, adding a bone graft and screws. This will give the nerve roots more space and in some cases, the vertebrae are fused or moved back into place.

You will be under general anesthesia; therefore, unconscious. You must plan for at least one week in the hospital and several months for healing and recovery. These are serious surgical procedures that involve risks.

2.A laminectomy corrects the compression of the nerve caused by the bone. The procedure removes bone and other tissue. This will lessen the pressure and force on the nerve root. However, by removing the bone this may leave the spine unstable.

Spondylolisthesis-surgery

To improve stability, spinal fusion surgery can be performed. This is done by transplanting bone back into the area and as it heals the bone fuses together in place. The other method is to take the slipped vertebra and fuse it to the next vertebra in the column. Rods and screws may also be added to improve strength permanently. Sometimes, the spinal disc needs to be removed. Healthy discs are the cushioned shock absorbers between the vertebra that allow the spinal column to be limber and flexible. Over time, routine wear-and-tear, age, and injury cause them to just wear out. If this happens a ‘cage’ is made from a bone graft and placed in between the vertebrae to create space.

Surgery is serious and has risks complications. These include:

  • Infection
  • Blood clots
  • Deep vein thrombosis (DVT)
  • Nerve damage
  • Paralysis
  • Loss of bowel or bladder control

It is very important you discuss all possibilities and outcomes in detail with your health care provider before deciding which treatment option is the best for you.

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Can Spondylolisthesis be prevented?

While spondylolisthesis, family history, and aging is not preventable, there are things you can do to reduce the risk of vertebral slippage.

  • Obesity is the only factor that you can actively prevent. Reduce weight if necessary as it adds to the strain on your lower back. The added weight to the body increases the force and stress pressure on the spinal column. This speeds up wear-and-tear and vertebral erosion, which is the trademark of spondylolisthesis. By maintaining the correct weight for your body type, your spine will be able to withstand normal breakdown as you age.
  • Keep your diet healthy and well-balanced. Provide your body with the vitamins and minerals it needs to build and maintain tissues, cartilage, and bone.  For example, Vitamin D, calcium, and anti-oxidants. By doing so the body can better resist degeneration and recovery from tissue damage.
  • Stretch exercises to strengthen back and abdominal muscles. Keeping your body limber will reduce ridge muscle pressure on the spine and minimize injury. Add regular and frequent stretching to your warmup routine.
  • Regular exercise  increases bone thickness and expends calories. These activities include lifting weights along with your exercise practices. You will not only burn fat, but help your body build muscle mass which will stabilize skeletal structures.
  • What to avoid: Avoid high-risk sports such as football, gymnastics, and weightlifting. Instead, choose low-risk sports such as swimming and biking. Avoid alcohol and smoking as alcohol  leads to dehydration and smoking speeds up the aging process.

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False positives of Spondylolisthesis?

Poor movement and back pain can originate from anywhere. When one movement area is affected there is compensation in another area. This eventually results in pain, discomfort, and overuse injuries. The diagnostic imaging procedures for spondylolisthesis are to rule out any false positives.

However, X-rays, CT and MRI scans give a clear picture of bone and tissue structure and have a low false positive rate. Other diagnosis may include;

  • Lumbar spinous which is a bony projection or growth from the vertebra. This may protrude and cause pain.
  • Discogenic pain is pain coming from a disc; however, it spreads to other parts of the body. The pain is felt at the other part rather that the back areas.
  • Chronic intractable neck pain is pain that is continuous, lasts more than six months, and varies in intensity level. A total diagnostic work-up will help in pinpointing the proper diagnosis.
  • Disc herniation is most common between the fourth and fifth lumbar vertebra of the low back area. The rubbery tissues are torn or ruptured. This will be seen on CT or MRI scan.

If you experience any back pain it is highly recommended you consult with a doctor. Levels of activity and quality of life will be affected if the injury or condition is left unchecked.

 

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Conclusion

Runners Marathon

 

Spondylolisthesis is a treatable condition. The first step is to determine spinal stability with a physical and neurologic examination by your doctor. If there is pain, the levels range from bothersome to agonizing. Diagnosis, treatment, and rehabilitation for bone, joint or connective tissue disorders are provided by physical medicine and rehabilitation doctors.

Diagnostic imaging includes x-rays, CT and MRI scans to look at the bigger picture. If your vertebra is stable then a traditional conservative treatment plan is the right fit. Eighty percent of people found improvement with rest, ice and/or heat packs, over-the-counter medications, bracing, abdominal and lumbar strengthening range of motion exercises, physical therapy, and chiropractic manipulations.

While under medical treatment, running and sports activity should stop to allow your body to rest, recover, and heal. If your condition is unstable, with unrelenting pain from the bone pressure and force on the nerve, surgery is the alternative.

Surgical intervention is successful in 85 to 90 percent of people for pain and functional movement limitations. A laminectomy reduces nerve pressure by trimming and removing excess bone and tissue. Whereas, spinal fusion surgery will insert bone and possibly attach rods and screws, to increase strength and stability.

There are never any guarantees. Injuries, medical treatments, and surgeries have serious risks and benefits. These must be taken into account and discussed with your health care provider. Any treatment method will result in downtime from running and sports activities. However, the alternative is a lifetime of chronic, potentially harmful injuries that will forever drain the joy from your running.

Stay the course and be persistent with your healing regimen. Exercise therapy compliance is the biggest hurdle for most non-athletes. Remember, your body is designed to move without pain. Anybody can train and go hard, what takes courage is to go slow and smart. The goal is to return to full activity with no pain. That goal is within reach, hold it, and visualize it.

The information in this article serves as a guide to ask deeper questions and pursue more research. In this way, you can effectively and appropriately make decisions in the treatment of your spondylolisthesis for the best possible outcomes.

This information is provided by RunnerClick solely as informational purposes and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical conditions or using anything listed in this article. Research for this article was performed citing reputable medical sources.

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Sources

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  13. MD Catherine Burt, What Are the Complications of Spondylolisthesis?, Jan 01, 1970
  14. A778388, Spinal Surgery: Laminectomy and Fusion, Jan 01, 1970
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