Spondylolisthesis – A Guide on Diagnosis, Treatment and Prevention
Spondylolisthesis + How it affects Runners
No one understands the joys of running better than a runner. There is a particular pleasure you experience when your body moves and aligns just the way you wish. When your breathing, heart rate, and muscles are all working in unison, the result is a Zen-like experience, creating a pathway between distance, space, and time.
The joys of running are tempered, however, by the rest and recovery necessary from a sustained injury. Running injuries vary widely in terms of severity, but the pain from spondylolisthesis will sideline just about anyone. Considerable developments have been made in sports medicine and kinesiology in recent years that have improved our understanding of the human body’s biomechanics. Overuse and impact injuries of the lower extremities are common in the runner’s world, and the discoveries we have made into the nature of these injuries can help us to better understand injuries such as spondylolisthesis. Proper identification, treatment, and prevention of this condition is vital to keeping you healthy, active, and able to continue enjoying the sports you love. Cowritten by Mike Valverde and curated by Diana Rangaves, PharmD, Rph, the purpose of this runner’s guide: to provide you with valuable information that can assist you in understanding this condition and mitigate the effects it can have on your life.
“’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 when dealing with running injuries to move past the focus of running, sports, and activity and concentrate instead on rest and recovery. Many runners experience spondylolisthesis and spondylolysis injuries over the duration of their active years. Despite its cryptic name, this condition is surprisingly common: reports can be found of more than 3 million cases in the United States alone. The mainstay of treatment for this condition is to stop and rest, but other methods of recovery and prevention are outlined below.
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 the worsening of symptoms. In the worst cases, neglecting treatment for this injury can result in chronic pain, lifelong flare-ups, or permanent crippling damage.
What is Spondylolisthesis?
The spinal column, also known as the backbone, is made up of 33 vertically stacked bones called vertebrae. Spondylolisthesis, or olisthesis as it is sometimes called, 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 in a process known as anterolisthesis, or slip backward in what is referred to as retrolisthesis. In either case, the result of the injury is mounting pressure on the nerves affecting the bones in the lower back, which will generate pain.
Your body contains a vast network of nerves, similar to a highway system, leading from your brain to all of your organs. When you are injured, this communication network sends electrical signals to the brain that are read as pain. Pain from this condition depends on the graded degree of vertebral slippage, with it becoming more severe in worse cases. For clarity, spondylolysis is a medical term used when a part of the vertebral bone (the pars interarticularis) is broken, damaged, or defective.
There are seven vertebrae in the cervical region by the neck, marked as C1 through C7 in the diagram above. Twelve vertebrae are located in the thoracic area, marked above as T1 through T12, five are located in the lumbar area as L1 through L5, five in the sacral area as S1 to S5, and four in the coccyx tailbone area. The distinction between these different parts of your spinal column is important when diagnosing and treating spondylolisthesis, as painful deformity, narrowing, and nerve compression can occur. While this can happen in any region, the most common places this injury develops are in the lumbar section of the spine.
Symptoms of Spondylolisthesis
You may learn you have spondylolisthesis from an X-ray scan to diagnose a different condition entirely, as many people do not feel pain from the injury. Once a vertebra slips, people have gone for years without noticing any symptoms and may not even know they have it.
Symptoms fall on a spectrum of discomfort, from none at all to mild, moderate, and severe pain. The first signs of this condition start with a light muscle strain along the lower back. Muscle spasms may be felt in the hamstrings of your thigh, causing you to take smaller steps when walking or running. Pain, tingling, or numbness may be present down the buttocks 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 prolonged standing
- Reduction in range of motion and flexibility
- Ongoing pain, tingling, or numbness in thighs or hamstrings
- Muscle weakness, stiffness, or tightness in thighs or hamstrings
- Gait abnormalities, such as waddling motions or limping when walking
- Trouble with bladder or bowel control
- Bulging, protruding abdomen
Long-term problems and difficulties involve acute and chronic pain in the lower back and legs. If the condition advances, the nerves may be further affected and cause weakness in your legs. This can result in reduced walking ability, running ability, and flexibility. With extended inactivity comes the potential for weight gain, osteoporosis from bone loss, and reductions in muscle strength and mass.
Causes of Spondylolisthesis
There are many small bones and joints in the spinal column that can get out of alignment. Spondylolisthesis’ cause and 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 children from 7 to 10 years old and teenagers, as they begin to participate in sports and increase their level of physical activity. High-intensity sports such as weightlifting, football, and gymnastics tend to have a greater risk of injury, although it can still occur as a result of running. As you grow older, normal wear-and-tear will give way to degenerative progression. This usually occurs after 40 years of age, and will cause cases of olisthesis to be more frequent and more severe.
Spondylolisthesis cases are categorized in one of six potential groups, determined by their root cause. It is important to meet with a doctor or medical professional when discussing these causes in order to accurately diagnose your injury.
The six groupings are:
- birth defects
- defect or fracture in the pars interarticularis
- degeneration due to age or overuse
- tumors or other chronic diseases
- previous spinal surgery
Developmental congenital spondylolisthesis, or dysplastic, is an inherited condition. In these cases, patients were born with a vertebral bone that tends to slip forward; the result of this mutation is an increase in the risk of developing this condition. Common areas where this occurs are in the lumbar spine L-5 and sacrum S-1 area, as labeled by the diagram above. Even though the condition is present since birth, oftentimes it is not noticed until well into adolescence or adulthood.
Acquired Isthmic spondylolisthesis is the most common type of defect, causing small hairline stress fractures of the bone. It is usually located in the part of the vertebra called the pars interarticularis, and is caused by recurring impact, strain, injury, and damage. It is further subdivided into Type A and Type B.
- Type II A
This form of Type II spondylisthesis consists of micro-fractures and complete fractures of the pars interarticularis bone. This is produced by overuse and overarching of the body, as seen in activities such as gymnastics, football and weightlifting. In addition, ordinary household activities may cause stress on the spine, such as when lifting heavy objects.
- Type II B
In Type B cases, the par interarticularis bone does not fracture. Instead, the body lays down new bone as it heals, causing the surrounding area to expand, stretch, and lengthen. This deformity is what allows the vertebra to slip in these cases.
Degenerative spondylolisthesis is age related, and seen commonly in people older than 50 years of age. It is usually located at the L-4 and L-5 spots of the spine, as indicated in the diagram above. Normal wear-and-tear causes the cartilage disc cushion to deteriorate. With this disintegration, the intervertebral discs hold less water and proteoglycan. These fluids act as lubricants and cushioning agents that can absorb shock from physical activity, such as your feet hitting the ground while running. As the discs thin, the bone facets are unable to control spinal mobility and movement, and sooner or later the vertebra slips.
Traumatic spondylolisthesis, as the name implies, is the result of a direct bone injury or trauma. This type of back injury is less common than other forms of this injury, but it can affect individuals of all ages if they have been exposed to trauma targeting their lower back. The vertebrae bone is fractured in Type IV cases, splitting the front from the back. Examples of trauma that can cause this injury include falling from a substantial height or being involved in a car accident.
Pathologic spondylolisthesis is the result of a tumor or chronic disease triggering an abnormality that weakens the bone. The result of this is that the vertebra becomes unstable and slides. This type of injury can be the result of Paget’s disease, where the bones weaken and trigger pain, fractures, and deformities. People also have a higher risk of developing arthritis when facing this form of olisthesis. Other conditions, such as infections, osteoporosis, tuberculosis, giant cell tumors, and tumors that have metastasized or spread will weaken bones and lead to this injury.
Iatrogenic post-surgical spondylolistheses is the result of spinal surgery that weakened existing bone structures. This leads to persistent slippage and the worsening of the condition, even after spinal surgery. Often, additional surgical procedures are required to treat this condition.
Risk factors for Spondylolisthesis
The likelihood of developing this condition increases with age and exposure to intense physical activities. In addition to these risk factors, some are unavoidable for certain individuals, being due to genetic factors.
Risk factors for Spondylolisthesis:
- Family history of spinal conditions, tumors, disease, and bone disorders. This includes rheumatoid arthritis, osteoporosis and osteomalacia. Seek medical attention and follow the treatment plan set up by your doctor to minimize the risk of this injury occurring, as well as to prevent other long-term effects of cartilage degeneration.
- A birth defect of the par interarticularis bone means that you can be born with this condition. However, there are some lifestyle changes that you can do to minimize or prevent future pain and surgery if you are at risk due to this.
- 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 the 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.
- A sedentary lifestyle, meaning a daily lifestyle that involves sitting for long periods of time, can cause your back muscles and bones to weaken. This will make your spine more susceptible to damage, increasing the potential risk of injury.
- Poor posture when walking, sitting, or sleeping can cause strain in your back muscles and cause eventual spine damage. Consider using orthotics, ergonomic cushions, or mattress pads if you feel pain in your lower back from any of these activities.
Actively applying good spine health habits will go a long way towards maintaining your optimal performance and health.
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. From there, your doctor will move on into more specialized methods of determining the cause of your pain.
You can expect the doctor to:
- Determine location and levels of pain
- Inquire about sports or other physical activities
- Complete flexion and extension movements of your limbs
- Test the range of motion for joints, reflexes, and muscle strength
- Observe your posture and physical condition when standing and walking
- Watch your gait and body movement
- Observe how your spine curves (spinal curvature) as well as its alignment
- Feel your spine, muscles, and surrounding tissues to test specific areas of pain
- Order X-rays, CT scans, or MRI scans to examine the bone and tissue composition with greater detail
If it is required in order to move forward, your family doctor or primary care physician 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 to take 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 and properly diagnosed.
There are two more viewpoints available when performing imaging scans of your spine. One is the flexion x-ray, which is taken as you bend forward. The other is the extension x-ray, taken as you bend backward. All of these scans will provide adequate information that can be used to reveal any fractures, hairline fissures, and vertebral slippage. It will also be used to customize a treatment plan to fit your specific needs.
Once the injury has been diagnosed, its severity is graded using a five-point scale. The least severe is grade one and the most severe is grade five. It is based on the angle and percentage of vertebra forward slide when compared to the adjacent vertebra.
The radiologist makes this determination based on the chart shown below.
- 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.
If there are many other symptoms or damage, additional imaging diagnostics are often ordered. The next stage of imaging scans, which can provide greater detail and isolate the exact location of the injury, is a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. In addition to bone structure, 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 the results of a scan, the doctor can also order a myelogram. In this procedure, a dye is inserted around the nerves into the nerve sac after numbing the area. This image will clearly show the structural components of your spinal column, bones, and nerve pathways, highlighting any deviations and irregularities.
As most people do not have any symptoms or devastating pain, many people have discovered spondylolisthesis in their body when performing these tests for other conditions. 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 that can diagnose and treat this condition include orthopedic surgeons, neurologists, internal medicine physicians, and rheumatologists.
Treatment for Spondylolisthesis
The prognosis of spondylolisthesis is positive, in the great scheme of things. There are multiple non-surgical and surgical treatment options that can provide relief from symptoms and facilitate a full recovery. Ultimately, 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 initial episode. It is possible that you never have another episode, and it is also possible that the condition can reoccur if the bone presses against a nerve. If the traditional conservative treatment plan does not improve your symptoms, the next option is surgery. Even in very severe cases, surgery is successful in providing symptom relief in 85 to 90 percent of people. Relief from pain and a potential cure do exist, so a diagnosis is not a death sentence.
As there are many treatment methods to choose from, it is recommended that you discuss all treatment options with your health care provider in order to find the ones that are the best fit for you and your pain level. In this situation, one size does not fit all. Be patient, as it can take 8 to 12 weeks for a full recovery. The goal is stronger, flexible muscles, better movement, and a return to full activity without future episodes.
In deciding if a particular treatment plan is right for you, there are some things to take into consideration:
- Age and weight
- Lifestyle and daily routine
- Preexisting health conditions and diseases
- The grading level of slippage
- Severity of symptoms
- Effect on activities of daily living
The key method in a traditional conservative treatment plan is to listen to your body’s symptoms. Treatment techniques involve rest, medication, massage, and gentle exercise. Using these methods, the majority of cases will not require 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. Avoid strenuous activity such as bending and lifting. Ice packs temporarily relieve pain and reduce inflammation; the cooling sensation slows blood flow in the area and the pain impulses to the brain. The best practice when using ice packs is to apply them to the affected area for no longer than 20 minutes every hour. Alternatively, heat packs relax the surrounding muscles. They bring more blood flow to area, reducing the number of inflammatory substances. Alternating between heat and ice packs is a common practice in physical therapy, and is referred to as cryotherapy.
Medication can be used to great effect in different stages of the treatment process. Some medications can be used to treat certain symptoms, while others can help facilitiate a full recovery. Not all of the medications listed below will be required for every individual suffering from spondylolisthesis, but some of them may be beneficial. While some of these medicines are available over the counter, some will require you to get a prescription from a doctor. Oral non-prescription analgesic medications are available over-the-counter and fall into two categories:
Non-steroidal anti-inflammatory drugs (NSAID) work by reducing the substances that promote inflammation and pain. Examples of common NSAIDs are ibuprofen (found commonly in Motrin®) or naproxen (found commonly in Aleve® or Naprosyn®). They need to be taken with food. Aspirin is another common NSAID, but it has been known to cause Reye syndrome: a rare and serious swelling of the brain and liver. Because of that, it is not recommended for people under 20 years of age to take it.
Some side effects include:
- Nausea, vomiting
- Constipation, diarrhea
- Poor appetite
- Headache, dizziness
- Rashes, drowsiness
Get them here: (Tylenol)
Acetaminophen (commonly found in Tylenol®) will reduce minor aches, pains, and fevers. Although effective in treating the symptoms of spondylolisthesis, it is important to not exceed the maximum dose of 4,000 milligrams in a 24 hour period. Doing this, or taking acetaminophen with alcohol, can increases the risk of liver damage or death.
Some side effects include:
- Light-headed feeling
- Nausea, vomiting
- Stomach pain, constipation
- Sweating, weakness, fainting
- Itching, hives
If these non-prescription medications are not enough to treat your symptoms, the next course of action is to try stronger prescription medication. Be sure to consult with your doctor before deciding if these medicines are right for you.
Muscle relaxants are strong medications that are ideal for treating muscle spasms. If your back injury is caused by excessively tight or overactive muscles, taking these can both reduce the pain from your injury and prevent the condition from worsening. Common muscle relaxants include Baclofen and Chlorzoxazone.
Some side effects include:
- Light-headed feeling
- Chest pain
- Numbness on one side of your body
- Irregular heart rhythm
- Diarrhea or constipation
- Headaches and dizziness
Neuropathy is a term for medical treatment used to combat nerve-related pain. Neuropathic medication is commonly used to treat other conditions such as epilepsy and depression, but the same medicines used to treat these conditions can be helpful in treating nerve-related back pain. Common neuropathic medications for treating back pain include Lyrica and Neurontin.
Some side effects include:
- Heart problems
- Allergic reactions
- Weight gain
- Suicidal thoughts
Opioids are very strong pain relieving drugs, used to help manage the symptoms of back pain. They are controlled narcotic substances and are prescribed only to patients in extreme pain, such as when recovering from invasive surgery. Opioids are dangerous, since they are easily abused due to their addictive nature. Some common opioids used to treat back pain are Codeine and Oxycodone. Do not take opioids with alcohol under any circumstances, as the combination can be deadly.
Some side effects include:
- Nausea and vomiting
- Anxiety and irritable feelings
- Physical dependence and addiction
As with any medication, read the labels, ask your pharmacist or health care provider any questions before taking. It is important to be safe.
Braces or back supports can be used to promote healing over time. These accessories stabilize the lower area of the back by reducing movement. Most importantly, it serves as a gentle reminder that you are injured and that you need to take it easy! Be sure to discuss this option with your health care provider before using back supports; in some cases, a brace may actually cause the muscles to weaken.
Get them here: (Back Brace)
Physical therapy rehabilitation will keep joints and muscle limber during healing. There are many simple resistance exercises that will increase your muscles’ strength and range of motion. In addition, there are exercises you can do to stabilize and strengthen your back and abdomen muscles, encouraging a faster recovery. General muscle strengthening exercises are swimming, Pilates, and yoga, with more advanced strengthening exercises involving weightlifting. 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 also help with recovery and prevention.
Back Strengthening Exercises
There are some simple exercises you can perform in order to increase the strength of your lower back, hip and core muscles. Improving these muscle groups will help to prevent injuries such as spondylolisthesis, as well as provide other benefits such as improving your posture. Some of these exercises will require additional materials, such as a mat, a chair, or some hand weights such as dumbbells or kettle bells. Perform these exercises regularly in order to achieve ideal results, but stop immediately and seek medical attention if you begin to feel sharp pain.
- Pelvic Bridges: This exercise will target and strengthen your lower back, pelvis, and core. Start by lying on your back, using a mat. Keep your hands and arms flat on the ground, while your knees are bent and your feet are touching the ground as well. Slowly lift your butt off the mat while keeping your back straight and stop once your body forms a straight line from your upper legs to your torso. Hold this position for ten seconds, then slowly return to the starting position. Perform this exercise three to five times a day. For added difficulty, try resting your feet on an exercise ball instead of bending your knees.
- Kneeling Extensions: This exercise will strengthen your core muscles. Start by kneeling on a mat or rug, supporting your weight with your knees and hands in an all-fours position. Slowly raise one arm until it is pointing straight in front of you. At the same time, lift the opposite foot until it is pointed straight behind you. Hold this position for up to ten seconds, then slowly return to the starting position. Repeat this exercise three to five times with each arm and leg.
- Planks: This is one of the simplest and most effective exercises that will directly engage your core. Begin by lying flat on your stomach, using a mat or rug. Keeping your body in a straight line from your upper torso to your feet, lift your upper body off the ground with your hands. You can either rest your weight on your elbows and hands, or lift up higher off the ground by resting your weight on your hands alone. Hold this position for thirty seconds to a minute, keeping your core muscles tight the entire time, then relax and return to the starting position. Perform this exercise two to three times a day. For added difficulty, try holding the position for longer periods of time, or by lifting one leg while performing the exercise.
- Chair Crunches: This is an exercise that targets your core muscles near your stomach. Begin by lying flat on your back. Your legs should be elevated, with both of your feet resting on the seat of a chair. Place both of your hands behind your head, bending your elbows, and slowly lift your head and neck off the ground. You should feel compression in your stomach muscles when performing this movement; hold the position once you’ve lifted your shoulders off the ground as well. Hold for up to five seconds, then slowly lower your upper body back to the starting position. Repeat this exercise ten times for one set, and perform up to three sets a day. For extra difficulty, try performing sets with a greater amount of reps.
- Reverse Flies: This exercise will target your upper back. Stand up straight, holding a free weight in each hand. With your feet about shoulder width apart, lean your upper body forward while keeping your back straight and your arms dangling under your torso. Slowly raise your arms to either side of your body while keeping them straight, forming a T pose. Hold for a second or two, then slowly lower them back to the starting position. Perform ten to fifteen reps of this movement for one set, and perform two to three sets every day. Additional difficulty can be added with heaver weights.
- Bent-Over Rows: This exercise will target the muscles in the middle of your back. The starting position for this exercise is similar to the position for reverse flies: feet shoulder-width apart, back straight, leaning forward, and arms dangling with weights in each hand. In this position, you should also have your knees slightly bent and your butt sticking out. Slowly pull the two weights upward toward your chest, bending your elbows in order to do so. Hold for a second or two once you reach your chest, and then slowly lower your hands back to the starting position. Repeat this movement ten to twelve times for one set, and perform two sets every day. Be careful when adding extra weight to this exercise, as back injury can occur if it is too heavy.
Back Stretching Exercises
By slow gentle stretching, the back muscles, tissues, and nerves are used. Chinese and Indian Yoga, modified sit-ups, Cobra stretch exercises, and other stretches can offer a relaxing sensation and pain relief. By performing regular stretches, the muscles in your body lose tension and increase their range of motion, which will in turn reduce pressure on other parts of the body such as your spine. A variety of running injuries can be treated and prevented this way, and it is a common practice in physiotherapy. Some of these exercises will require the use of a mat or rug. Remember to always take deep breaths while performing these stretches. Deep inhalations and exhalations give your body the oxygen it needs. This will allow your muscles to function properly, preventing any further strain during your treatment process. Bodily issues involving oxygen supply and muscle functionality can lead to your injury becoming worse, or can lead to re-injury after recovery. You can expect some soreness if you perform these exercises properly, but stop immediately and seek medical attention if you begin to experience sharp pain.
- Hamstring Stretch: This stretch targets the muscles in the backs of your upper legs, which are instrumental in walking and weight bearing. Begin by laying on your back completely flat, using a mat or rug. Then, lift one leg into the air, keeping your knee from bending. Grab the back of your knee with both hands and gently pull it towards your upper body, holding the position once you feel slight tension. Hold for twenty to thirty seconds, then release and slowly return to the starting position. Repeat this movement two to three times a day with each leg.
- Cat and Cow Poses: This is a traditional Yoga routine that will increase flexibility in your back and spine. Begin by kneeling on all fours using a mat or rug, similar to the starting position for the kneeling extension exercise listed above. Slowly lower your head and round your spine, forming a convex curve from your lower back to your head; this is the cow pose. Hold this position for a few seconds, then lift your head upward and curve your back in the opposite direction, making a concave curve; this is the cat pose. Alternate between these two poses ten times, holding each pose for five seconds before switching.
- Standing Hip Stretch: This exercise is meant to increase flexibility in your hips, preventing gait abnormalities that can lead to back problems. Begin by standing up straight, with your feet shoulder width apart. Take a step back with one foot, bending the knee of your other leg. While holding this position, distribute your weight to the leg behind you. Hold the back of the leg with your hand and slowly bend your upper body forward until you feel tension in your hip. Hold this position for ten to twenty seconds, then return to the starting position. Repeat this movement with the legs reversed.
- Cobra Stretch: This stretch targets the lower back, preventing excessive strain on your lumbar spine. Begin by lying flat on your stomach, using a rug or mat. Keeping your legs flat on the ground, hold your weight on your hands while bending your upper body, forming a curve in your lower back. Continue extending until you feel tension, then hold the position for ten to twenty seconds and return to the starting position.
- Piriformis Stretch: This stretch targets a large muscle in the buttocks that can contribute to back pain, known as the Piriformis muscle. Begin by lying on your back, using a mat or rug. Cross one leg over the other leg and bend both of your knees so that your feet are lifted off the ground. Grab the back of your uncrossed leg’s knee with both hands and pull towards your upper body, similar to the movement used when performing the hamstring stretch. Hold this position for ten to twenty seconds, then release. Switch the position of your legs so that the other leg is crossed in front, then repeat the stretch.
Other Medical Procedures
Some people find relief with chiropractic manipulation treatments. Chiropractic adjustments can be used to treat back and neck pain. The goal of a session with a chiropractor is to restore alignment, reduce pain, and support the body’s normal capacity to heal. People have experienced improved range of motion and reduced pain after visiting a medical professional specializing in back problems.
Epidural cortisone injection can provide instantaneous relief. It is a medical procedure very similar to surgery, so it 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 well as promote growth of nearby tissue.
Some side effects and complications of cortisone injections include:
- Nerve damage
- Infection in the joint
- Weakened tendons
- Excessive sweating
- Bruising or discoloration around the injection area
Each person and situation is unique. Spondylolisthesis is generally treated medically, and does not require surgery if your vertebra grading is a Grade I or Grade II. However, surgery may be needed if the condition is Grade III or Grade IV, pain is unrelenting, or slippage is present. 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; the other goals are to stabilize the spinal column, relieve the pain, and improve your ability to function. Check with your doctor to decide if you are a good candidate.
There are two primary types of surgeries. Sometimes it is necessary to have both.
- Vertebra repair can involve removing scar tissue and adding a bone graft or 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. Before scheduling this procedure, you must account for spending at least one week in the hospital and several months for healing and recovery. These are serious surgical procedures that involve risks, so you will need to be observed a short time after the surgery and make several followup visits.
- A laminectomy corrects the compression of the nerve caused by the bone. This surgical procedure involves removing bone and other tissue, lessening the pressure and force on the nerve root. The issue with this surgery is that by removing the bone, the spine may be left unstable, necessitating regular use of a brace under risk of re-injury.
Additional Surgical Procedures
To improve stability, spinal fusion surgery can be performed. This is done by transplanting bone into the affected area. As it heals, the bone fuses together in place. The other method of spinal fusion is to take the slipped vertebra and fuse it to the next vertebra in the column. Rods and screws may be added to the bone grafts in order to improve strength permanently.
Sometimes, the spinal disc needs to be removed entirely. Healthy spinal discs are shock absorbing cushions between the vertebra that allow the spinal column to be limber and flexible. Time, routine wear-and-tear, age, and injury can cause them to wear out. If this happens, a ‘cage’ is made from a bone graft and placed in between the vertebrae to create space.
Surgery is seriously risky and has many potential complications. These include:
- Blood clots
- Deep vein thrombosis (DVT)
- Nerve damage
- 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.
Can Spondylolisthesis be prevented?
With spondylolisthesis, family history and aging related causes are not preventable. However, there are actions you can take in order to reduce the risk of vertebral slippage.
- Obesity is the only risk 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 stress and pressure on your spinal column. This speeds up wear-and-tear and vertebral erosion, which is a harbinger of spondylolisthesis. By maintaining the proper 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 are all very important for proper body functions. By incorporating a variety of healthy foods, the body can better resist degeneration, and recover faster from tissue damage.
- Perform stretches to improve your back and abdominal muscles. Keeping your body limber will reduce ridge muscle pressure on the spine and minimize injury. Adding regular stretches to your warm-up routine before running is a simple way to incorporate this into your daily life.
- Regular exercise increases muscle strength, thickens bones, and burns fat by expending calories. Some excellent physical activities include lifting weights along with your standard exercise practices. You will not only burn fat, but also help your body build muscle mass which will stabilize and protect your skeletal structure.
- Avoid high-risk sports such as football, gymnastics, and weightlifting. Instead, choose low-risk sports such as swimming and biking, where the possibility of sustaining trauma is significantly lower.
- Avoid alcohol and smoking as alcohol leads to dehydration and smoking speeds up the aging process. There are some health benefits to enjoying alcohol in moderation, but avoid drinking to excess regularly, as this will prevent your body from burning fat and can cause damage to your liver.
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, which can be falsely attributed to back problems such as spondylolisthesis. The diagnostic imaging procedures are intended to rule out any false positives. X-rays, CT scans and MRI scans give a clear picture of bone and tissue structure and have a low false positive rate. When performing these scans, it is possible to determine if the source of your symptoms is actually a different condition entirely. These false positives usually require entirely different methods of treatment, so it’s very important to rule them out.
Alternative diagnoses for spondylolisthesis include:
- Arthritis, in situations where pain is felt in multiple joints and not just the lower back. If pain is felt at varying levels during different times of the day, and if you have a genetic predisposition for it, this may be a potential culprit.
- Coccyx Injury can present similar symptoms, such as an aching pain in the lower back. It can also be caused by trauma, such as in contact sports. However, this injury is usually a temporary inflammation that will go away after a short period of rest and rehabilitation.
- Muscle Strain is one potential indicator for this injury, but it can also be a condition that occurs independent of spinal damage. Strain in your lower back or upper legs can mean that your body is simply overworked, and doesn’t always indicate a serious vertebral injury.
- Compression Fracture is a very similar back injury that shares symptoms such as lower back pain and potential nerve damage. Similar surgical procedures can be used to treat this condition, but the best practice when treating it is to follow RICE protocol.
- Discogenic pain is pain coming from a disc. While it originates in the back, it can spread to other parts of the body. The pain is often felt in the area where the pain spreads, rather than in the back.
- Chronic intractable neck pain, defined as 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. In this injury, the rubbery tissues are torn or ruptured. This will be seen on CT or MRI scan, and looks different from standard cases of spondylolisthesis.
If you experience any back pain, it is highly recommended that you consult with a doctor. Levels of activity and quality of life will be affected if the injury or condition is left unchecked, and improper treatment due to a false diagnosis can be devastating to your health and wallet.
Spondylolisthesis is a treatable condition. The first step in treating it is to determine spinal stability with a physical and neurological examination by your doctor. If there is pain, the levels vary 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 scans and MRI scans to look at the bigger picture. If your vertebra is stable, then a traditional conservative treatment plan is the right fit. 80% of people found improvement with rest, cryotherapy, 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 in order to allow your body to rest 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. Alternatively, spinal fusion surgery will insert bone and possibly attach rods and screws in order 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, so long as you visualize it in your mind and hold it in your focus.
Co-written by Mike Valverde
Curated by Diana Rangaves, PharmD, Rph
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 your treatment for the best possible outcomes. This information is provided by RunnerClick 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 condition, and before trying anything listed in this article. Research for this article was pulled from reputable medical sources.
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