January 3, 2010
Spondylolisthesis…A Burlington Chiropractor’s View
Quite often we have new patients come to our clinic with a diagnosis of “sciatica”. This term has become popular for describing any condition that involves leg pain related to lower back dysfunction. Believe it or not, “sciatica” is not a diagnosis and there are many different conditions that involve symptoms of nerve irritation in the legs. For a treatment to be effective your condition must be diagnosed properly. Has degenerative lumbar spondylolisthesis been considered as a potential diagnosis for your leg symptoms? Has it been ruled out as a cause of your low back pain?
Spondylolisthesis – What is it?
Lumbar spondylolisthesis is a condition in which one vertebra “slips” forward on the one below. There are many different types of spondylolisthesis, one of the most common being degenerative. In this type, the slippage is linked to wear and tear in the joints of the lumbar spine. But what has some of the more recent research uncovered about degenerative lumbar spondylolisthesis?
Spondylolisthesis at L4 and L5…
The 4th and 5th lumbar level is the most commonly effected, with the quadratus lumborum muscle and the iliolumbar ligament often playing a role. The Quadratus Lumborum muscle and the iliolumbar ligament are both soft tissue structures that generate pain. Often times, treatment targeted at these areas can result in drastic improvement in pain associated with spondylolisthesis and lumbar degeneration.
Degenerative Disc Disease and Spondylolisthesis
Although frequently seen with this condition, disc degeneration is not an important predisposing factor for slippage. In fact, certain progressions of degeneration in other areas of the vertebrae can actually help to stabilize the slippage!
Other risk factors for degenerative spondylolisthesis in the lumbar spine include being older than 50, being female, having previous pregnancies, being African American and having generalized joint laxity.
Physiotherapy or Chiropractic?
Physiotherapy and Chiropractic both have something to offer the patient with spondylolisthesis. Effective treatment for degenerative lumbar spondylolisthesis involves maintenance of proper motion in the hips and other areas of the lumbar spine. This can be achieved through the use of gentle spinal movement techniques, active release technique and graston technique (which are treatments performed by our Chiropractors). Ensuring that certain muscles in the lumbar area assist in stabilizing the spine is also important. This can be achieved through proper education on the right and wrong way to strengthen a spine with spondylolisthesis (which is a service provided by our Chiropractors and our Physiotherapists). As previously mentioned, diagnosis is the key to proper care. Call us today, we can help. Our doctors are trained and qualified to order and read the appropriate x-rays necessary to accurately diagnose your lower back pain. From there, they can make up to date, evidence based recommendations for your treatment and home exercise! 905.220.7858 info@burlingtonsportstherapy.com
References
Kalichman L, Hunter D. Degenerative lumbar spondylolisthesis: anatomy, biomechanics and risk factors. Journal of Back and Musculoskeletal Rehabilitation 21 (2008) 1-12.
Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine 30 (2005) S71-S81.
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Tags: back pain, degenerative disc disease, degenerative spondylolisthesis, lower back pain, sciatica, spondylolisthesis
Mike Hale, D.C.
June 6th, 2010 at 9:39 amMy wife has a severe degenerative spondylo at L4-5. She has had treatment from many different chiro techniques with little success. A friend in Maine that does motion palpation treated her one time and she was pain free for 2 days, even with a long walk which usually causes lots of pain. Unfortunately, it returned on the second treatment. She has had the problem for over 2 years and does not want to have surgery. There are times that it seems to tighten up and there is very little crepitis. Other times the crepitis and movement is severe. A muscle relaxer does help. She has had bracing and facet blocks, but with little help.
Is there anything you do special, besides the core strengthening? She has problems with exercises that cause excessive movement in that area.
Any help would be appreciated.
Mike
Kevin McIntyre DC
June 6th, 2010 at 8:48 pmOur treatment usually depends on the patients specific presentation. Quite often this would include active release technique (ART) and/or graston technique to any dysfunctional soft tissue. Laser might also be used to help improve blood flow and generally improve the celluar composition of the area. In terms of rehabilitation, we would usually advise against an approach that involves repeated flexing and extending the affected level. Instead, we would recommend a lot of static (plank type) strengthening in the lower back and abdomen while trying to minimize shearing of the spine, especially in the affected area.
mandy
February 21st, 2011 at 4:10 pmhi,read your above response to a query with interest, as I’ve had spondy pain many years. all exercise seems to cause pain. can you please explain what you mean by ‘static (plank type)’ exs. thank you
Kevin
March 27th, 2011 at 10:47 pmSorry for the delayed response Mandy. Static or “plank” exercises involve challenging the abdominal and lower back musculature without moving the spine; you basically get in the exercise position and hold. An example would be when you balance in the push-up position (but usually on your elbows instead of your hands) and hold. If you’re interested in some more details or some images, feel free to email us.
wayne stout
April 26th, 2011 at 2:57 pmhow do i do the plank exercise because i have severe lower back pain,severe leg and feet pain, and in the buttocks.pain medication and muscle relaxers are doing nothing to relieve the pain.Thank you for any help you may advise .Im desperate to try anything.