Do I have a 'bad' back?
Spondylolisthesis and lower back pain
In my early thirties I began to suffer with constant left lower back pain. It came on gradually, and I couldn't pinpoint the onset to a specific time or event. Eventually, I went to see an Osteopath who identified that I likely had a spondylolitheisis in my lower back. He recommended I get a scan to establish the extent of the slippage and as a marker should anything change with my back pain.
The scan showed I had a grade two isthmic spondylolisthesis and I was advised by a doctor to avoid running, rowing and certain weight training exercises. I was stretching regularly and trying to improve my core strength, but nothing was impacting my pain level - the constant dull ache remained.
What is spondylolitheisis and how does it cause back pain?
Greek - spondylos meaning spine or vertebra; listhesis meaning movement, sliding or slipping.
Spondylolisthesis is where one of the bones in your spine slips forward, putting pressure on the nerves in your spinal canal. It usually occurs in the lower back, but can be higher up or in the neck.
Symptoms
Reported symptoms are lower back pain, a stiff back, curvature or bulging of the spine, and tight hamstrings.
The pressure on the spinal canal can cause pain, pinching, numbness and weakness, usually in your lower back and legs.
Causes
There are three main types of spondylothesis:
Congenital spondylolisthesis — a defect in the formation of a baby's spine before birth that increases the risk of a vertebra slipping in later life
Degenerative spondylolisthesis — the most common type of spondylolisthesis caused by thinning of the vertebral discs (fluid-filled cushions that sit between the vertebrae) as you get older; the discs thin because they lose water and thinner discs increase the chance of a vertebra slipping out of place
Isthmic spondylolisthesis — a defect of the spine usually caused by a stress fracture
So what does this mean for me?
Managing my spondylolithesis
After six months of greatly reduced activity, and feeling worse than before I had eased up on my training, I returned to the Osteopath and discussed the situation and remedies further - in hindsight I should have done this far sooner!
Despite the evidence of this slipped vertebra my back felt better during and after exercise. I didn't feel an increase in pain when I loaded it sensibly, be that squatting, deadlifting, or gardening. In fact it felt better. Given my response to activity and the stable nature of the slippage, combined with the bands of ligaments and muscles in that region, the Osteopath reassured me that as long as I listened to my body and was sensible I should be fine to return to whatever training I enjoy.
I have no idea how or when the spondylolithesis occurred, however such an 'injury' is common when certain sports are practiced frequently in our teenage years - sports which involve heavy or rapid sheering and twisting forces, such as judo (my case), gymnastics, and cricket (bowling).
I am now able to squat and deadlift (for example) far more than I ever did as a younger man, and typically my lower back will feel better for it the next day. If it does start to ache, then foam rolling, specific stretches and mobility drills, and some magnesium spray calm it down. Combining this with periodic trips to my Osteo, keep me doing what I love, hopefully for a long time yet.
