This week I’ve diagnosed another ‘SPONDOLITHESIS’ , this is a low back problem which causes different levels of debilitation and dysfunction . I remember when I first came across this problem , I was working as a student Osteopath 19 years ago in the school clinic ,of the LONDON SCHOOL OF OSTEOPATHY . The client booked in with what would be considered bread and butter of Osteopathy ; LOW BACK PAIN . The low back pain radiated to buttock was sharp to dull in nature and worsened on standing . The client had a long history of this ‘ache’ which he reported had recently become exacerbated after the standing phase of a ‘lift’ at work – I remember he worked as a Carpenter. On examination no particular sign of disc herniation as indicated by the STRAIGHT LEG RAISE completed in the supine position . ADDITIONALLY NO SYMPTOMS when the ankle was moved upward as the leg was raised , this is called BRAGGARDS TEST . It is customary and clinically required to test for SENSATION , POSITION SENSE , MOTOR POWER and REFLEXES , I completed this with some positives however no very obvious signs of change in these modalities of the NERVOUS system .
As an INITIAL observation, which is my personal one and not really definitive , the client was sitting forwards on the chair and not extended back with leg stuck out ( this is the posture of the sciatica patient , in fact they would rather not sit ). The problems with a disc relate to the body being forward over the disc . Heres a video that illustrates this point . If you have radiating pain from the back to the buttock and leg thats worsened with forward bending then you can guess its a ‘disc ‘ problem
DISC PAIN – AND POSTURE
A note of WARNING if the pain radiates down your leg and you have NUMBNESS AROUND YOUR SEAT (your bum that is – TECHNICALLY CALLED SADDLE PARASTHESIA) with changes in bowel and bladder then please phone the EMERGENCY ROOM .
Because of the problem standing up straight ( ie provokes pain) you can probably guess it s the spondolithesis, the client satnd with their rear end stuck out . there are other problems around the sacrum and specific muscle spasm that can produce the same problem . So what exactly is a spondolithesis?
Heres the Wiki answer its labelled ‘uncited’ – dont get too worked up about Wiki some of the stuff there is ok , this particular definition is Universal :
‘Spondylolisthesis is the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. The variant “listhesis,” resulting from misdivision of this compound word, is sometimes applied in conjunction with scoliosis. These “slips” (aka “step-offs”) occur most commonly in the lumbar spine. Spondylolysis (a defect or fracture of the pars interarticularis of the vertebral arch) is the most common cause of spondylolisthesis. This is not to be confused with a slipped disc, where one of the spinal discs in between the vertebrae has ruptured’
What does this mean –
Well this phenomenon of ‘slippage’ can happen in the neck (cervical spine) as well as the lumbar spine . Lets go for a simple explanation . If you take your hand behind you and feel the lower you should be able to feel your way all the way down the column feeling bone all the way and there shouldnt be any acute cahnge in this gradual curve . Usually a soft spot or a ‘step’ may indicate a problem , in this case a slippage of one joint against another , the diagram illustrates this clearly . This can happen from direct wear and tear , trauma or as the result of a defect termed a SPONDOLOLYSIS – a picture is better than a thousand words so please refer to the diagram below
the known symptoms are :
- Stiffening of the back
- Tight hamstrings
- Tendency to want to bend forwarss afer prolonged standing
- Pain standing from sitting – sometimes a slipping sensation standing rom the sitting position
- Ocassionally a waddle because of lack of stabilisation of the pelvis.
- Coughing and sneezing can intensify the pain .
Some of the defining symptomS Ive seen over the years has been the tight hamstrings and a GAP or SOFT spot paplpated over the LOWER LUMBAR SPINE .
For the Doctor/ Osteopath/Physio/Chiropractor there are definitive tests for the disc problems that will come out as negative, and specific test which provoke symptoms ,along with paplpation these may form an important part of the diagnosis
Here a couple of patient history classics ;
- TROUBLE SHOPPING OR STANDING
- PLAYS CRICKET AND HAS PROBLEMS WHEN FIELDING
- FEELS LIKE BODY IS IN TWO HALVES
- PAIN AFTER LYING ON FRONT (PRONE)
- PAIN AFTER SPRINTING WORSE PAIN ON THE BENDS (RUNNER)
- PAIN AFTER TRAVELLING ON LONG RAILWAY JOURNEYS
- I USED TO ‘ROW’ AS A TEENAGER AND AT UNIVERSITY
- I PLAYED IN THE SECOND ROW (RUGBY)
- ITS ALWAYS BEEN PAINFUL
These ‘patients ‘ their problems , their look IS EMBEDDED in my experience : as an Osteopath I have indeed passed the 10000 hours border of experience and learning , this is considered a requirement for expertise along with formal training . ( its a good way to plan your own experential learning check out Malcolm Gladwell and Outliers)
‘The emerging picture from such studies is that 10,000 hours of practice is required to achieve the level of mastery associated with being a world-class expert in anything. — Daniel Levitin, Neurologist’
I could probably spot a client like this in a supermarket que . my hope in spinalsolutions Osteopathic Clinic in Birmingham City Centre is that you can gain from the benefit of my experience so if you have a young relative with persistent low back pain , have a look at their back , any suspicions then get them referred . Or if you have a tell tale ‘STEP’ in the LUMBAR SPINE, its not always ‘picked up’ until problems arise.
If you have persistent back pain that follows any of these patterns, then DO’NT allow anyone to manipulate this point directly , that at whatever level of the spine it manifests . I have in recent years consulted a client who had this problem, and was treated with manipulation before seeing myself at spinalsolutions , he was in a lot of pain but had problems standing upright. I identified the problem and subsequently requested a private MRI he proceeded to have an operation to fuse the spine which was the correct solution , prolonged treatment was unecessary
If this is your problem – dont worry – it can be fixed if its a gross problem ( surgically) and if its mild then specific exercises will help to manage the problem . Dont worry about spinal fusion surgery , Ive heard that Ian Botham the cricketer had this operation as the result of wear and tear from fast bowling and underwent sucessful surgery . He contiued to play after the surgery , it produced some limitations but did not prevent him playing completely at a high level. There is a well known NBA basket ball player in America Steve Nash was known to have this problem but still played successfully.
Exercises should be aimed towards FLEXION or working with a curved spine , and also STABILISATION by strengthening the CORE and MULTIFIDIUS – muscles either side of the spine that STABILISE THE VERTERBRA , also STRETCHING OF THE HAMSTRINGS – EXCESS ROTATION AND HYPEREXETNSION ( LEANING BACKWARDS) are to be discouraged and AVOIDED
Added to the basic exercises above we could add core training exercises such as the PLANK, SIDE PLANK
(The advice and exercises in this blog are offered as advice and are not definitive – Individual cirmcumstances may apply – if in doubt contact your General Practitioner or see a Professional Therapist or contact us at firstname.lastname@example.org) . If any exercise causes pain or additional problems cease immediately).
So please watch the video , consider the symptom list , study the diagram – if this is your profile – phone me up – see your GP – phone up a Physio/Chiro/Osteo , of course email me at email@example.com I would love to hear from you . Stay healthy .
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