Spondylolytic spondylolisthesis

[B.J. Norris]

Hey Guys,

My PCP has still not been able to track down the cause of the pain in my lower lumbar area. X-rays, MRI and an ultrasound have all come back as normal. After doing some more research on my own, my symptoms seem to match Spondylolytic spondylolisthesis pretty much to the T. I was thrown off a horse when I was about 12 or 13, and fell probably 15-20 feet right onto my lumbar, so I have a feeling that this may something to do with it. Mostly, it's a dull burning pain after some type of physical activity, and it also seems very prone to re-injury. About a month ago, I could run (albeit fairly slow ~8:30-9 minute pace), and ruck with a 40 lb pack without too much discomfort, and figured I was on the upswing. But since moving over the past few weeks, it's almost impossible for me to run without a severe burning pain, and I can feel the muscles start to tighten after carrying the same ruck with about 20 pounds in it from the front door to my truck.

At one time or another, I've been through the list of non-surgical remedies, and while some provide temporary relief, none have truly "fixed" the problem. Probably has what worked the best in terms of length of relief is Norflex, but at this point in my life, I'd really rather not take a muscle relaxer twice a day to be able to active...

I'm working on getting an appointment with a specialist in town, but in the mean time, does anybody here have any experience with it? The corrective surgeries seem pretty heavy duty, and look like that wold put me out of pretty much anything for at least 6 months.

[PINMAN44]

BJ I have the exact same problem,

It stopped my bodybuilding career. Do you have severe spondy? and if So what area most likely lumbar/sacrum?

and Fyi I wouldnt undergo surgery, back surgery isnt a science and the treatment for spondy is usually fusion of some sorts. If you are going to go the surgery route go with a Neurosurgeon rather than an ortho.

Edited July 6, 2010 by PINMAN44

[Glshooter]

Hey BJ, I'm a chiropractor and am familiar with a spondylolytic spondylolisthesis. My wife actually has that condition. However, a sponylolisthesis is when one vertebrae slides forward on another one. This is usually easily seen on an x-ray or other diagnostic tests. Since your tests were normal, I doubt that is the problem. What led you to that conclusion? I couldn't give you a guess without knowing location and description of your symptoms.

I suggest you see someone other than your PCP. Believe it or not, most PCP's are quite lacking in musculoskeletal training. I am biased toward chiropractors since I am one but you need to see someone with more experience in this area such as a chiro or orthopedist. Let me know if i can be of any help.

Dave

[Chills1994]

b.j. ...aren't you in the Army?

if so...sorry... I just don't put much faith in military docs.

[B.J. Norris]

Dave,

In all honesty, I was throwing a shot in the dark, as we have so far been unable to find anything, and it seemed to match my symptoms and I had taken a fairly hard fall on my lumbar when I was young. After researching some more, I have found that it is easily seen on an x-ray, and with the amount of x-rays I've had, between the military and civilian worlds, it was be crazy to think that somebody didn't catch it. At this point, I will most likely head back to a chiropractor that I saw over Christmas break, who did have an idea what was wrong, and believed he could fix it.

Chills,

I was in the Army when I started having problems, but have since been voluntarily discharged, under a Chapter 11 ELS. When the military docs (well, I say doc, but all I ever saw was a P.A., even at the main hospital), couldn't find anything wrong, my senior DS and I thought it would most likely be for the best, at least for now until I could figure out what was going on. My CO did make sure to code my discharge so it would be possible for me to re-enlist if I desire to do so later, but for right now, I've got fix my back before I can really do anything. I can manage to shoot well, but trying to stay in shape has been a nightmare...

Edited July 9, 2010 by B.J. Norris

[Intel6]

BJ,

I also have sponylolisthesis, it is what put me out of the Army after 10 years of active duty. I have been living with it as surgery is a last resort for me. It has been getting slowly worse as I get older and I have a harder time dealing with it, especially with shooting.

Neal in AZ

[Bear23]

Your MRI's would have picked this up if they were read correctly. I would get copies of your most recent MRI and X-rays and see a Spinal specialist. Either Ortho or a Neurosurgeon. Its usual for any degree of spondylolishthesis to have some disc degeneration and or facet DJD (arthritis), so if your were read as normal i doubt you have any of this. That is assuming they are normal (caveat).

[Alan Meek]

Back in 2004/2005 I developed a real severe pain down my left leg. The pain was so bad I could not walk, sit lie down or even sleep. It was unbearable. I went to my PCP he initially diagnosed it as a tight hamstring. And gave me stretching exercises to perform. That pain then proceeded to get worse with a little from a fellow forum member. (Hey Sterling). And then I was told it was sciatica. The PCP was talking about a herniated disk causing the pain. A trip to the ER and the sciatica would come and go. I did mention to the PCP and the ER staff that back in the mid 80's I fell off a roof of a house under construction and landed on my nail bag with my left buttock. All of them said it had nothing to do with it. A few more years of trips to the ER and then in 2007 I went to the ER one night where an Orthopedic DR was on duty. He discovered that my left leg was 1" shorter than my right and that my left hip was 1" lower than my right hip. He performed a simple chiropractic adjustment and the pain was gone within the week. The next time it returned I went to a chiropractor and in the course of treatments she discovered that my left pelvis was lodged into the tailbone. During the treatments she finally got the pelvis to release and I have not had any pain or recurrences in the last three years. Hmmm, you think the fall mentioned above had anything to do with it.

BJ, talk to more than one and even a couple of different areas of expertise.

Alan

[XRe]

If worst comes to worst, I know a very good physical medicine doc here in Austin - she diagnosed an issue I was having in my hip after a thorough exam. This was an issue that manifested as strange symptoms (including pain in my foot), and confounded several other docs and my chiropractor. It boiled down to an imbalance in my hip stability and flexibility, and was resolved over about 6 months through skilled physical therapy. Point is - finding the right diagnostician for these things is crucial... The diagnosis, in my case, was a strained SI joint - you're having pain in a different area, of course, so not going to be the same type of thing, but it could be that due to some kind of muscular imbalance, you've strained something that's cascaded into irritating other things, etc. Or, you could be having referred pain from somewhere else entirely... It's crazy stuff...

I don't have any idea what your issue is, obviously It sounds similar in some ways to what I went through, though - imaging showed no structural problems, and gave no clues about what might be wrong. Yet, I still had pain - and that pain was exacerbated through certain types of exercise (notably, in my case, hard lateral movement, like the stuff we do with our shooting).

[Dancin Dan]

Back in 1980 I was hit by a car and since then I have had issues with my back both upper and lower.Two years ago after getting to the point of so much pain in my hips, I had three injections at a pain management clinic, did no good whatsoever. I went to a acupuncturist who was also a chiropractor. he started to manipulate my back but I stopped him because, not to say anything bad about chiro's but they have never worked for me, usually they make things worse, my wife loves hers! Anyway he put me on this thing called a true back, the next day the pain was gone. I went back the next week he used it again and gave me the website so I could get my own, which really impressed me. I ordered one and have used it ever since with no pain returning. I would highly recommend one. The website is www.trueback.com. I have recommended them to several people and they have all called me to thank me. Give one a try.

[Jadeslade]

Hi BJ-sounds like a herniated disc. Technical term herniated nucleus pulposus, hnp. Spondylolisthesis is a symptom, not a disease. A good physician can usually diagnose a herniated disc on physical exam if he is good at taking and listening to a history and performing a good exam, including a neuro exam. Xrays are often normal, MRIs can be non-diagnostic. A straight leg test is most sensitive, as is pain with a Valsalva maneuver( bear down like a bm after taking a deep breath and holding it). That said, an occult vertebral fracture (not showing up on Xray), congenital malformation (sacrum fused to pelvis), and other singular issues can lead to the constellation of symptoms you are having. All of these have different treatments. Physical therapy is extremely important, but finding a good physical therapist is like finding a good psychiatrist-very difficult. They will also need a diagnosis before proceeding.

Treatment of a true hnp by surgery gives good results when only a simple discectomy is performed, provided the correct diagnosis has been made. Fusion has not provided any benefit to the process-this has been well documented in the literature. Fusions may be necessary in severe trauma(car accident, fall off roof). Epidural injections have not proven lasting benefit.

By history, both orthopedic and neurosurgery can lay claim to having expertise in the area of surgery for treatment of herniated disc.This was by design. The doctors who wrote the first article(c.1957)on this were next door neighbors in Cambridge, MA. One was a neurosurgeon and one was an orthopedic surgeon at Brigham and Women's Hospital(Harvard Med School). Lots of work has been done since. My feeling is that orthopedic surgeons have a better understanding of body mechanics and weight bearing issues, but there are good back surgeons who are neurosurgeons.

The best way to get to someone good is to ask a surgeon you know-a family member or family friend or someone in your church or town who they would go to if they had to have back or neck surgery. Surgeons have lots of neck and back pain from the position they are in in surgery daily for years. They end up having surgery for back pain (and its related issue of leg, hand, arm, foot symptoms) at a higher rate than the general population.

It can be difficult to get what you need, but just like you found what you needed to do to become a GM in shooting and a Steel Challenge phenom, you will be able to do it. I think your history of trauma is important, and also your shooting activities. Ever picked up a lot of heavy steel targets and moved them around? It is an art to glean the correct diagnose out and get the correct treatment for a particular patient. Be wary of "quick fixes", injections, and advice to "take it easy". What you need is an ortho guy in his sixties or seventies who likes guns and shooting. That will be a doctor who has the experience and who will also understand your issues.

[badchad]

At this point, I will most likely head back to a chiropractor that I saw over Christmas break, who did have an idea what was wrong, and believed he could fix it.

Sure what else is he going to tell you? FYI: http://www.youtube.com/watch?v=6uD_JPtsP-Q

FWIW I think this guys stuff is good: http://www.backfitpro.com/dvd.php

[Glshooter]

At this point, I will most likely head back to a chiropractor that I saw over Christmas break, who did have an idea what was wrong, and believed he could fix it.

Sure what else is he going to tell you? FYI: http://www.youtube.com/watch?v=6uD_JPtsP-Q

FWIW I think this guys stuff is good: http://www.backfitpro.com/dvd.php

Yeah, Penn & Teller are qualified to give medical advice. Get a clue buddy. Read this instead. Its called scientific research.

http://www.becomehealthynow.com/article/chiroed/543/

[Neomet]

Hey BJ. Attempting to diagnose a radicular complaint by the symptomology is almost impossible. The symptoms will give you general clues where to look but that is about it. Very different things can cause similar symptoms The negative MRI and plain films tend to eliminate a fair number of causes but further investigation into a diagnosis is most important. Just as an example I started losing significant muscle mass and strength in my hands. Initially I went through the usual x-rays and MRI route. Minor old guy findings but nothing of clinical significance. I went to my PCP, an ortho, a hand specialist and then finally a neuro who did an EMG (ouch) where we found out my diabetes has resulted in really serious degradation of the long nerves going down my arms. Not exactly my, or my PCP's first guess. Knowing what the cause is we can now understand our treatment choices (or the lack thereof).

My .02 is to focus on attempting to diagnose the problem as opposed to simply trying different treatment modalities. I've got a guess as to what it is but my best advice is to get a better guess than mine from a professional.

Best of luck to you. Pain sucks.

Edited July 11, 2010 by Neomet

[badchad]

Yeah, Penn & Teller are qualified to give medical advice. Get a clue buddy. Read this instead. Its called scientific research.

http://www.becomehealthynow.com/article/chiroed/543/

Penn & Teller are awesome! Lots of "scientific research" on chirobase: http://www.chirobase.org/, managed by a DC and an MD, and their conclusions are about the same as Penn & Teller's. Also P&T generally use experts to help make their case rather than making things up on their own. Heck they even had a chiropractor on their side. You can't have a problem with that can you?

Wikipedia conclusions are largely the same: http://en.wikipedia.org/wiki/Chiropractic#Evidence_basis

Edited July 11, 2010 by badchad

[Glshooter]

Still looking for actual research in your links. Not personal opinion. Nothing like finding 1 moron in a profession and using them as the model. I can post plenty of links from the gun control people that show guns are responsible for every crime on the planet. Doesn't make it true does it?

[badchad]

Still looking for actual research in your links. Not personal opinion. Nothing like finding 1 moron in a profession and using them as the model. I can post plenty of links from the gun control people that show guns are responsible for every crime on the planet. Doesn't make it true does it?

I'm not sure which DC in the video or the various websites you consider to the moron. Maybe the "separation of self guy?" As for studies on chirobase and wiki, just keep reading. After some of the sentences there will be a number in brackets. Wiki was kind enough to make them blue and hot links. You can then find the number at the bottom of the page to find the source, some of which are studies, reviews, books, comments etc. Personally I thought the wiki page in particular made an effort to be neutral.

Funny you would mention gun control, P&T do have an episode where they rip gun control, with a funny (if your not a chiro) dig at chiros in the beginning. Others episodes are on astrology, reflexology, therapeutic touch, etc. So I'm curious if in general you think their show reasonably credible or not?

[badchad]

Also I should mention Stuart McGill, from the backfitpro.com website I initially posted is a spine researcher.

[CSEMARTIN]

B.J.,

If you send me your films, I will get you a free second opinion.

Like a previous poster stated, the problem may not be with your back. A negative MRI is pretty convincing and referred pain is real.....you may have an problem inside your abdomen perhaps?

Clearly, this is out of the league of your PCP. Send me a PM if I can help you any further.

[Jake Di Vita]

My first question is what does your exercise regime look like. I saw you mention you were running and rucking, but that they greatly exacerbate the problem (probably shouldn't do either for the time being). I guess my real question is, how strong are you and how exactly do you train? (Your description does sound a lot like a herniated disc though).

[badchad]

My first question is what does your exercise regime look like. I saw you mention you were running and rucking, but that they greatly exacerbate the problem (probably shouldn't do either for the time being). I guess my real question is, how strong are you and how exactly do you train?

I've got to agree. With few exceptions the exercise program, and one's response to it, is probably more important than the diagnosis (which is often sketch anyway regardless of tests). I'd still send CSEMARTIN your films though.

[VegasOPM]

Back pain is a bitch to diagnose and fix. I have several issues that I have been fighting since I was young. I do use a Chiropractor, but I take my primary medical advice from my D.O. Doctors of Osteopathic undergo very similar training to that of an M.D., but also include osteopathic manipulative medicine. To be honest, you will probably need to talk to several specialists to get significant relief. My strongest suggestion would be to find a Back Pain specialist clinic that includes M.Ds, D.Os, P.Ts and Chiros. Most major cities have a few.

Edited July 12, 2010 by VegasOPM

[Jake Di Vita]

The general consensus from trainers who actually train people with Spondylolithesis is that flexion/extension exercises of the spine such as sit-ups and back extensions tend to aggravate the symptoms while exercises that hold the spine in normal anatomical position isometrically, like squats and deadlifts, are not only fine but necessary for stabilizing the injury. Anything overhead will have to be done carefully, but are still valuable. Form will have to be very good and I wouldn't recommend trying to teach yourself through trial and error, a good coach here is indispensable.

The doctors that recommend the complete cessation of heavy lifting in cases like these are the ones who don't fully understand the bio-mechanics of the structures involved.

If you are one of the majority of Americans whom have never squatted or deadlifted, increasing strength would likely be a good place to start, but start slow.

[CSEMARTIN]

B.J.

Do you feel any better after reading everything that has been posted? Perhaps I am misunderstanding some of the previous text, but it is my medical opinion that an accurate diagnosis be made before beginning a treatment plan.

If the engine of your car were not working properly, would you begin replacing parts randomly?

My offer still stands.

Chris