Tag: pars defect

What to Do When Suffering from “Damn Back” aka Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. Learn how to fix that “damn back” problem.

Understanding Spondylolysis

Spondylolysis is a condition created when a localized fracture of the bony arch, referred to as the pars interarticularis. This injury is most commonly located in the lumbar spine. This stress fracture is usually do to excessive force or repeated strain. This low back injury is typically found unilateral and if it becomes bilateral, it can easily progress into spondylolysthesis, characterized as having bilateral fractures and a forward “slippage” of the body of the vertebral spine.  An injury to the pars interarticularis is often referred to as a pars defect.

Young athletes participating in sports which involve contact, backward bending and aggressive rotation such as football, wrestling, martial arts and gymnasts are more succesptable to suffering this type of a back injury.  A comprehensive history is needed to determine if past activities contributed to the current low back pain. Obtaining lumbar spine x-ray, CT scans or even MRI may be required to confirm the diagnosis.

Signs & Symptoms of Spondylolysis

  • Pain and stiffness located at the center of the lower back.
  • An increase in symptoms with backwards bending or lumbar extension.
  • Patient notices an increase in symptoms with an increase in activities and an decrease in symptoms with rest.
  • With more severe cases of spondylolysis, the patients can experience pain radiating down one or both legs which is referred to as neurogenic pain.
  • A localized ache or stabbing pain involving the central low back region following prolonged standing or sitting.
  • If nerves are involved, there may be a decrease in lower extremity reflexes and/or the sensation of pins and needles in the low back, hips or legs.

Professional Treatment for Spondylolysis

Treatment of symptoms from these stress fractures are often accomplished in 3 general steps.  Initially, the low back is “quieted down” followed by efforts to improve both the core strength and core flexibility and lastly, returning to normal activities with a comprehensive education of the “Do’s and Don’t’s” to avoid any setbacks.

  • Implement an aggressive flexibility plan focusing on the low back, hamstrings, quads, groins and hip flexors.
  • Using a low back brace if needed to stabilize the lower back and pelvis during functional activities.
  • Initiate a progressive core stability program that addresses functional abdominal strength and endurance while training the trunk and pelvis to avoid excessive lumbar extension.
  • Continue to apply ice to the entire low back while resting on a firm surface with a pillow under your abdomen.  Only when the main symptom is “stiffness” should heat  be used.  The heating can be utilized via a hot tub, heating pad or hot packs.
  • Postural training to promote a painfree posture involving the pelvis, low back, upper back, shoulders, neck and head.  All of these areas have a direct impact to the lumbar spine and the pars defect.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Avoid all activities and positions that promote hyper-extension of the lower lumbar spine.  This “sway back” or lordotic curve is normal and necessary but when it becomes excessive and the pelvis rolls too far forward, that’s when spondylolysis becomes painful.
  • Slowly progress with low back strengthening exercises such as planks, bridges, Superman exercises, balance drills and proprioception exercises.
  • In extreme cases where non-surgical treatments becomes ineffective, a surgical laminectomy or posterior lumbar fusion is considered.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. How bad is my back injury and do I have spondylolysis or spondylolysthesis?
  2. Can you show me the “Scotty Dog” view on my x-ray?  This is a key view on an x-ray of the lumbar spine used to confirm the diagnosis for and the difference between spondylolysis and spondylolysthesis.
  3. How can I alleviate the pain I’m currently experiencing without causing further injury to my back?
  4. What activities and exercises do I need to avoid while I rehab my back to significantly improve my back function?

Elite Sports Medicine Tips from Mike Ryan

  • Stick to the Plan – Your specific physical therapy program is individually planned for you. The program may take weeks or months but stick to the plan to ensure an optimum recovery.
  • Balance is the Best –  Your goal is to attain the perfect combination between strength and flexibility of your paraspinal and abdominal muscle groups.
  • The Nasty S Word – Sitting may be easy to do but it can destroy your low back.  Learn to sitting properly and do as little of it as possible.
  • Body Mechanics is Key – As with sitting, poor body mechanics with standing and lifting will hurt your back very quickly.  Become a believer in that and you will quickly get back to an active lifestyle.
  • Become The Ab King – Flexible low back muscles with strong Abs is the winning combo with spondylo.
  • Know the Good C Curve – With standing and walking, the “C” curve of your low back has it’s opening facing backwards.  Strive to maintain the “Good C Curve” and your back will thank you.

The Slipping Back Problem of Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The lumbar spine accepts a majority of the weight bearing stress. Because of this important role, it the most susceptible level of the spine for this type of an injury. Learn how to stand up straight against Spondylolisthesis.

Understanding Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The term was coined from its Greek root words, spondylo + listhesis which means “vertebra” and “to slip”, respectively. Hence, the particular description of this injury when one of the spine bones slips forward over the one below causing a mechanically motivated inflammation involving the surrounding bone, capsule, ligaments and nerves resulting in pain and limitations.

The lumbar spine accepts a majority of the weight bearing stress.  Because of this important role, it the most susceptible level of the spine for this type of an injury. There are two major causes of this disorder observed in a specific group of people.

For younger adults, slipping of the 5th lumbar vertebra occurs because the vertbraes of the spine tend to sit in a forward direction over the sacrum.  Meanwhile gravity applies a force which increases this forward slippage of the vertebral body.  Another factor is the type of sporting event.  Activities that increase the extension of the lower back can easily result in a stress fracture of the bony ring of the lumbar spine.  When this fracture present with no slippage, it is referred to as spondylolysis.

Signs & Symptoms of Spondylolisthesis

  • Low back pain and tenderness which increases with lumbar extension or twisting.
  • Pain and stiffness which can involve the buttocks area.
  • Tight feeling in the hamstrings region or weakness on the thigh and/or leg.
  • Walking accompanied by  a back and forth shifting shuffle pattern.
  • Slowed lower extremity reflexes.
  • With serious cases, difficulty controlling bowel and bladder functions.
  • Sudden weakness and poor voluntary control of abdomen muscles.

Professional Treatment for Spondylolisthesis

  • Rest on a firm surface in a non-weight bearing position, which completely eliminates the symptoms.  This is usually most effective in a supine (face-up) or side lying positions with pillows placed behind the knees.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • A core stability program targeting your functional abdominal strength and endurance along with enhancing trunk and pelvis control.
  • Always avoid all positions and activities that increase lumbar hyperextension, the #1 enemy of spondylolysis and spondylolisthesis of the low back.
  • Wearing a low back brace or corsets may be a smart option for players with a weak core and/or pain with prolonged sitting.
  • Rehabilitation therapy is recommended to minimize activities causing extension pressures at the lumbar vertebrae and to build up your muscles promoting an antilordotic posture.
  • An optional form of treatment for chronic suffers is an epidural steroid injection (ESI).  ESIs is a potent anti-inflammatory injection which helps to reduce pain and swelling. This type of treatment is only considered with advanced cases or when physical therapy is not completely effective.
  • In severe cases where the lumbar slip is causing abnormal walking patterns, loss of control in bowel or bladder function, or simply a worsening condition, surgery may be required. Surgical procedures may include laminectomy, posterior fusion with instrumentation or posterior lumbar interbody fusion.
  • Employing updated physical therapy modalities are also provided to decrease pain and reduce swelling. Treatments of heat, cold, ultrasound, and electrical stimulation may be used to reduce pain, enhance painfree motion and minimize muscle spasm.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What part of my spinal vertebrae is responsible for my pain and limitations?
  2. How important is my core strength to my recovery?
  3. What condition would require wearing a rigid back brace?
  4. Do you think I will eventually need surgery to fix my spondylolisthesis?
  5. When I’m painfree, what preventive steps I should take to avoid a recurrence of this injury?

Elite Sports Medicine Tips from Mike Ryan

  • Go to the core of the problem: Exercises such as planks, pelvic tilt and crunches focus on strengthening core core muscles.
  • Prevention is always the better alternative: A pre-existing bilateral spondylolysis can easily develop into spondylolisthesis.
  • Aim for the right angle: Keeping the spine healthy requires consitent changes in posture.  Movement helps the spine promote circulation and reduce muscle fatigue. Sitting for a prolonged period eventually will make a even a healthy low back unhappy.
  • Get ahead of your game: As you make progress, progressively advance into functional strengthening exercises that get your core, trunk and lower extremity ready to get back in the game!