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.

Why You Are Having Leg Numbness

“I’m having numbness down my leg and no one seems to know why!” she barked out frustratingly over the phone.  I hear similar complains from high level athletes and desk jockeys almost on a weekly basis.

80% of the population suffers from low back pain within their lifetime and numbness or pain down the leg is a common symptom.  Finding the reasons for the nerve involvement is almost as difficult as treating this injury.

Bulging lumbar disc, herniated disc, bone spurs, spinal stenosis, scar tissue, piriformis muscle syndrome and nerve entrapment are just a few of the possible sources of leg numbness.

Understanding Leg Numbness

If you have static on your home telephone, where could the problem be located?  Your puzzled look is justified.  The truth is that the “lesion”, as we say in sports medicine, can be in the headset of your phone, the wire going to the wall, the jack in the wall, the wire in the wall, the connection on the telephone pole, on and on.  The truth is that the source of the problem could be anywhere between your ear and the microphone in the phone of the person on the other end of the phone call.

Although the distance is significantly shorter, much of the same can be said about the numbness down your leg.  The pressure on your leg nerve can be located anywhere from within the spinal cord to within the leg itself.

It’s important for the readers to understand that when pressure is placed on a nerve, typically the initial symptom is numbness.  If greater pressure is applied to any part of a nerve and more of the inner nerve is impaired, leg pain and weakness in the pattern where that nerve travels can result.

This is the reason why a doctor will implement a variety of tests including reflex tests, manual muscle tests, pin-prick tests and range of motion assessments while comparing each of the results to the opposite leg.  Understanding the exact type and location of the symptoms is the first step to determine where the lesion is located and, ultimately, how to treat the leg numbness.

Signs & Symptoms of Leg Numbness

  • Numbness and/or pain can extend anywhere from the low back to the toes.
  • Low and mid-back spasms often accompany leg numbness.
  • A sharp “stabbing pain” in the low back region can initiate symptom.
  • can be initiated by a sharp “stabbing pain” in the low back region.
  • The intensity of the symptoms and even how far down the leg the numbness travels is often worsened with prolonged sitting and with the transition from sitting to standing.
  • A sense of hip and leg weakness is common with leg numbness related to nerve pain.

Professional Treatment for Pain Down the Leg

  • Contact your orthopedic physician for a thorough exam.
  • Get off your feet as much as possible to decrease the pressure on your lumbar spine and associated nerve structures.
  • Lying on your back on a firm surface with pillows under your knees is often the best position to rest and sleep.
  • Low back massages, PAINFREE hamstring stretches and lumbar icings will help to minimize localized spasms and pain.
  • While lying on your back with knees bent and feet on the floor, slowly use your arms to pull each knee to your chest while exhaling.  Alternate each leg for 5 reps then 5 reps with both legs together while keeping your head and shoulders relaxed and resting on the ground.
  • Progressive crunches with firm exhale with your feet on the ground along with no low back pain or any increase in leg numbness.
  • Strong emphasis on core stability, hamstring flexibility, sound body mechanics and maintaining a lordotic (sway-back) curve position of the lumbar spine with all activities.
  • Progressive return to activities while avoiding setbacks that would initiate the pain>spasms>more pain cycles.

Asking the Questions a Pro Athlete Would Ask

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 is the source of my leg numbness?
  2. Can you show me on a model or picture exactly what my low back looks like and what is contributing to my leg numbness?
  3. Do I need to have an MRI to determine the status of the discs in my lumbar spine?
  4. Am I at risk for permanent numbness and/or weakness in my hip and lower extremity?
  5. Do I need surgery or can I avoid surgery with a very aggressive low back therapy program?
  6. In your opinion, who are the best low back physical therapists in town?

Elite Sports Medicine Tips from Mike Ryan for Leg Numbness

  • No Low Back Pain? – With leg numbness, the actual low back pain may be minimal.
  • Centralization – Simply stated, the less numbness/pain in the leg the better.  The farther the symptoms extend down the leg, the greater the pressure on the lumbar nerve.  That’s not good.  Centralization is when the pain moves out of the lower extremity and into the lumbar spine.  That’s better.
  • Disc 101 – Only the outer rim of the disc has nerve fibers so if you’re damaging them, you will never know.  Avoid a slouched posture and keep the curve in your low back and your discs may be nice to you.
  • Un-Clear Mechanism – Sometimes it obvious but often pain down the leg “just happens” and it will take a specialist to determine why.
  • Take The Blinders Off – Look at the big picture.  Hip injuries, poor sleeping surfaces, childhood injuries and bad shoes can all be reasons for back injuries so step back and evaluate all the factors.