Spondylolysis/Spondylolisthesis? (lower back pain)

Good luck to those going through severe back issues.

Quote:

---

Originally Posted by old goat

My advice re backs--as a patient, not an expert--is to see a PMR (physical medicine and rehab) doc, also called a physiatrist. They can prescribe the proper PT for your particular situation, prescribe non-surgical methods (epidural steroid injections worked for me, or maybe just time), and advise you when surgery is necessary. I wouldn't start with a surgeon. Surgeons love to operate.

Re yoga, often mentioned in these threads. Yoga hurt my back. See PMR first--learn about what body mechanics make your particular situation better or worse. Than you can figure out which yoga poses to do and which to avoid. To some extent the body does what it needs to do to protect the nerves--by altering posture and stiffening certain muscles. The wrong yoga can undo that. For many back problems, including mine, what MU said--tuck the pelvis (posterior rotation), which is why strengthening the abs helps.

---

quoting for truth, IME. I do not believe my back "issues" are nearly as severe as the OP or others in this thread, but the last severe episode that I had, i visited my GP, who is also a practicing DO (i.e. residency in osteopathic medicine). he sent me to a local physiatrist. By the time I had an appt with the physiatrist, my pain had gone away. we had a consultation and get-to-know you session. following his consultation advice, for me, has worked well for several years (consistent exercise, kelley starett-prescribed running/stretching, posture). I have since used that same physiatrist to recover from a broken foot and related knee issue . The knee/foot issue also introduced me to one of his PTs. Something that has been important to me about the physiatrist and the PT is that they are both athletes, parents, and skiers (one grew up in Olympic Valley and the other in Bishop).

When I was in HS, i got really into mogul skiing. by the time i was in my late teens, i would often have a pretty sore back after a day of bashing bumps, and I had one episode of descending the hill on a backboard after a big huck to flat hardpack landing ass-first (i shit my pants on impact and couldn't sit normally for a few months), which I believe did some undiagnosed damage. i started tele skiing out of curiosity when i was 20, and i've been a full time tele skier for the past 23 seasons. there's a lot more available leg suspension/movement in a tele turn compared to an alpine turn. I still bash bumps and zipperline but on tele skis, and i do not experience the back pain issues. It's something to consider if you need to be easier on your back and still want to ski.

My right leg nerve pain went chronic this month. Excruciating stabbing and aching deep in the leg. Sensitive to touch the skin.

The offender, from Friday’s MRI:
L3-4: Trace retrolisthesis. Likely right paramedian disc extrusion with inferior migration of disc material with stenosis of the right lateral recess. Ligamentum flavum hypertrophy. Facet arthropathy. Mild to moderate spinal canal stenosis. Moderate bilateral neuroforaminal stenosis.
Attachment 375702

I am pretty much immobilized, curling up on the couch when the pills are wearing down. This sucks.

I have been referred to UCSF, but haven’t heard anything yet. I don’t see therapy as an option for a blown out disc that is squeezing my cord.

Damn.

I hope they get you in soon...sounds shitty

Quote:

---

Originally Posted by zion zig zag

For example the first exercise in this video:

https://m.youtube.com/watch?v=4BOTvaRaDjI

Is that flexion or extension?

---

I would think that's extension but not really sure. Good question for your PT, whenever they refer you to one (or if you have one you use already).

I’ve been dealing with back issues similar to many of you.

Compression fracture in L5 after a bad landing off a cliff while skiing in 2004 at 21. A few months of rest and PT followed by my last year of college and an internship at a law firm definitely put me into untrained shape. Next season a fairly “normal” fall caused me to herniate my L5/S1 disc.

This has basically been haunting me ever since. Every few years I’ll get busy at work, sit too much, move too little and I’ll end up tweaking it doing something silly like moving a box or playing Wii bowling (not a joke) and I’ll be laid up for two months while it calms down.

I’m 38 now and hoping to avoid the knife as long as I can although I feel like it’s in my future.

A couple things that helped me: get really flexible in your hips. Lots of time spent talking about hamstring stretching but tight hip flexors and a tight groin are just as bad for me.

My most recent PT also talked a lot about the atrophy of the small stabilizers in my back that big core workout movements had missed. So he gave me a list of small movements and how to isolate those tiny stabilizers. Did a world of difference for me.

Good luck ZZZ. It’s going to suck but I think you’ll get back to a semblance of normal as long as you trust the process and make sure not to rush anything. And switch to wheeled luggage for travel if you haven’t already.

Quote:

---

Originally Posted by zion zig zag

Thanks for the replies so far, it's helping me wrap my head around this. I do have some questions, and I hope they don't come off as obtuse.

1. I assume that my recent pain is from the load I put on it from the shoveling yard work. Did the disc/vertebrae actually slip some more from the state of weakened muscles? Or did I just inflame the old injury? Basically, did I do more long term damage? It's strange to me that the pain didn't come during the act, but a day later doing something trivial.

1a. The radiologists report says that it's stable, does this mean that it shouldn't get progressively worse? Or is that possible and even likely?

2. Why now? I did similar work last summer and fall. I'm guessing this can't be answered.

3. If it's not a new injury and is just inflammation and irritation to an old injury, why would recovery take so long? I was "trained" previous to this latest bout. I would think that once the irritation/inflammation is relieved it'd be back to normal. But no one has said that to me.

4. I can't get into see the recommended PT until end of June. What activities are ok? Is pain my guide here? Hiking with small pack? Smooth MTB trails (although position may not allow this). Pushups, air squats, pullups? Just trying to find away to not atrophy away to nothing and the exercises that I google aren't going to cut it.

5. Any of you carry some high dose pred in you bc kit now in case you have to self extract from somewhere two days in when your back decides to "go out?" Just a thought.

---

FWIW oral prednisone did nothing for my spinal stenosis. Epidural helped a lot. Even if oral prednisone works for you I wouldn't expect it to work quickly enough to turn an evacuation into a walk out. And BTW, don't take it longer than 2 weeks at a time.

Re getting in to the PT--see if your PMR can give you a link or a name of exercises to see online until you can get in. There are specific exercises for specific back conditions.

There is hope for back problems, at least sometimes. I was diagnosed with severe spinal stenosis L4-5 and spondylolisthesis 5-6 years ago, taking Naprosyn and Tylenol around the clock, toes numb, sometimes couldn't walk a 1/4 mile due to pain. I did some PT, had several ESI's, the last a couple of years ago. Currently my pain is zero to mild on no meds. Toes are still numb. Even when I was relatively good I used to have to hike with trekking poles to avoid hard steps down. Not any more. I was on the verge of having back surgery until heart surgery got in the way. (minimally invasive laminotomy, no fusion). I know the problems could come back.

Unless your xrays show an unstable spine the decision for surgery is generally based on the symptoms, not how bad the xray is described.

So the 6 days of prednisone helped quite a bit. Still hurts and I still know that I am limited, but at least I can tie my own shoes now without debilitating pain. Yesterday may be the first day I didn't take naproxen/ibuprofen or tylenol for pain in maybe three weeks? That seems like progress. I'm doing a bunch of different stretches and exercises that I found on google a few times a day, which also seems to be helping.

Quote:

---

Originally Posted by zion zig zag

So the 6 days of prednisone helped quite a bit. Still hurts and I still know that I am limited, but at least I can tie my own shoes now without debilitating pain. Yesterday may be the first day I didn't take naproxen/ibuprofen or tylenol for pain in maybe three weeks? That seems like progress. I'm doing a bunch of different stretches and exercises that I found on google a few times a day, which also seems to be helping.

---

That's great progress, stay with the stretching and light exercise. It will get better

Quote:

---

Originally Posted by GoldMember

I'm going through something like this right now, myself. Sep 2019, lifting an 80 lb package out of the back of my car, something felt wrong. Fast forward, did PT for 5 months, never really got over the discomfort. Talked to my GP (he performed x-rays when first occurred and prescribed PT) and he referred me to Dr. X, a spine surgeon for consult and ordered an MRI. Also spoke to another friend who's also a spine surgeon, Dr. Y. He suggested the MRI as well and asked that I have it sent to him, too for a courtesy second opinion. His last words on it were that, if I wasn't having leg pain, he'd probably recommend I not do anything surgical at this time and keep doing the activities I do (skiing, golfing, mountain biking, hiking, etc.).

Had the MRI last Tuesday, Dr Y asked where I had it, looked it up and texted me this; "Sorry to hear about [a friend who just died of cancer]. How is [friend's father]? You have a degenerative spondylolisthesis at L4-5. Very fixable with a decompression/fusion. You will do great." Not what I was looking for...

Just to share, this is the MRI narrative. Any of you dentists have expertise or experience that would indicate that a fusion is in order? I haven't seen Dr. X yet so don't have his diagnosis but when my buddy tells me that, especially after his initial comments, I'm concerned. The major issue apparently is the "Severe spinal canal and severe left-sided neuroforaminal narrowing at L4-L5. Left L4 intraforaminal nerve root compression." Severe doesn't sound good.

---

I saw Dr X this morning. He checked out that MRI, compared to 09/2019 x-rays, had me get 2 more x-rays from the side showing flexion and extension. He also did a number of leg strength comparison tests, left vs. right, checked reflexes, and questioned me about activities. His bottom line was that if I'm still doing what I do, he's sees no purpose for surgery at this time. "My cure is worse than your disease". He provided a web portal for me to contact him should things change and I feel compelled. Suggested that if Aleve is taking care of any issues, an epidermal injection might be worth doing but since I only take Aleve once in a while, probably not at that point. He just added that I should try and maybe step up my core exercises a bit to help but, all in all, not in too bad of condition and my activity level is very high and not diminished by this so stay the course. Yay!

I can't say it doesn't bother me a bit to think I'll be living with this annoying discomfort but it's pretty manageable so better that I can still do what I like to do and deal with it than to have the surgery and not do as well. I'm pretty happy with his advice.

Quote:

---

Originally Posted by GoldMember

I saw Dr X this morning. He checked out that MRI, compared to 09/2019 x-rays, had me get 2 more x-rays from the side showing flexion and extension. He also did a number of leg strength comparison tests, left vs. right, checked reflexes, and questioned me about activities. His bottom line was that if I'm still doing what I do, he's sees no purpose for surgery at this time. "My cure is worse than your disease". He provided a web portal for me to contact him should things change and I feel compelled. Suggested that if Aleve is taking care of any issues, an epidermal injection might be worth doing but since I only take Aleve once in a while, probably not at that point. He just added that I should try and maybe step up my core exercises a bit to help but, all in all, not in too bad of condition and my activity level is very high and not diminished by this so stay the course. Yay!

I can't say it doesn't bother me a bit to think I'll be living with this annoying discomfort but it's pretty manageable so better that I can still do what I like to do and deal with it than to have the surgery and not do as well. I'm pretty happy with his advice.

---

Good news, glad to hear you aren't going to have to go under the knife for now.

And I'm the same as you regarding it bothering me to live with the discomfort. But, I have to remind myself that I was doing it for four years at a fairly high level of activity. So I really think what's bothering me now is knowing that it is broken. It somehow makes me feel vulnerable and weaker.

Quote:

---

Originally Posted by zion zig zag

Good news, glad to hear you aren't going to have to go under the knife for now.

And I'm the same as you regarding it bothering me to live with the discomfort. But, I have to remind myself that I was doing it for four years at a fairly high level of activity. So I really think what's bothering me now is knowing that it is broken. It somehow makes me feel vulnerable and weaker.

---

Yeah, same here. I've been fortunate to mostly avoid injuries outside of a few broken bones (fingers, thumbs, ribs), meniscus tear, miscellaneous relatively minor injuries that I always knew would heal. With this, there's no healing, no getting it back to where it was earlier in my life. That's the depressing part but, I'll still do what I do until I can't. I've been pretty lucky to this point so really can't complain. Time marches on...

Lumbar Laminectomy with Foraminotomy / Discectomy.

Done by their top dog neurosurgeon.
And I walk out 23 hours later.
That’s the plan for July 15.

Fuck this pain.

Quote:

---

Originally Posted by powdrhound

Lumbar Laminectomy with Foraminotomy / Discectomy.

Done by their top dog neurosurgeon.
And I walk out 23 hours later.
That’s the plan for July 15.

Fuck this pain.

---

Best wishes. Interested to hear how this goes for you.

Quote:

---

Originally Posted by powdrhound

Lumbar Laminectomy with Foraminotomy / Discectomy.

Done by their top dog neurosurgeon.
And I walk out 23 hours later.
That’s the plan for July 15.

Fuck this pain.

---

Amazing what they can train dogs to do these days--and without opposable thumbs. Good luck with your surgery. Fuck pain indeed.

In Dog we trust.Attachment 378710

Make sure to give the surgeon a treat if they do a good job.

Quote:

---

Originally Posted by old goat

Make sure to give the surgeon a treat if they do a good job.

---

Yesterday I had my dura sewn closed.
We tried to see if the CSF leak would seal on its own. Nope. Nonstop headaches.
The new surgeon found a half inch tear at the laminectomy location.
So, I start the whole healing process again. No lifting over 5-15 lbs for 6 weeks, then begin therapy.

I may get to ski by March…

Right now I just want to get out of this bed and go to the bathroom. Soon.

Quote:

---

Originally Posted by powdrhound

Yesterday I had my dura sewn closed.
We tried to see if the CSF leak would seal on its own. Nope. Nonstop headaches.
The new surgeon found a half inch tear at the laminectomy location.
So, I start the whole healing process again. No lifting over 5-15 lbs for 6 weeks, then begin therapy.

I may get to ski by March…

Right now I just want to get out of this bed and go to the bathroom. Soon.

---

Damn, that's frustrating. Here's hoping that you are on the right road to recovery now.

Man, that sucks. Hoping for a late season for you.
CSF leak headaches are the worst.

Update after three years; I did the pt as prescribed 2-5 times per week and stretched 5-7 times per week. Although I pretty much always had some level of discomfort it got to be fairly routine and normal and I was able to live with it. I skied/mountain biked/hiked with packs pretty much as "normal" and rarely felt limited in activities. I would have occasional flare ups that would briefly limit me in someway, but nothing of note, usually a couple of ibuprofen would allow me to do whatever.

And then yesterday....I decided that a 50 pound bag of pea gravel had to be moved right away and apparently I couldn't be bothered to lift it correctly. I pretty much moved it in the stupidest way possible and knew I had fucked up before the bag even hit the ground. Now I can barely get myself off the couch to piss and getting back down is almost unbearable. I'm deep into a bottle of hydrocodone that I found from years ago and started a course of Prednisone today. This episode may be the worst I've had as I never remember wincing in pain trying to walk 5 feet. I'm hoping that the prednisone at least gets me moving again fairly quickly.

And now I know from experience that I'm probably at least two months out from feeling somewhat normal. It's amazing how quickly back pain can take you from feeling like a competent, confident human to feeling absolutely worthless and fragile in a split second.

I can relate. Way overdid it last week. Spent a whole day on my knees sanding and staining a deck. Next day rowed my raft 10 miles down a river that pretty much required constant maneuvering. Then spent a day loading a bunch of construction materials into a trailer, then unloading them, then discovering that they fucked up the order so I had to load them again and bring them back. Then had to spend a lot of time sitting in the car driving across the state and back for my kid's track meet. Bottom line is my back is officially fucked. Tonight I had the most intense painful muscle spasms ever. Which is saying a lot considering I've been managing back pain more than 30 years. Right now I'm afraid to even get out of my chair because the spasms almost make me collapse in a heap. Chiro usually helps but so far I don't think he's figured out what's going on. Gotta get back there tomorrow and try again. This sucks! [emoji31]

Wondering if yall have tried yin yoga at all?

I have never gone to a doctor for my issues but I really jacked up my back/neck/shoulders thru bad posture and tense activities (guitar/computer use, soccer, skiing). This affected everything from my posture to gait, breathing, how my arms lift.

Yin yoga has clearly improved all of the above and I feel better everyday it's stuck to. It's hard to put into words but it feels like I am unwinding my body through it. Every time a breath hits a spot it hasn't in a while, loosening happens. Another huge benefit is that it's possible to use the activities that used to hurt me as tools to further loosen up. As an example, guitar playing would make me tense AF; now I focus on my breathwork while playing. You also learn that everything is connected and how to use those connections to spur gains. An example would be twisted posture from guitar and ankle injuries from soccer. Thru yin I have strengthened these weaknesses, better aligned things and improved balance which affects the entire chain.

The main takeaway from this form of yoga is that stretching is never supposed to be accomplished by painful brute force. Leaning into the breath right at the edge is far more effective, enjoyable and easier on the body. It's ultimately loosening muscles that have learned to stay tense because of my overactivity through oxygen and motion. It's also something that once learned can be done literally almost anywhere and anytime.

This form of yoga is sometimes called restore. If any of yall are in the SLC area and want to check out a yoga class along these lines for free, send me a PM.