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Nathan Elliott
10-06-2003, 11:18 AM
I have found out that I have a phase 1 spondilolysthesis. My L5 vertebrae (the one right above the sacrum) is slightly out of alignment with the rest of my spine due to a fracture or break of some sort that must have occurred in that area of my spine. Does anyone know anything about this type of injury and whether or not I will be able to continue Crossfit? I know that the injury does not require surgery but my chiropractor and dostor said I can't do squats and deadlifts or anyhting of that nature right now. Does anyone know what limitations I can expect from this injury?

John McCracken
10-07-2003, 01:22 AM
Here is a helpful link with some advise, illustrations and exercises for you to discuss with your doctor: http://websearch.mcit.med.umich.edu:8765/querybak.html?rq=0&col=htaz&qc=htaz&qt= Spondylolisthesis&qp=&qs=&ws=0&qm=0&st=1&nh=10&lk=1&rf=0&oq=&rq=0&image.x=11&ima ge.y=14 (http://websearch.mcit.med.umich.edu:8765/querybak.html?rq=0&col=htaz&qc=htaz&qt=Spondylolisthesis&qp=&qs=&ws=0&qm=0&st=1&nh=10&lk=1&rf=0&oq=&rq=0&image.x=11&image.y=14)

For further reading, you may want to go to your local university medical school library and review this article:
SPONDYLOLISTHESIS IN THE ATHLETE
Clinics in Sports Medicine
Volume 21 • Number 1 • January 2002
Copyright 2002 W. B. Saunders Company
R. Lane Wimberly MD
William C. Lauerman MD
Department of Orthopaedic Surgery, Georgetown University Medical Center Washington, DC

Nathan Elliott
10-07-2003, 11:08 AM
John-
Thank you for the information. I appreciate it.

Joe Perez
11-09-2007, 05:36 PM
Your body is your guide. Spondys are not forgiving and will let you know. If something is bothering you stop, develope your core, and go back. If it still bothers you just stop. Ive been dealing with this for several years. It became more of a problem after I took a couple of year off from power lifting. I still lift but am much more cautious. Core training is paramount! My chiropractor said a Roman chair and back extensions are great exercises for athletes diagnosed with spondys. I just bought one and have been using it for a couple of weeks. Back feels great.

Good luck.

Corey Duvall
11-09-2007, 08:40 PM
Joe, Who is your chiropractor? I love to hear that he encourages the Roman Chair... I'm in chiro school but am a bit alone on the front of functional strength here.

William Hunter
11-10-2007, 06:35 AM
Joe, Who is your chiropractor? I love to hear that he encourages the Roman Chair... I'm in chiro school but am a bit alone on the front of functional strength here.

Corey, I'm coming up on 10 yrs in practice, and unfortunately I'll have to say that it gets even lonelier once you're out of school. CF-type thinking may be growing, but it's still quite rare. I encounter many patients who are completely afraid of challenging themselves and re-developing their functional capabilities. Just gotta keep pluggin along.

On another note, why are we responding to a thread that's 4 years old?

John C. Brown
11-10-2007, 09:37 AM
Nathan,
I am going to start this by saying I feel your pain... literally. I have been (for 5-6 years now) diagnosed with the same spondy that you have. I have also had 2 herniated discs (L4-L5, L5-S1) and a fracture of the L5. It happened years ago and was misdiagnosed for a long time. At 22 I had significant sciatica(spelling?) so much so that it hurt to drive. I was told I could have surgery (for the discs) but would be unable to continue in my current line of work (naval special warfare), I wasn't ready to give it up, so I told them to F off. I dealt with the pain for several years after that, and they told me the same thing, no DL, no squat etc... After starting a powerlifting workout that I found in(can't believe I am admitting this) Muscle and Fitness, I found that the only relief for the pain was Deadlifting and squats. A few months later I found Crossfit, and have been doing the program for about a year and a half or so. I don't have back pain anymore, and I think (and have had this theory substantiated by my wife, a physical therapist, and avid crossfitter) that since I made the muscles that support the joints stronger they were able to pull the spine vertebral body back into place, relieving tension from the nerve. I have not backed this up with x-ray/ MRI evidence, but I may do that for school now.

I AM NOT A DOCTOR AND AM IN NO WAY TELLING YOU TO BLOW THEM OFF. What I am saying however, is that I feel that if you deadlift correctly, making sure that the erectors are fully engaged and holding the back straight and the vertebra as a single unit, that that may be one of the better and more functional way of getting healthy. As far as the Doctors telling you to not deadlift, woe unto you if you are ever placed in a situation that requires you to lift a weight off of the ground and you haven't prepared yourself.


I'M dumb, who dug this up and made me help myself look stoopid:-)

Joe Perez
11-10-2007, 07:13 PM
Corey,

My chiropractor is Dr. Matt Janzen of "Janzen and Janzen Chiropractic." His office is in Campbell, California. Frank Shamrock and other MMA guys go there. I've been told he sees alot of cross fitters also.

Keep in mind he does not endorse any squating and/or dead lifts. I experienced the same situation as John Brown. My back feels great when I dead lift and squat. However, according to the doc I'm putting unnecessary stress on my spondy and exposing my condition to further slippage. Dr. Janzen said those exercises stimulate the muscles around the lower back eliminating any 2nd hand effects (spasms etc). The long term still exist.

Believe it or not, I still squat once in a while. Did heavy barbell thrusters yesterday and had a flare up today.

Good luck. Please pass any info to help us "handicapped" crossfitters.

Steven Bourdage
11-11-2007, 09:11 AM
Im a chiropractor and i also have a grade I spondy. I still deadlift and squat...from is key as is having a strong core. There is no research that shows a grade I will progress to a grade II and beyond from physical activity. If there is research showing this id love to be enlightened because i have not seen it.

Keep your core strong, stay limber and flexible, and keep your form tight. There will be times of flare ups, it cant be avoided...just use those times as a learning experience. What caused the flair up? how could you better deal with it next time? etc, etc...

Christopher Dunkin
11-11-2007, 08:05 PM
was looking for a thread on shoulder dislocation, but since i noticed the spondy talk i thought i'd let you know my situation. i to was diagnosed with grade I spondy of the L5, and fought the pain for about 2 years. i was lifting at the time (chest/tri's, back/bi's, legs and shoulders) and the pain just kept getting worse. i never took any meds for the pain, but did take the doc's advice and started swimming with a masters team, but the pain never went away. the sciatica got so bad that i actually fell a couple of times; legs would just give out.
the thing that worked for me was rolfing. real, hardcore, rolfing. the kind that makes your eye water. after the first session i had no more pain. i withheld judgment of any kind for 3 months, but after a year and a half i was still pain free. after a year and a half i angered the spondy again doing some dl's, but i recovered with no pain in about 2 weeks. i've been cf'ing since april, and doing the wod's as rx'd for 3 months, and even though i feel it every once in a while it is far from debilitating, and i fully recover within a couple of weeks.

Joe Perez
11-11-2007, 11:25 PM
Steve,

How does a spondy progress?

Thanks.

Steven Bourdage
11-12-2007, 09:55 AM
From my understanding and my experiences they don't progress.

I have heard the debate that a car accident or another similar major trauma MAY cause furthur slippage.

Kelly Brown
11-12-2007, 11:20 AM
John's wife the PT here.
Spondys do progress if abused. Please understand that. It is important. Spondylisthesis is a bilateral (meaning both sides) fracture of the pars interarticularis which is part of the posterior structure of the spine (the part that creates the tunnel for your spinal cord to run through - this should be a red flag). When you have a bilateral fracture it means it is possible for one vertebra to slide forward on the other because the only thing preventing complete slide is the connective tissue at the disc itself. That tissue is not designed for controlling translation and will give over time if continually or rapidly overstressed. The usual instigator is aggressive/excessive back extension. I am sure you could also do it with loaded flexion, as in a deadlift without maintaining the lumbar lordosis. A grade I spondy means there is some movement but it is still stable. Grade III means you are at significant risk for damaging your spinal cord ( this means possible paralysis). You can also have a spondlylolysis which is a unilateral fracture which does not allow translation and means your spinal cord is not at significant risk. All the above conversation about needing core stability is correct. If you are a grade I and you have very good core stability and very good form you are probably fine to do whatever you want (I would avoid high velocity back ext on a GHD, though). I see no reason not to squat if you do it right.

The most definitive sign that you are no longer a grade I is if you start having any neuro signs (numbness, tingling, shooting pains down your back or legs). Pain would also be a good reason to stop. But I am sure you know this already.

William Hunter
11-12-2007, 03:29 PM
Whoa.

I think before this thread goes any further we should all agree on what we're discussing, and make sure the vocab is understood.

My textbooks, old as they are, define Spondylolisthesis as the anterior (forward) displacement of a vertebral body in relation to the segment immediately below. Spondylolysis is an interruption of the pars interarticularis, which may be either unilateral or bilateral. There can be (a) spondylolytic spondylolisthesis, or (b)nonspondylolytic spondylolisthesis. (b) would not involve a defect in the vertebral arch, and subsequently be far less serious of a condition. An example of nonspondylolytic spondylolisthesis would be degenerative spondylolisthesis, which could involve facet joint arthrosis, disc degeneration and whatever remodeling processes that are likely underway. I think these can slowly get worse over time.

There. That should be as clear as mud.

John Tuitele
11-12-2007, 08:55 PM
Nathan,
I am going to start this by saying I feel your pain... literally. I have been (for 5-6 years now) diagnosed with the same spondy that you have. I have also had 2 herniated discs (L4-L5, L5-S1) and a fracture of the L5..........

A few months later I found Crossfit, and have been doing the program for about a year and a half or so. I don't have back pain anymore, and I think (and have had this theory substantiated by my wife, a physical therapist, and avid crossfitter) that since I made the muscles that support the joints stronger they were able to pull the spine vertebral body back into place, relieving tension from the nerve. I have not backed this up with x-ray/ MRI evidence, but I may do that for school now.

I AM NOT A DOCTOR AND AM IN NO WAY TELLING YOU TO BLOW THEM OFF. What I am saying however, is that I feel that if you deadlift correctly, making sure that the erectors are fully engaged and holding the back straight and the vertebra as a single unit, that that may be one of the better and more functional way of getting healthy. As far as the Doctors telling you to not deadlift, woe unto you if you are ever placed in a situation that requires you to lift a weight off of the ground and you haven't prepared yourself.


Given that statement, this video of John is all the more impressive and worth serious consideration.....
http://media.crossfit.com/cf-video/CrossFit_BWx15OHS.mov

Yes, it is family and work safe, even if it is from CF's website.

Kelly Brown
11-12-2007, 09:30 PM
Whoa.

I think before this thread goes any further we should all agree on what we're discussing, and make sure the vocab is understood.

William

Indeed, that is a very impressive use of your Orthopedics textbook. And yes, technically, a spondylolysis can be bilateral or unilateral.. but a bilateral spondylolysis will inevitably become a spondylolisthesis if proper care is not taken... which I believe is the intent and purpose of this thread. So fancy words with lots of syllables aside, CrossFitters, like all other human beings, should be extra careful about form if their diagnosis begins with "spondy" anything.

William Hunter
11-13-2007, 05:48 AM
William

Indeed, that is a very impressive use of your Orthopedics textbook. And yes, technically, a spondylolysis can be bilateral or unilateral.. but a bilateral spondylolysis will inevitably become a spondylolisthesis if proper care is not taken... which I believe is the intent and purpose of this thread. So fancy words with lots of syllables aside, CrossFitters, like all other human beings, should be extra careful about form if their diagnosis begins with "spondy" anything.

(Sigh) This is why I shouldn't post much. I generally suck at it...

Kelly, I can only assume by your internet smackdown that I offended you with that post. That was really, really, really not my intent. I apologize sincerely.

You made an excellent and informative post. The only phrase that really threw me off was "Spondylisthesis is a bilateral fracture". I've been under the impression that a spondylisthesis could occur from purely degenerative factors, and that you add the spondylolysis term to denote the pars defect/fracture. Am I incorrect here? Also, I've never used the spelling that you used and that also confused me.

Your recent post about CF'rs as well as everyone else taking caution with a spondy dx I agree. However, like your husband has so ably proved, exercise can be powerful medicine, and many pts refuse to engage their core musculature b/c of fear.

And, in the spirit of full disclosure, it was a radiology textbook, not ortho :)

Corey Duvall
11-13-2007, 07:32 AM
Chris, I am going to have to advise against you doing something that causes pains to occur for weeks out. It would be my guess that you are doing things incorrectly resulting in pain. Get your form checked and keep that under control. A nasty butt-wink or rounding of the back on a deadlift can be very dangerous, esp with an already established spondylolistesis.

On an interesting side note... in Craig Liebenson's "Rehabilitation of the Spine" (2007) they state that prevalence of a spondylolysis (pars fracture) is up to 7% in the asymptomatic population and spondylolisthesis (sliding of one vertebrae relative to another) is as much as 8% in men and 5% in women and can be totally asymptomatic. For that matter, studies also show that degenerative changes (degenerative joint disease, classically known as arthritis though that is an out-dated term) and disc bulges/protrusions are also present in the asymptomatic population.

Perhaps the pain is not necessarily due to the damaged/misused tissue, but instead to the actions that caused the damage/misuse and once those actions are ceased or corrected, the pain disappears as well. Note: this is not taking into account structural changes that will compress nervous tissue, such as osteophyte encroachment or stenosis.

For those of you with diagnosed spondy's or DJD and have worked on stability and continued, let pain be your guide and keep working hard.

Jared Buffie
11-13-2007, 09:42 AM
Kelly,

William was just trying to clarify. Here's why:

You said:

"Spondylisthesis is a bilateral (meaning both sides) fracture of the pars interarticularis which is part of the posterior structure of the spine"

You were wrong. Spondylolisthesis is the anterior slippage of one vertebra on another for whatever reason. Yes, it could be due to fracture (identifiable on a lumbar oblique film), but also due to congenitally elongated pars.

I hate to say "typical PT", but....

Kelly Brown
11-13-2007, 01:24 PM
William-
Thanks for your thoughts. I apolgize for my barbed retort. I also should not respond to posts after a long day of work and chasing a very busy 18 month old. I am glad that we straightened that out:) Also, I suck at spelling.

Jared -
You, my friend, are trying to be nasty. I am not sure of your profession or background, but criticizing mine doesnt really seem productive. The silly thing about this whole thing is that these disagreements are about technicalities (which I glossed over because I got the impression that the people asking the questions were not as versed in all of this and therefore that level of detail would only prove confusing... ie William's previous post that started this whole little discussion.) I am very aware that there are many in my profession that are living in the dark ages. That is true with all areas of medicine and these progressions take a long time. I am no where near one of them, and if you had actually read anything I wrote you would see that this is true. I am sorry you hold such poor opinion of PTs and I truly hope you never incur an injury that requires our services.

That being said. I am opting out of this dicussion and all others related to injury. I naturally gravitated to it becuase that is what I deal with all day long. And I was truly concerned that some folks were at risk for hurting themselves. However, if this forum is just a chance for medical people to try and make eachother look stupid, I have no use for it. Best of luck to all you "spondys" that were just trying to get some help. Be safe. Be strong. Try and stay out of my office :)

Joe Perez
11-14-2007, 11:43 PM
Thank you too all who added to this posting. This is the most I have learned about my condition (I'll just call it a "spondy"). However, I need more information. Kelly, please add your "opinion".

What are some treatments available when a spondy flares up?

Mike Rogers
11-15-2007, 07:44 PM
Great topic!!!

I have been suffering Spondylolisthesis for years. After seeing 2 different chiropractors and my doc, the key to reducing flair ups seems to be developing a strong core. I also stretch daily after my body has warmed up. One of the docs told me that stretching first thing out of bed is bad for this condition because the vertebrae have not had a chance to compress. Not sure if there is any truth to this but I seem to be more flexible an hour after waking up. I have also found that the more inactive I am, the better chance I have of a flair up. A few years ago I was taking 2 forms of martial arts and when I first started my back would bother me. After a month there was no pain.

I am very interested to hear other peoples ideas and ways that they deal with this.

Crissy Seamster
12-09-2007, 10:30 PM
Not sure if this thread is still going, but I was trying to find other people that have what I have. There isn't much out there it seems.

I tried to find my back surgeon paperwork, but can't. I do remember him saying I had a grade 1 spondylolisthesis, and that mine was genetic, that part of my bone was missing and causing it to slip. My sister has it too, and my dad said him and his brothers all have it.

I've dealt with back pain since I had a wreck when I was 19. I'm 33 now. Went to a chiro instead of a doc (not smart) off and on for 10 years. they never knew I had it even though they did xrays. when I was 28 I had such a bad episode of pain that I couldn't move, and was stuck in the bed for I don't know how many weeks. I could barely crawl to the bathroom. had an mri done and saw a back surgeon. He told me I had 2 disc buldges, disc degeneration very bad in the lower lumbar area, and the spondylolisthesis. He said he couldn't tell me what was actually causing me the pain, could be all three. He told me I'd have to have surgery by the time I hit 40. I thought he was joking. nope.

That was 5 years ago. So, after that I went to P.T. I'm very glad for that, it really helped a lot. I wouldn't recommend traction though. was very painful at even the lowest setting for just 1 minute.

I also learned that the really tight feeling that's just so bad and hurts is caused from the inflammation. Inflammation causes pain. it's your body's way of telling your cells.... 'hey, we need help over here!' Inflammation is a good thing that your body does, like a fever, but it's definitely not good when it's chronic. So it's very important for your back and your health to be in control of it. Everyones already talked about how important stretching and building your core so I won't talk about it.

Dealing with inflammation...I'm not one for taking drugs, so please don't just use advil and muscle relaxants and stuff. they aren't dealing with the problem, and/or they have side affects, like stomach bleeding:advil. What I did find about 3 years ago was a product called Celadrin. I used that instead of the advil, and I can really say that it prevented me from having a major relapse again. It's just esterfied fatty acids which is a natural anti-inflammatory. I took that for 2 years. You can find it in most healthfood stores, or online. although I think some brands are better than others.

However, I have switched from Celadrin to another product earlier this year called MonaVie. It has esterfied fatty acids in it also, as well as the acai berry that has anti-inflammatory properties itself. I really found it to work better than the Celadrin. this summer I was even carrying 40 lb bags of dirt, painting my house, and doing lots of stuff I wouldn't have ever done before for fear of a relapse. So I'm really excited to see how I'm doing by next year.

I hope that everyone is able to deal with their spondylo problems effectively. I've been "disabled" I don't know how many times because of my back during my 20s... and I'm a healthy slim woman but I still suffered like I was diseased or something. So I totally understand how frustrating and painful it can be.

Joseph Shreckhise
12-18-2007, 04:37 PM
I was diagnosed with a spondy as well and was told not to wrestle anymore. This was about 4 years ago before my senior year in highschool and I am now approaching my fourth year as a college athlete. Great advice in the previous posts, core strengthening has been very beneficial but be cautious not to hyperextend your back. Also focus on keeping your pelvis tilted (as to keep your low back flat to the floor when lying down) when doing abdominal exercises and in your general posture. I would think you could get some injury specific core exercises from most any physical therapist. Good Luck!