T Nation

Lower Back Injury - Spondylolisthesis


#1

I have a spondylolisthesis, i can’t do deadlifts and squats, so it`s a big problem for me.
Can it be cured? Will I be allowed to do heavy squat and deadlits someday??

I went to physiotherapist and he said me: "This can not be cured, the end with the weight"
I depressed by this injury.

What do you think about it?


#2

there is a book “the gift of injury” of dr mcgill, i think it can help you.amazoon sell it


#3

McGill is a good author and has some very good stuff so I second reading his stuff (though I am not familiar with that title). Also consider treat your own back by Robin McKenzie (I am a Diploma level certified McKenzie therapist). I am a PT (and have been for 21 years), I also have a 30 year history of LBP myself). You need a new PT because although what they said is true (actually it’s not even, because surgery can “fix” it but that’s a whole other conversation) it is only part of the equation. You would be amazed at how many people have asymptomatic spondy’s. Why that therapist would even put that thought in your mind is beyond me (were they young?). What we say to patients can have a marked impact on clinical outcomes. Furthermore, a lot of times the “spondy” is a just a radiographic finding and the actual pain is caused by a disc issue, not the spondy itself.

Do yourself a favor and find a McKenzie certified provider (usually a PT) and have a good eval done (Mckenzie MDT.org > find a provider). I have seen many patients with spondy’s and many have done well. Of course strengthening and some modifications will be required but at the end of the day a lot times it is poor postural habits and the loads you are putting on your back (in or out of the gym) that are more responsible for the causing the pain than the injury or abnormality itself. Sometimes some simple repeated motions can “set things right”.

Do a google search for “abnormal MRI findings in normal people”. You will likely be amazed, or at the least entertained in the results. It’s staggering actually (I have a study right here on hips and of 45 volunteers with no history of hip pain, issues, or injuries labral tears (the cartilage - often repaired with surgery) were found in 69% of the participants - Register, B. (2012) Am J Sports Med "prevalence of abnormal hip findings in asymptomatic…) . I have seen studies where people had herniated discs with fragments floating free and pressing on nerve roots and this was in people with no history of LBP!

Don’t get all hung up in it being just about strength either. I was deadlifitng in the 400’s and doing crunches with a 45 plate on my chest and still had back pain. I’m not saying strengthening won’t help or isn’t needed, but there are a lot of other variables that need to be looked at. The things I did that affected my back pain in the most positive manner had zero to do with strengthening exercises.

Find a a good PT and educate yourself :).


#4

That sucks bad mane. Don’t lose hope tho. Definitely get in the gym and do what you can even if you have to bargain with whichever health professionals are seeing you. Even if its just benching or light weights or something it’ll make you feel much better which is super important at a time like this where the tendency is to be feeling a bit down.

If you haven’t already I’d recommend thoroughly reading up on what Spondylolisthesis is and clarify with your physio, doctor or other medical professionals exactly what kind you have e.g. looking at medical imaging such as X-Rays together.

While I wouldn’t go so far as to doubt or dismiss what your physio has found or said, nor would I be going on nothing but hope and chance that the actual source of your symptoms is something else (hopefully with better prognosis and outcomes).

However the “No more lifting for life” thing sounds a bit extreme unless your physio has X-ray vision and magical diagnostic powers so they could determine the severity of your injury. Depending on the grade of your injury things could be looking nowhere near as bleak.

Low grades usually get return to sport once symptoms are managed while high grades get advice to avoid certain activities to not make things worse. If your physio hasn’t explained to you how severe your injury is and why they’ve made these recommendations I’d ask them to clarify. If they can’t its time for a second opinion elsewhere and a proper diagnosis.

Seek out second opinions, from other physios and medical professionals and make it clear that you wish to return to your sport i.e. lifting.

Am curious because you’ve actually not mentioned anything about it but what kind of problems is your lower back injury causing? How bad is it? Since when? How is it affecting you in the gym and outside during daily life?

If you’d put stuff like constant debilitating back pain and other symptoms with loss of bladder control in the original post I think this becomes a different story lel.

Some helpful stuff especially on rehab/prehab and coming back from injury and preventing recurrence.

Brian Carroll’s return from injury was awesome to say the least, almost as awesome as his powerlifting career, but among his extensive list of back problems including a broken sacrum, multiple endplate fractures, , degenerative disc disease, stenosis, tons of arthritis and herniated discs at L4-L5 and L5-S1, spondylolisthesis is not on that list. Certainly not a high grade injury at least.


#5

This is the crux of it, but there is more to it. Look, we all have to start somewhere and the truth is experience matters. Not all PT’s get the same education in school, and after that forget about it, it gets wild. Post graduate training is all over the map. I can take a geriatric course (even though I do Orthopedics and that still counts as my con-ed for the year). I can’t recall the exact study but it showed less than 40% of PT’s actually go on the take continuing education they are responsible for (ie. not just sit in some class for 3 days and collect a certificate but actually test out and get some post graduate certification for showing you know the material). The other thing is imaging. Did they do flexion and extension films (ie. actually test the stability), or was this recommendation being made solely on a static MRI or plain X-Ray? I can think of one patient I saw with a Spondy and the Surgical PA told her they could guarantee a 100% successful outcome with surgery. Ended up that she had kidney stones (and that was the main cause of the LBP she was having) and when they compared her current MRI (after the onset of pain) to an old one (when she didn’t have that specific pain) the Spondy had not changed at all!

Get educated on the matter, and varied opinions. I’ll be honest and say at times I want to not be associated with the healthcare industry because of the nonesense I hear about every day in the clinic. Patients seen for no time at all, a wave of patients in and out on the hour like some sort of cattle drive, clinicians not actually listening to what the patient is saying and just running on their clinical bias’, patients barely supervised (if at all) by techs and not even licensed providers.

My opinion is you should see results, if not day one, within 3-4 weeks tops. Please don’t be one of those patients that works with someone for months on end but is not getting better (or worse yet, is getting worse). I used to spend a lot of time trying to educate the Docs about this stuff. Sadly, many have financial relationships as either owners in a PT clinic or have relationships with the providers. I have come to realize the people that need to be educated are the patients. So, here I am trying to educate the public one patient at a time :).

At the very worst this is something you can work around (and still be lifting). At the best, it’s a radigraphic finding with little if any clinical relevance. You have seen providers so we can (hopefully) surmise the nasty things have been ruled out (like progressive neurological deficits, etc).

McGill has some excellent work and insights. I have read most of his books and attended his seminars. Personally I think he overlooks some simple mechanical stuff we see using MDT, but in the grand scheme of things he’s at the top of the heap with regards to providers that “get it” when looking at back pain.

As an aside, there is a very eye opening book that came out called “crooked, examining the back pain industry”. There is a lot of money to be made treating LBP (low back pain) and sadly that entices some practitioners to paint a dark clinical picture to justify an expensive or prolonged treatment (however, at times that is the only option)…the challenge is knowing which is which.

I apologize for the rant, but it just really ticks me off when I feel that patients are not getting solid and patient specific information. No one gets it right 100% of the time, but blanket statements like that (after what seems like only one visit with you “I went to physiotherapist and he said”) seems premature.


#6

I`m sorry for my error word, english is not my native language.
I live in Poland, so getting this book is a bit of a problem, but I will try.

This back injury is a problem because, I have pain in lifting even light things, but it’s also a psychological problem, it destroys me that I can not train powerlifting.

I have only 18 years old and physio gave such a sentence.

My back rentgen photo, 5 month ago(here 1 degree Spondylolisthesis). Now i can 2 degree by my stupidity (i did deadlifts and squats after sentence- stupid things)

https://zapodaj.net/68d9509f5ff04.jpg.html


#7

At the worst, you might need to avoid very heavy (or even totally avoid) deadlifts, overhead presses and maybe squats. I don’t believe in generalizing though so you need to find someone there to work with you. It is possible you just need to strengthen some weak links and improve your form. MDT (mechanical Diagnosis and therapy) is a Physical therapy method that is used internationally. There may be someone trained in it near you. Look for McKenzie clinicians near you. There is an international website for McKenzie that should have a find a provider option.

I will add that if you think you are getting worse then be smart and don’t push yourself until you get it sorted out. You can make it worse if you are doing the wrong stuff. better to take a few months now and hold yourself back than rush it blindly and make it so bad that you really do have to stop doing a lot of what you enjoy.