T Nation

Spinal Stenosis or Spondylolisthesis?

dont know if tis the right post to put in this thread but there was no section for injury posting. Hi have been training now and managed my back pain quite good. I can lift a lot of weight now without any pain. I currently can deadlift 120kg,squat 115kg and perform good mornings with a slight bent in the knee for 100 reps using 20kg as a weight.

My only problem is that Im into martial arts. and although im doing good in the weights i cannot seem to bend forward with my legs straight or else I get siatica in my left leg. Now the thing is that I was diagnosed of having grade 1 spondyliolisthesis and literature tells you that bending forward makes it better. How come mine is the opposite. I can hyper extend my back without any pain but when i bend forward i feel the nerve becoming pinched.

Any help from medical branch?

Granted, I’m only a final year med student, but I’ll help where I can.

  1. Who diagnosed you (what specialty), based on what examinations/investigations? At what level is the slippage?

  2. When do you get the pain? Is it radiating from the back all the way down the leg with the same type of pain, or do you just feel it radiating only to the back of the thigh? Is it bilateral? Or is the pain only localized to the back of the leg

As spondylolisthesis is associated with hyperkyphosis of the lumbar spine and thus severe anterior pelvic tilt, this may lead to hamstring tightness. This may be present in all grades. The pain here is localized pain to the hamstrings only, not radicular pain (sciatica), and is basically due to stretching of the muscles.

If you know what level is the slippage, you can have someone test the pain by applying pressure to the particular spine above the slippage. This may induce radicular pain by reducing the vertebral space, pinching the nerves. This pain should radiate from the back all the way down the leg. This is sciatica.

Hi thanks for your reply the slippage is 25% grade 1. I was diagnosed by a spine specialist. The pain is only unilateral on my left side. I only happens when i bend forward more than 90 degrees. It feels like a pinching of the nerve and is felt on the hamstrings radiating towards the lateral part and the back side of my leg. I have no kyphosis and a small anterior pelvic tilt. The thing is that my back is constantly cracking when pushing my pelvis to the front and it makes me feel better. I also have x-rays if you want.

Hm, it sounds like it could be 1) a pinched nerve as it exits the spine or 2) pinched while in the spinal canal. The former would be the typical picture, while the latter would occur if there is still further instability.

In spondylolisthesis, patients may also have disk issues occurring due to the fact that it has to withstand compression + shear stress from the slippage with degeneration from the disease process. This may cause flexion-based pain due to disk prolapse, and may be bilateral/unilateral. The anterior pelvic tilt is what keeps the defect stable, as it changes the center of gravity. When the pelvic tilt is lost, the vertebrate can further slip forward causing pain from further shear stress as far as I understand it.

But hyperextension may also cause further pain by aggravating the impingement of the nerve roots as it exits the spine via the foramina, and may present unilaterally. This is the typical of spondy.

In any case the pain would be radicular in nature regardless of whether the nerve is impinged in the spinal canal or foramen.

My hunch is that you may have impingement of the nerves within the canal due to the slippage from a disk issue which is also present, which becomes worse as you bend forward. Was an MRI done to exclude disk pathologies which may be present at the same time? The problem here is that the pain can be due to both flexion or extension, with different causes within the same disease.

Sorry that I can’t give a more informative answer, as I did not have any experience with spondy patients during my orthopedics posting; they were all prolapsed disk patients. Do ask your specialist, as spondy for the most part is postgraduate material in a UK-based medical education. And don’t forget to monitor for neurological deficits: check your ability to 1) toe walk, 2) heel walk in both legs. Good luck, the sight of people with radicular pain just sucks.

Sorry for the hijack, but, does anyone else on this board have Spondylolisthesis? I was recently diagnosed with this myself. My doctor didn’t talk about “levels”, but I was told that my L5 has slipped about 5mm, is cracked, and that the disks above and below are slightly herniated and degenerating. According to the MRI, the fluid sack still looks healthy.

Because of pain down my leg and this diagnoses I haven’t been doing any serious lifting the past month, and I haven’t really done any serious leg work since about May. My doctor, of course, has told me that I absolutely cannot squat, do goodmornings, deadlifts, etc. I am prepared to take his advice, but I was wondering what other people’s experience with this is. How do people control the pain? What sort of lower body lifting do you do? Currently I take naproxen when the pain in my leg comes around, but I’ve found regular stretching helps a lot. As for lower body lifting, given how serious my pain became this last year doing leg work I don’t see myself doing any heavy squats ever again. Back in May when I stopped squatting because of pain I was repping 400lbs regularly in workouts and doing heavy box squats with bands.

So, any experience or advice? I cringe at thinking about not squatting again and being stuck to leg presses, but I’m not willing to put myself into a wheel chair or live with constant pain in my back/leg just to squat.

Level simply refers to the level where the slippage is, ie L5/S1 in your case (and is the most common).

You might find ideas here to controlling your pain:

Gokudmc18:
I looked at your previous posts, I found out that you do have a history of a herniated disk. I think the problem is that along with the spondy, your herniated disk never healed well enough before this. And (I am only assuming here) to compensate for the flexion-based pain of the disk prolapse you did too much hyperextension of your lower back leading to spondy.

Try reposting to this guy:

or Eric Cressey who he works with- both very knowledgable on this sort of thing

with disc heniations, and extrusions or even lumbar ddd. what are the likelyhood that these disc will some day prolapse. and also after being diagnosed with severe athritis in the lumbar region do you beleive it is ok to resume sports if there is no pain other than arthritis which exercise makes it feel better. and what percentage of athletes develop lumbar ddd at an early age.