Have you ever felt back pain or stiffness when you wake up in the morning? Have you ever had to sit down due to back pain or numbness, as well as leg pain, after standing or walking for a long time?
These are common signs and symptoms that may be associated with arthritis or lumbar stenosis and/or lumbar nerve root disease (commonly referred to as "sciatica").
Spinal isthmus and spondylolisthesis are conditions that affect the small joints, which align the vertebrae one by one. Spinal isthmus is a weak point or stress fracture in the small joint area. This weakness can cause bones to slide forward out of their normal position, known as spinal spondylolisthesis, and twist spinal nerves. Treatment options include physical therapy to enhance muscles. A back brace can be used to support the spine. In some cases, surgery can rearrange and fuse bones.
The anatomical structure of small joints
Your spine is composed of 24 movable bones (known as vertebrae) that provide the primary support for your body, allowing you to bend and twist. Each vertebra is separated and cushioned by a gel shaped intervertebral disc to prevent them from rubbing against each other. Vertebrates are connected and fixed to each other through ligaments and joints (known as facet joints) (see spinal anatomy).
The upper and lower joints are connected by a narrow bone bridge called the interphalangeal region. The lower facet of a vertebra perfectly aligns with the upper facet of the lower vertebra - overlapping like a wooden tile - starting from the vertebrae at the bottom of the skull and ending at the coccyx.
Each vertebra has two small joints, one connected to the upper vertebra (upper small joint) and one connected to the lower vertebra (lower small joint). The thin bone bridge between the upper and lower articular surfaces is called the facet joint.
What is spinal isthmus
And spinal slippage
Spondylysis and spondylolisthesis are independent but related conditions. Vertebral spondylolysis usually occurs first, but not always. The term comes from 'spondylo', meaning spine, and 'lysis', meaning division. Spinal isthmus is the rupture or fracture of a narrow bridge (known as the facet joint) between the upper and lower articular surfaces. It can occur on one side (unilateral) or both sides (bilateral) and at any level of the spine, but is most commonly found in the fourth or fifth lumbar vertebrae. If there is a spinal isthmus, then you may experience spinal spondylolisthesis. The more common type of spinal spondylolisthesis is caused by degenerative processes. This situation is most common in the fourth and fifth lumbar vertebrae.
Spinal isthmus is a fracture or fracture in the joint area.
Lumbar spondylolisthesis refers to the forward sliding of the vertebrae. The term 'listing' means to slide forward. This occurs when the weakened intermuscular muscles separate and allow the vertebrae to move forward, resulting in nerve compression and pain. Spinal spondylolisthesis usually occurs between the fourth and fifth lumbar vertebrae or between the last lumbar vertebra and the sacrum. This is where your spine bends into the most obvious "S" shape and where the pressure is heaviest.
The measurement range of sliding points ranges from level 1 sliding points (25%) to level 4 sliding points (100%). The more curves on the lower back (backward or forward), the steeper the slope.
Spinal isthmus and spondylolisthesis
What are the symptoms?
Mild spinal isthmus and spondylolisthesis usually cause mild pain. In fact, when a person undergoes a back X-ray examination for unrelated reasons, these conditions are often accidentally discovered.
When spinal isthmus and spondylolisthesis do cause pain, you may experience lower back pain, stiffness, and muscle spasms. You may also suffer from sciatica (pain radiating downwards from one or both legs) or numbness, although this condition is not common. When you stand or walk, leg pain usually becomes more severe.
You may experience very subtle symptoms, such as tight leg muscles or finding that you can no longer touch your toes but do not feel any nerve pain.
Degenerative slips typically manifest as difficulty walking and gradually worsen over time. You may find that walking a certain distance can cause heaviness, pain, or discomfort in one/both buttocks/lower limbs. When you sit down, the symptoms will alleviate, but they will reappear when you walk again. This type of pain is called 'neurogenic claudication'.
Spinal spondylolisthesis
How to make a diagnosis?
When you feel pain for the first time, please consult your doctor. He will record a complete medical history to understand your symptoms, any previous injuries or conditions, and determine if any lifestyle habits are causing pain. Next, a physical examination will be conducted to determine the source of pain and test for muscle weakness or numbness.
X-ray examination can examine the bones and vertebrae in the spine, and can tell your doctor if there are any bones or vertebrae that are too close together, or if you have changes in arthritis, bone spurs, fractures, or any vertebral slippage.
MRI is required to confirm clinical results and scan for any abnormal conditions.
When to seek emergency treatment
Because spinal spondylolisthesis can compress or impact the nerve roots that leave the lumbar spine, similar to a herniated disc. Due to the nature of this injury, it is sometimes appropriate and necessary to seek emergency medical attention.
If you have any of the following signs or symptoms related to lower back pain or spinal spondylolisthesis, please contact your emergency medical service provider:
Acute refers to newly or recently occurring intestinal or bladder dysfunction, including difficulty urinating or leaking urine.
Acute means new or recent severe fatigue.
Continuous pain at night, without changing position.
Weight loss or gain within the last month>10% of body weight.
Progressive weakness or numbness/pain in the legs, and worsening condition.
If you do not have any of the above signs or symptoms, you can safely seek physical therapy care directly.
Conservative treatment of spinal spondylolisthesis
The initial treatment depends on your doctor and the severity of the symptoms.
If your symptoms are severe, some doctors may recommend epidural injection to initially control your pain and swelling. After epidural injection, your doctor may recommend hot or cold compress and medication (such as gabapentin and nonsteroidal anti-inflammatory drugs) to control your pain and swelling.
If you have any questions about epidural injection, you can consult your doctor.
The physical therapy for spinal spondylolisthesis may vary depending on your signs and symptoms, including the duration of symptoms and the severity of symptoms during activity.
If the pain level is high, the activity is very limited, and there is numbness and/or tingling sensation, the initial goal of physical therapy is to control the symptoms through central nervous system pain and discomfort.
Physical therapy may also vary depending on the specific type of injury and the direction of vertebral sliding (known as forward sliding or backward sliding).
Front slip and rear slip
For most backward bending or stretching injuries, the vertebrae will slide forward. This is called forward slippage.
In this case, it is strongly recommended not to repeatedly stretch the spine like in gymnastics.
This does not mean that you must always avoid bending backwards. A reasonable time range is 6-8 weeks to facilitate tissue healing and reduce swelling. However, before you can actively control the muscles around the spine to help stabilize the injured area, it is best to avoid these activities if they cause further pain.
For most flexion or flexion injuries, the vertebrae slide backwards. This is called back sliding.
In this case, it is temporarily not encouraged to repeatedly bend the spine, such as bending over to wear shoes/socks. Once again, this does not mean that you must always avoid bending forward! We need these tissues to heal, and muscles need to be strengthened to protect the injured area.
This is where physical therapy comes in handy.
Physical therapy for spinal spondylolisthesis
The goal of physical therapy is to provide you with tools for healing. A physical therapist will assess your symptoms and work with you to develop a rehabilitation plan. It is important to maintain consistency every week - exercise and strength take some time to recover, so patience is key.
The first step is to restore painless range of motion for the spine and hips.
Your physical therapist will work with you to improve the length and tighten the muscles around the injured area that may be protected. This also involves improving the mobility of joints above and below the injured area, making general movements easier.
Restoring mobility through various soft tissue techniques, including:
Soft tissue mobilization, soft tissue self release surgery, myofascial release, manual stretching, combined mobilization
These technologies will be praised for your efforts. You will learn stretching and strength exercises specifically tailored to your needs to enhance your new activity abilities.
Once your spine and hips have resumed full range of motion, you can start stabilizing exercises for the core, gluteal muscles, and even pelvic floor and diaphragm to help you learn how to properly support your spine.
Once you feel comfortable and confident, your therapist will gradually increase more reinforcement activities. The goal is to restore you to your previous level of activity or physical activity.
Please remember, patience is key. Your reinforcement activities will gradually be carried out to reduce the risk of re injury. As the saying goes, learn to walk first, then learn to run!
Core Enhancement: How to Start
No matter what type of spondylolisthesis you suffer from, being able to support your spine correctly is the key to reducing the burden on the injured area. One of the most common exercises is plank support!
Flat support
The goal is to maintain correct tablet support for one to two minutes, but at the beginning, there should be an interval of 10 to 30 seconds. Practice three rounds.
Firstly, tighten the lower abdominal muscles appropriately. Imagine inhaling 360 degrees into your abdomen and filling it up like a balloon. Then pull the navel towards the spine when exhaling.
You should feel like you have a belt/tight corset.
Make sure your elbows are placed directly under your shoulders and push the ground away to exercise your shoulder muscles.
If your neck is tense, apply force directly to your torso instead of "pulling" your elbows underneath your body without actually moving them.
Extend your knees and squeeze your hips to ensure that your legs feel locked in place.
Feet should be separated by shoulder width or a comfortable distance.
If the tablet support is too challenging or you feel lower back pain, you can modify the exercise by kneeling down. Alternatively, it can be done on elevated surfaces such as benches or kitchen counters.
Maintain equidistant back extension
The core muscles also include the spinal extensor muscles, not just the abdominal muscles, so learning to properly recruit and utilize these muscles is key to treating and controlling back pain.
The goal is to maintain this position for one to two minutes, but at the beginning, there should be an interval of 10 to 30 seconds. Practice three rounds.
First, find a bench or a fitness ball and place the edge of the bench or ball on top of your hips.
Lift your torso to the center position - do not bend backwards. You should feel the back muscles moving, but there is no pain.
Maintain posture - try not to extend or sag from a neutral position.
If this is difficult, you can adjust the position of the bench or fitness ball above your hips to make it easier until you are ready to face more challenges.