posted on Wednesday, March 22, 2006 8:05 PM
by
irenept
Spondylolisthesis
A wife of a patient asked me how to treat a spondylolisthesis. She said that she thinks her husband had spondylolisthesis and he responded to the exercises from the "Treat Your Own Back" (TYOB) by Robin McKenzie, but needed pointers to continue his progress... So I thought I would post a copy of my reply here for your reference.
"First and foremost, you need to make sure that your husband truly has a clinically significant spondylolisthesis ("spondy"). A true spondy is an anterior derangement, that is an obstruction, such as a protrusion, in front (anterior) of the vertebra. As opposed to an anterior derangement, a posterior derangement is an obstruction going towards the back (posterior) of the spine--for examples, common disc herniation, stenosis, etc. The symptom behavior as well as the treatment of an anterior derangement are almost opposite of that of posterior. The book "Treat Your Own Back" addresses the most typical lumbar spine disorders which are in the posterior aspect fo the spine, except for stenosis. Some of the reasons why posterior derangements are by far more common than anterior is that many people have developed slouch posture over the years, and moreover they bend their lumbar spine forward all the time, stretching their posterior disc wall again and again. All of these factors quite easily contribute to posterior derangement such as bulging disc at some point in their life.
If your husband responds to the exercises in the TYOB book, then he is likely to have a posterior derangement rather than an anterior one. Even though you may see spondy on a MRI, it may not be a symptomatic one. In the same way, many people with a symptomatic bulging disc may not see such on their MRI, since a MRI is only taken in 1 unloaded position and the person taking the MRI may not be having the symptoms at the time of taking the MRI.
Only if you have accurate diagnosis can there be targeting treatment. My advice for you and your husband is to
first find out what he really has from a McK certified professional (
http://www.mckenziemdt.org/). If his history, range of motions and movement testing...in their evaluation all point to a spondy, then a precise treatment plan can be established (and by the way, those therapeutic exercises are not in the TYOB book), and it usually does not take more than a few weeks to resolve a derangement. In the meantime, let his symptoms tell him what he needs to do. If he has positive response to the McK ex in the book, then continue them very faithfully. Only do the movements that help eliminate the symptoms, and do them every hour. And for the next several weeks, avoid doing things that cause the symptoms to sustain.
Lastly, if the right exercises are established with the right amount of force progression in the right direction, and your husband keeps the right precautions adequately, then as soft tissue takes about 2 weeks to heal, you husband can and should expect to recover within a few weeks as well.
Hope this helps!"