January 3, 2010
Quite often we have new patients come to our clinic with a diagnosis of “sciatica”. This term has become popular for describing any condition that involves leg pain related to lower back dysfunction. Believe it or not, “sciatica” is not a diagnosis and there are many different conditions that involve symptoms of nerve irritation in the legs. For a treatment to be effective your condition must be diagnosed properly. Has degenerative lumbar spondylolisthesis been considered as a potential diagnosis for your leg symptoms? Has it been ruled out as a cause of your low back pain?
Spondylolisthesis – What is it?
Lumbar spondylolisthesis is a condition in which one vertebra “slips” forward on the one below. There are many different types of spondylolisthesis, one of the most common being degenerative. In this type, the slippage is linked to wear and tear in the joints of the lumbar spine. But what has some of the more recent research uncovered about degenerative lumbar spondylolisthesis?
Spondylolisthesis at L4 and L5…
The 4th and 5th lumbar level is the most commonly effected, with the quadratus lumborum muscle and the iliolumbar ligament often playing a role. The Quadratus Lumborum muscle and the iliolumbar ligament are both soft tissue structures that generate pain. Often times, treatment targeted at these areas can result in drastic improvement in pain associated with spondylolisthesis and lumbar degeneration.
Degenerative Disc Disease and Spondylolisthesis
Although frequently seen with this condition, disc degeneration is not an important predisposing factor for slippage. In fact, certain progressions of degeneration in other areas of the vertebrae can actually help to stabilize the slippage!
Other risk factors for degenerative spondylolisthesis in the lumbar spine include being older than 50, being female, having previous pregnancies, being African American and having generalized joint laxity.
Physiotherapy or Chiropractic?
Physiotherapy and Chiropractic both have something to offer the patient with spondylolisthesis. Effective treatment for degenerative lumbar spondylolisthesis involves maintenance of proper motion in the hips and other areas of the lumbar spine. This can be achieved through the use of gentle spinal movement techniques, active release technique and graston technique (which are treatments performed by our Chiropractors). Ensuring that certain muscles in the lumbar area assist in stabilizing the spine is also important. This can be achieved through proper education on the right and wrong way to strengthen a spine with spondylolisthesis (which is a service provided by our Chiropractors and our Physiotherapists). As previously mentioned, diagnosis is the key to proper care. Call us today, we can help. Our doctors are trained and qualified to order and read the appropriate x-rays necessary to accurately diagnose your lower back pain. From there, they can make up to date, evidence based recommendations for your treatment and home exercise! 905.220.7858 firstname.lastname@example.org
Kalichman L, Hunter D. Degenerative lumbar spondylolisthesis: anatomy, biomechanics and risk factors. Journal of Back and Musculoskeletal Rehabilitation 21 (2008) 1-12.
Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: review of current trends and controversies. Spine 30 (2005) S71-S81.