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Glut Pain Part 2: Spondy What?!

Introduction

Your spine is made up of 33 bones called vertebrae, 9 are usually fused together, the remaining 24 can be thought of as ‘floating’, all held in place by ligaments and muscles. The vertebrae hold onto each other through facet joints, which are hook like bones that grow off the back of your vertebrae. Intervertebral disks lie between them to cushion the bones from compressive forces. Each vertebra should sit comfortably on this disk and be balanced over the vertebrae bellow, unless you have a congenital (from birth) condition, wear and tear or suffered trauma to the back that caused misalignment of the spine. A vertebrae that has ‘slipped’ forward out of alignment could be caused by a condition called Spondylolisthesis (spon-dee-lo-lis-thee-sis). This will almost always follow a condition called Spondylolysis (spon-dee-lo-lye-sis) which is a condition where the facet or hook like bones on the back of the vertebrae are broken off from the main body of the bone. Which makes the vertebrae truly ‘floating’ as there is now very little keeping it in place. This branch of injuries is termed ‘Spondy’ for short. So whenever you hear someone talking about their ‘spondy’, you now know roughly what their on about.

Figure 1: Typical side view of the lumbar spine

The Problem

Spondylolysis, is a fracture of the pars interarticularis, the part of the bone that joins the facet joint (the part that links the top and bottom vertebrae together) and the vertebral body (the part the nerve passes through). This commonly occurs in L5, the lowest of the ‘floating’ vertebrae as this is where most of the pressure is compared to the other floating vertebrae. There are numerous factors that can play a part in developing this condition, including anterior pelvic tilt, tight hip flexors and weak hamstrings, arguably these are tied in an infinite loop as they are all unavoidably linked. Over time, with this anterior tilt, additional compressive and sheer force is applied to a relatively smaller surface area as the spine has less range of movement. If we tilt the sacrum forwards, it increases the slope on which the lumbar vertebrae sits. This increases the sheer/sliding force between the facet joints leading in part to this fracture.

Figure 1: Side view of spine with fracture of pars interarticularis

The fracture heals over time, however, there is a duration where the vertebrae is for all intents and purposes free to move as it wills. More accurately, free to be pulled and pushed at the will of the muscles, ligaments and gravity that influence the bones. Looking at the diagrams above, it can only move forward, thanks to gravity. When the vertebrae moves forward it is called Spondylolisthesis. When this happens the vertebral foramen (the whole the nerve passes through in each vertebrae) no longer lines up with the ones from the vertebrae above and below. This can lead to a ‘trapped nerve’ or pinching of the nerve.

Figure 3: Side view of Lumbar spine with Spondylolisthesis

It is imperative that you understand this injury is not always a symptomatic condition. People can live their entire lives with a spondy condition and never show symptoms. Likewise people who go through the rehab and return to their sport showing no more symptoms are not always ‘healed’. The fracture can remain as bone takes a long time to heal, so technically, they still have spondylolysis.

The Fix

There are two options for the so called ‘fix’. There is the option of having your spine screwed in place. There are many ways that this can be done, and vary depending on severity of movement/slippage of the vertebrae and level in the spine. Where possible I would strongly advise against having yourself cut open, unless there are no conservative options available. There are of course scenarios where surgery is necessary, but if you can recover without going under the knife, I would strongly advise that choice. If for no other reason than the surgeon could make a mistake, no matter how small and this could have a lasting effect.

My favorite option, is to go and see a therapist for some hands on mobilisation of the broken segment, because movement is king! Movement is not bad for acute injuries or injuries in general and promote healing, prevent stiffness and pain building up. Mobilisations will reduce the pain you get, relieve the stiffness and allow you to start getting closer to the acts of daily living that tend to stop because of back pain. Then, you should work on your core strength, but the core in the truest sense of the word, everything from your neck to your tail bone. Your therapist, and another blog post will go into more detail here. The core strength will help your spine stay in place and can prevent your vertebrae from moving forward.

Both these options are not going to FIX the issue, only prevent it from getting worse. This being said, when conservative therapy is the choice, the vertebrae may be held in place long enough to allow healing of the fracture to complete and effectively be a full recovery. The second option is not a one stop shop. It requires that you continue to work on your core “stability” FOREVER! As you will now know, the segment can move forward, and even when you show no symptoms, the fracture will still be present. SO, it is immeasurably important that you stay on top of your core strength so you can stay involved in sport and continue doing what you love because for a longer time.

Conclusion

There are many conditions that can affect your spine. Conditions such as spondylolysis and spondylolisthesis are not life threatening. Even with a broken vertebrae you can still compete in sport. IF you go to see someone who also believes you can recover. Under the guidance of a good therapist, even after surgery you can progress back to a level you were at (depending entirely on the severity of the injury! No promises on 100% return). Remembering that even though you may not have symptoms during play, this does not mean you are allowed to stop the core exercises. Keep doing core exercises until you no longer care about the health of your spine.

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