In most cases, patients who come to see Dr. Nathen Horst with complaints of lower back pain will be either middle-aged or older adults. However, in some cases, an adolescent will present complaints of lumbar (lower back) pain. Almost invariably, it will turn out that they regularly participate in some sort of athletic activity, such as gymnastics, football, or wrestling, that either hyper-extends or puts a heavy stress load on the lower back. An MRI or CAT scan may identify the problem as spondylolisthesis, which is the most common cause of lower back pain among children and adolescents, although it is usually just dismissed as “growing pains.” The truth is that spondylolisthesis can go completely undetected until symptoms worsen.
What Is Spondylolisthesis?
Spondylolisthesis occurs when the bone joining the upper and lower part of the fifth lumbar vertebral joint (the pars interarticularis) fractures, causing the entire vertebrae to shift forward due to instability of the broken pars interarticularis. Although this almost always will occur on the fifth lumbar vertebrae (L5), it can also happen at the fourth lumbar vertebrae (L4).
How Common Is Spondylolisthesis?
The general rate of spondylolisthesis is between 5 percent and 7 percent. In most of these cases, spondylolisthesis occurs due to a genetic defect in the pars interarticularis. However, among younger patients participating in sports such as football, diving, gymnastics, wrestling, or weight lifting, this rate may be anywhere from doubled to quadrupled.
What Is the Traditional Treatment for Spondylolisthesis?
Standard initial treatment is usually non-surgical and involves rest and gentle stretching exercises, combined with intermittent use of a back brace. In cases where the shifted vertebra pinches a nerve, causing pain that interferes with daily activities, surgery may be recommended. The surgery will usually consist of fusing the L5 to the sacrum just below it, in order to stabilize the joint. Internal bracing of rods and pins may also be used to hold the L5 in place while the fusion heals.
What Are the Chiropractic Treatments for Spondylolisthesis?
There are a variety of chiropractic techniques that can be used to treat spondylolisthesis:
- Direct manipulation of the affected vertebrae
- Trigger-point therapy to determine tight spots on muscles through hand or finger pressure
- Joint stretching and resistance techniques
- Flexion distraction, which is commonly used for degenerative spinal disc conditions
- Soft tissue therapy, which can treat spinal tissue
Much of this can either be done with the hands (manual manipulation) or with a special instrument that can deliver a greater amount of thrust with less force. A special table that can raise or lower certain parts of the body is also commonly used, particularly for flexion-distraction therapy.
What Does the Research Say?
An article in the September 2009 issue of the Journal of Chiropractic Medicine discussed the case of a 43-year-old Marine veteran with spondylolisthesis. He underwent 10 chiropractic treatments, including flexion distraction therapy, for eight weeks. At the end of the eight weeks, he reported that his back pain had reduced by 25 percent. The researchers concluded that conservative treatment of spondylolisthesis, including chiropractic care, could be an alternative to surgical treatment.
Contact Horst Chiropractic today.