Injury blog: Spondylolisthesis

Hello readers! Our blog this month focuses on a spinal condition that in the sports world most commonly affects cricketers and gymnasts, but in reality, can affect anyone! The condition is known as spondylolisthesis (pronounced ‘spon-di-lo-lice-thee-sis’) and most commonly affects the lowest segments of the lower spine region.

What is spondylolisthesis? 

Spondylolisthesis is the slipping forward of one vertebra on another. This most commonly occurs at the L5 segment (the lowest vertebrae in the lumbar spine), which slips forward on the S1 segment of the sacral bone. The runner up? L4, which is also a commonly affected area.

There are a few different causes of this condition, and so it has been classified into different types. There are five categories of spondylolisthesis. These are:

1.     Degenerative: Occurs due to degenerative changes to the spinal facet joints and discs

2.     Isthmic: Occurs due to a bone defect in a part of the vertebrae known as the ‘pars interarticularis’

3.     Traumatic: Occurs following a trauma that results in a fracture of either the spinal facet joints or pars interarticularis

4.     Dysplastic: Occurs due to a developmental defect of the vertebrae which alters the direction of the spinal facet joints, leaving the segment(s) open to slippage in the area where they are partially held in place by the facet joints.

5.     Pathologic: Occurs secondary to a medical problem such as infection or cancer

In theory, any process that leads to the weakening of the supportive structures of the spinal segments (i.e. the bones, ligaments, discs, muscles) can lead to abnormal movement of the spine.

Grades of spondylolisthesis

Spondylolisthesis is further classified based on the amount of slippage that has occurred:

•           Grade 1: Between 0-25% of the vertebral body has slipped forward on the vertebrae below

•           Grade 2: Between 25-50% has slipped forward

•           Grade 3: Between 50-75% has slipped forward

•           Grade 4: Over 75% of the vertebral body has slipped forward

The most commonly reported grade of this condition is grade one, accounting for approximately 75% of all cases.

Signs and symptoms

These vary depending on the cause, but can include any or all of the following:

•           Low back pain, including pain in the buttocks

•           Pain along the back of the thigh which rarely goes lower than the knee

•           Tight hamstring muscles

•           Changes in walking pattern

•           Pins and needles and/or numbness down the legs

•           Bowel and bladder dysfunction (in more severe cases)

If you come to us with low back and/or leg pain, we are trained to work out exactly what is going on based on your symptoms and medical history. We will ask you lots of questions to begin with to dwindle our list of potential diagnoses to just one or two. Then we’ll get you to move and through a thorough movement assessment, will be able to come to a specific diagnosis that we will work with you to treat.

Sometimes we may require the help of imaging to rule in or out spondylolisthesis, depending on the severity of symptoms and how much it is impacting your life. In these cases, we will send you off for an x-ray which can detect this issue.

Treatment

Most cases of spondylolisthesis can be managed conservatively, meaning non-surgical options are chosen over a surgical one. When this injury occurs, the instability of the particular spinal segment can lead to many of the signs and symptoms mentioned above. One of the main goals of treatment is to increase stability around the affected area and offload the forces that are acting on the injured area.

We will spend time educating you on the mechanics of the spine. If you understand what is happening to your spine, you will know how to protect it, without adding unnecessary stress to the area. We will also advise on appropriate footwear, as well as standing, seated and sleeping postures. Being obese or overweight is also a risk factor for developing, as well as maintaining this problem. If you need to lose weight, we can help you formulate a plan to get there.

Exercise to increase core stability, as well as flexibility of tight muscles is a very important part of therapy as this will reduce the need for external supports such as braces in the long term. And of course, not forgetting our wonderful hands which will get to work on your muscles and joints to reduce tension and tightness, while increasing range of motion.

All of the above treatments will help you to manage pain, increase function and get you back to work or sport or gardening… Whatever your goal is! Call us today on 0439379847 if you have low back pain, or even if you already have a diagnosis of spondylolisthesis, and we can help you formulate a recovery plan to get you on the road to better health.

Safety at work

The great thing about Osteopathy is that it’s not just about ridding people of their pain. It is a way of life. Yes, people come to see us to get rid of pain, but once they are in our caring hands, our work doesn't stop there. We are huge advocates of ‘prevention is better than cure’. So, we will delve deep into your life - your diet, sleep patterns, hobbies, job and more. We look at you and your life as a complete package and will help you work out what areas need adjustments so you can live a long and healthy life (which is as pain-free as possible!).

Work is a big part of most people’s lives and is often a significant contributing factor to their pain. This month we’re giving advice on two key areas to ensure you are looking after yourself at work, so you can avoid injury and keep food on the table. All in the name of ‘National Safe Work Month’! Read on to ensure you are giving yourself the best possible chance of staying injury-free at work.

Lifting posture

We see lots of people coming in for treatment because they have hurt their back, neck or shoulders in a lifting-related incident. Our advice for you…

1.     Plan ahead to make sure you have a clear path from A to B for the object you are carrying. Make sure the object is stable and is not going to topple over whilst you are carrying it.

2.     Get close to the object and with your feet hip-width apart, and whilst keeping a straight back, bend at the hips and knees to get low to the ground (key words here – “STRAIGHT BACK”!).

3.     Ensure you have a firm grip of the object and whilst keeping your back straight (there it is again!), lift from your hips and knees until you reach an upright position.

4.     Always move using your feet rather than twisting or leaning through your back.

5.     Always keep the object close to your body. Never try to hold it out in front of you with your arms, as this places a great deal of stress on your shoulders, neck and back.

6.     Always get help from another person(s) if the object is too heavy for you alone. It is NEVER worth the risk of injury by tackling a task that may be slightly beyond your physical capabilities.

Desk set-up

Postural strain from a seated desk job is another common work-related injury we treat. To ensure you are sitting pretty, our advice to you is…

1.     Ensure the top of the screen is level with or just below the level of your eyes, and centred in front of you.

2.     Sit with relaxed shoulders, elbows bent at 90 degrees and avoid cocking the wrists back when typing (adjust your desk height to suit this if possible).

3.     Adjust the tilt of your chair to allow the hips to sit at an open angle of 100-110 degrees.

4.     Adjust the backrest of the chair to ensure you are supported in an upright position whilst seated.

5.     Avoid slouching back on to your tailbone. Instead, gently roll your pelvis forward to sit on your sitting bones and bring the curve of your low back into its natural position.

6.     Take regular breaks from sitting. Get up out of your chair every 30-45 minutes to allow your body to move and stretch.

So there you have it. Our skills are much more than just our hands. We’re full of good advice! No matter what job you do, we’ll help you break it down to make sure you are getting the most out of it and not putting yourself at risk of a workplace injury. Here’s to a happy workday, every day!

Osteoarthritis: aging and your body

Hello readers and welcome to October’s blog post! This month we are turning our focus to the elderly - an ever-growing population. Did you know that there are approximately 700 million people in the world aged 60 and over? And did you know that it is estimated that by 2050, there will be around 2 billion people on the planet that fall into this age bracket? That’s just over 30 years away! That’s quite difficult to comprehend, but with people beginning to work and live longer, it’s important that the elderly population get the attention and care they need to stay healthy and active; so they can enjoy the quality of life they deserve.

You might think that as people get older, they become less active and therefore are less likely to injure themselves. This may be true to a degree, especially once reaching retirement age, but the elderly population are generally an active population and are just as much at risk of injury as the next person. A 60-year-old person might not play footy or run around the basketball court as much as a teenager might, but they have other things to contend with - an ageing body with years of gradual degenerative change and weakening that we all experience at some point as we go through life. One of the most common causes of injury in the elderly is falling. Unfortunately, as the body ages, it becomes more prone to falls. This usually boils down to a combination of individual factors (i.e. having multiple diseases, poorer eyesight, or general weakening of the body) and environmental factors (e.g. trip hazards around the home setting). Some of the most commonly seen injuries sustained from falls include fractured hips, arms and forearms, cuts and lacerations, as well as head injuries.

In a clinical setting, us Osteos see our fair share of older patients. It’s less likely we’ll see someone in the acute setting immediately following a trauma like a cut, laceration or in many instances where a fracture is suspected, but it does happen. It is much more likely however, that we will see patients experiencing pain related to postural strain (think about the retiree who sits around a lot), or from degenerative changes in the body. A common degenerative condition affecting the elderly population is osteoarthritis (OA). This most commonly affects the joints in the hips, knees and spine - particularly those of the neck and lower back. It’s no coincidence that these are the main weight-bearing joints of the body.

So what is OA?

OA is a condition affecting the synovial joints in the body (the joints between two bones in the body that have a lubricating fluid between them). It is characterised by changes to the cartilage and underlying bone, as well as inflammation and irritation to the soft tissues that help to hold the joints together - known as the synovium - it’s the tissue that forms the lubricating fluid that sits between the joints.

Primary OA refers to changes in the joints that relate to the ageing process. It will often run in the family, so if your granny or dad has it, you may be more at risk to develop it. Secondary OA is arthritic change from any other cause. For example, following on from trauma, repetitive stress, poor posture, or from diseases such as gout.

Signs & symptoms

The main symptoms (things the person experiences) of OA include pain, stiffness, poor joint function and muscle weakness. Signs (things we look for in the clinical setting) that a joint is degenerated include popping and clicking, poor range of motion, bone and joint swelling, deformity and instability.

What to do if you have or think you have OA

First things first, book an appointment to see your local Osteo. After questions and assessment, we’ll get to work on your body and putting you on a pathway to moving better. There is a good chance your arthritic joint is paining you because you aren’t moving well, and the joint is being loaded incorrectly. The good news is, we know how you should be moving, and what needs to be done to get you there. We’ll aim to reduce your pain down by releasing tight and over-worked muscles and mobilising your stiff joints. Mobilising the joints helps to increase range of motion and will help promote production of the lubricating synovial fluid that sits between the joints to allow smooth fluid movement. You should get off the treatment table feeling less pain and moving better. There is a good chance you’ll need to do some form of strengthening to the surrounding weakened muscles, so the joint is more supported when you move it. More good news, we know which exercises will be beneficial to get you on the path to stronger muscles. Unfortunately, we cannot claim to cure your OA, but we can certainly get you moving with less pain or in an ideal situation, no pain at all.

What’s the outlook with OA?

More often than not, if caught early, significant changes can be made to stunt the progression of this degenerative condition. So, don’t ignore pain, it’s your body’s way of telling you something isn’t right. With early treatment, the best possible outcome will be achieved. If you pop into the clinic and we determine your issue is not OA-related, we can provide you with a sense of relief and get you on the right track for your situation (a positive outcome, either way!). In severe cases, you may require the opinion of a specialist orthopaedic surgeon. Sometimes people require joint replacements and can go on to live a very good quality of life with a new hip or knee for example. Always see your Osteo first though. Using our skills, we can possibly keep you from having to go under the knife a bit longer, and maybe even at all. Worth a shot don’t you think?!