I have grade 1 Spondylolisthesis of L5 over S1, DDD with annular tear and bulge in L4-L5, and herniated disc with loss of disc height at L5-S1. As many of you know, I have been in horrid pain.
I started a NEW PT program this past Monday, and I am uncomfortable with some of the exercises they are having me do. Several of my new exercises involve back extensions, where I arch my back backwards. These exercises are incredibly painful, and I was under the impression that this could make my forward slippage worse. The pain this week has been worse than ever, so this morning I called my Dr. to see if these exercises are appropriate and safe for me to do.
The PA returned my call and said that I have to do them, and that my increased pain is because I am so de-conditioned. She said I have to remain active and do my chores and errands. She also said, and I quote "For every hour you spend on the couch, that is another hour you have to spend doing PT before you can have surgery."
Now this comment really bugged me because, first of all, I never once said anything to lead her to believe that I lay around. Secondly, I don't get that luxury anyway, I have to chase around my 1 year old all day. I have been a little unhappy with this Dr.'s office from the beginning, and now I think I finally will get a second opinion. But I would also like to hear your opinions on those exercises.
Hi megss...glad you posted this, because I too am looking for spondy-friendly exercises. I have grade 2 with severe DDD (no disc height at all...basically bone on bone) at L5-S1. Everything I have read on or about spondylolisthesis, says NOT to do back extension exercises...yet, my doctor (chiro) currently has me doing them too. I can tolerate certain variations of them, ok...such as doing them on a yoga ball or the ones where you are lying on floor on your belly (half cobra). But the standing one, where you just place your hands on the lower back and bend backwards (a McKenzie exercise) is rather painful for me, plus it puts strain on my neck.
Perhaps the reason they have you doing them, is because of your disc herniation. It's my understanding, that back extensions are usually prescribed for disc herniations. But seeing as you have BOTH, a herniation AND spondy at the same level...that's a pretty tough situation. I think I would definitely get a 2nd opinion. My chiro has finally agreed to refer me to an orthopedic spine doc for evaluation, since my back pain does not seem to be responding to any form of treatment. I've also been dealing with some fairly bad left hip pain as well...and I am positive that it is somehow related to my lower back issues.
In my experience, having spondy has me feeling like being caught between a rock and hard place. I know that I have to strengthen my core and lower back muscles...yet technically, us spondys are not supposed to do extensions...which IMO, is a key exercise for lower back strengthening. So it begs the question...what the heck are we supposed to do to strengthen our lower backs???
I'd also like to note, that I've already been through PT...and sadly it did absolutely nothing for me. It was very "old school" basic stuff that I had already been doing for years...so it wasn't challenging me at all.
I am wondering also about appropriate exercises for spondylolithesis as far as core strengthening. Prior to herniating discs at L3-L4 and L4-L5 this past summer I was doing Pilates type floor exercises and walking for exercise. I am currently recovering from a laminectomy with a bone onlay fusion of L4-L5 due to spondylolithesis plus I have some element of scoliosis.
I am 11 weeks out from surgery and when I went to the NS last he said he thought I should wait until I was 4 months out from surgery before beginning PT. He actually wasn't real keen on the PT as he felt I should just do gentle exercises at home and continue with my walking regimen. I just feel like I need some guidance with both disorders (bad discs and spondylo) as I too have read that extension is not the thing to do with the spondylo.
I have a flexion/extension film coming up and anxious about that as I haven't come out of my brace yet and really haven't done anything in the way of flexion or extension in almost three months. Wish I had more constructive input but hope that someone out there has been there, done that, and can contribute. I am not crazy about PT myself as I have some disc degeneration in my neck also and they have actually put me in excruciating pain at prior visits. Thanks for this post!
Some friends of mine run a rehab clinic and they have me doing standing excercises with some large ruber bands. You can double or triple up on them to adjust tension. I do these standing to strengthen the muscles in my back.
I also walk twice a day. I wear zcoil shoes for all of my walking to reduce any impact on my back.
A year or so ago I tried stretching excersises on the floor. I had the silly thought that the more I stretched out the better my mobility would be. The end result of that little excersise in stupidity was lots of pain and an increase in percoset usage.
If you have an advanced stage of DDD and what you are doing is causing pain its more then likely a bad idea to keep on doing it.
I didnot have "spondy" myself but, I did have DDD, several annular tears in both L4-5 and L5-S1.I had herniations and loss of disc height in both those disc as well. I can tell you, when my pain mgt. doc was examining me on my first appt., he had me bend backwards. WELL......it was very painful to say the least. I did know it was painful prior to him doing that too ha. He told me the reason WHY it was painful to bend backwards but I forget what terms he used. So, with that being said, I bet it has something to do with your disc issues. That is just my own opinion having had the same pain. Although it seems if you are going to PT they would KNOW what exercises is good for what? I did go to PT for several months and my therapist never tried doing any backwards bending exercises on me. It was all core strengthening exercises but none of the exercises resulted in me bending backwards. You have 2 different things going on.....spondy and disc herniations. So, not being a P-therapist or doc, I just dont know. I know myself, with just the disc herniations, I was hurting. My back issues was left untreated for years. So, my back was in really bad shape. OHHHHHHHHHHHHH boy and I know what you mean by NOT being able to lay around with a child. I have my adopted 3 1/2 year old and you DONOT get to LAY around LOL. I am fortunate that my baby goes to day care especially during my recovery from back surgery.
Let me just add, if you are not comfortable with what your doc is telling you or not happy with him in general, change docs. It never hurts to get a 2nd opinion anyways. I find it very important to trust and like your doc. I mean after all, he may be the 1 to be doing a major surgery on you and it is very important to have a good relationship with him. I from the get go, really felt confident with my doc. And comfortable as well. I feel he went over everything very thoroughly with me. He showed me my MRI and Xray<since the fusion> and he went over everything about the MRI and Xray. He pointed things out as well. I know I have read your post in the past about your doc and it sounds like what he is telling you is right as far as the treatment plan he is doing. I am saying that by comparing what my own self had gone through prior to my surgery. Like I said.....if you dont feel comfortable with him.....go for another opinion. Another doc may have something he can suggest as well. Good luck girly.....I know you are hurting....I surely have been in your shoes!
Glad you got that straightened out. I hope you inform the NP who told you to go back and do those exercises about the PT's response. She needs to put that in her brain bank for future use!
That just adds to my anxiety about going to PT as I feel that sometimes they have their routines and don't individualize their programs as they should. Seems the PT person should have known that on your first visit when you said that you had spondylolithesis and incorporated that information into your program. There is so much truth in the fact that we have to be our own best "health advocate". Good for you for questioning as it helps not only you but everyone else who goes to that particular PT.
We have a PT program here in San Diego called Spine Zone that I am hoping they will have expertise. I've already made up my mind that I'm not going to do anything that requires extension though as I don't think I can stand to go through this again. I don't have hardware on my fusion (just a bone graft with BMP) so I am going to be extremely cautious when it comes to any sort of PT.
I hope you are getting some relief. It must be difficult to manage back pain with a small child. My sister had tripletts and when they were around 2 years old she had to have a discectomy. I'm not surprised after watching her load them all three and all the equipment she needed everywhere she went. Take care of yourself!!
I couldn't agree more with having to me our own health advocates! This PT place I am going to is supposed to be the best in the area. It is called Physicians Neck and back Clinic. When I was with the PT guy at my last appointment, the lady next to me was doing the exact same stretches in the exact same order as myself. Chances are her injuries are different than mine. The other thing I don't care for is that I do not work with the same PT person at each visit. You work with whoever is available when you check in. I also have an appointment with a new Neuro-surgeon this coming Thursday. I need a second opinion anyway, but I am tired of being treated poorly by the PA at my current clinic. She has a major attitude problem!
It's funny but when I questioned my NS on my last visit about when I would be able to start PT he gave me a weird look. I don't think he is big on the PT scene. He made a comment that sometimes "you can get hurt if they don't know what they are doing." So I asked him if he knew a PT who he trusted so hopefully when he is ready for me to go he will steer me in the right direction. He wasn't pushing the issue though as he said he would rather I just continue to walk and do gentle movements around the house. I guess he is afraid I will mess up his work (and believe me there is no one who doesn't want that to happen more than me!).
Good luck with your second opinion visit. Getting a second opinion is always a good idea. And who needs "attitude" when you are trying to make decisions regarding your health! Jan.