spondylolisthesis (vertebra slip) rehab VS surgery/rehab & barefoot running

I just hit a marathon season "altering" situation. Around 12 days ago, I was hit with extreme lower back pain (unable to stand nor walk for more than 10 minutes without intense pain) after having done a week or so of heavy lifting. Pain/discomfort started slow and became progressive over the course of a few days. I had an MRI - Grade 1 spondylolisthesis (vertebra slip) of L4-L5 ... and I am sure heavy labor in my younger years contributed to my current "degenerated spine."
I meet with a back doctor on Wednesday to go over the MRI. Yesterday, I started barefoot walking and today I was able to go 25 minutes of brisk barefoot "cat walking" with no pain. I have no idea of a recovery time line, but I do know that barefoot running has taught me how to move gently/lightly and has gotten me going again. I have some leg muscle tightness, but it is hard to distinguish from the "normal" pain/discomfort as I have been transitioning to bare footing.

Yes, I would greatly appreciate ANY input for a 42 year old marathoner! I want to be smart & long term with my thinking. I am open to what is safest for my overall health.mri, mateo.jpg
---
MRI REPORT:
~ The MRI shows a Grade 1 spondylolisthesis of L4-L5 with a decrease of the ring in the T2 sequence and reduction of the liquid.
~ The L5-S1 also shows a decrease of the ring.
~ The bilateral image also shows a spondylolysis of the L4 vertebra with a slight widening of the L4 – L5 ring and a slight protrusion of minimal character of the L5-S1.
~ The images do not show any significant anomalies of the “sponginess” of the vertebrae body.
Conclusion:
~ Spondylolisthesis of a Grade 1, L4-L5 with associated dislocation & spondylolysis bilateral L4.
~ Slight protrusion of L5-S1 disc ring.
 
Nobody has the answer, despite symptoms and MRI findings everyone's case is individual.
Some with the same diagnosis will spend the rest of their lives sedentary,
while others will go on to run ultras.
Spinal issues and outcomes are not all that greatly understood .
 
Regarding your spondylolysis and Grade 1 defect, the MRI is showing a process that has been going on for some time, so it is rather unlikely that the Spondylo is new, or is the reason your back was in pain.

It is likely that you sprained your lower back and that it is healing nicely based on your history. There is evidence of disc involvement because of the bulge at l5-s1. Without knowing more about your gait, it is hard for me to comment further about the probability of your body mechanics and its susceptability to injury, especially since you were moving heavy boxes.

Running barefoot is likely not the reason your back is improving. I would suggest doing some core stability exercises such as lateral leg raises, hip extensions and it is a good idea to see a local chiropractor who knows myofascial release.

I hope that helps
 
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THANK YOU soooo much for your replies!! And helpful advice!!

I am seeing what the Spanish call a "traumatologist" on Wednesday. I have no idea what the English/American equivalent would be?

"... everyone's case is individual. Some with the same diagnosis will spend the rest of their lives sedentary,
while others will go on to run ultras. "
-----
Yes, this is the hard part of the journey for me at this starting point, taking it day by day, yet not knowing what direction my journey will go for me!!


"it is rather unlikely that the Spondylo is new, or is the reason your back was in pain."
----
I remember lower back "sprains" off and on over my years, usually connected with bouts of lifting, etc. and worked in farming as a youth and paid for college by being a loader at a warehouse and played American football and I was always the small guy.


"It is likely that you sprained your lower back and that it is healing nicely based on your history. There is evidence of disc involvement because of the bulge at l5-s1."
------
What exactly is a "sprain"?


"I would suggest doing some core stability exercises such as lateral leg raises"
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With or without bands?


" hip extensions"
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Like in the image I attached?


Also, if I might ask, what is your opinion on "flexion" VS "extension" exercises in my case? I have attached a journal article (unsure if it applies to my situation)?


"and it is a good idea to see a local chiropractor who knows myofascial release."
-----
We have few options ... but I'd assume Dr. Rodermans is qualified?
http://www.rodermans.es/web/index.php?option=com_content&view=article&id=27&Itemid=499
VICTOR RODERMANS D.C., D.A.C.N.B, FEAC
Universidad AECC Bournemouth, England, Doctor en Quiropráctica (D.C).
Master en Neurología Quiropráctica por la Universidad de Florida (USA) D.A.C.N.B (Diplomate American Chiropractic Neurology Board).
(specialist fellow of European Academy of Chiropractic) FEAC.
Miembro de:
Asociación Española de Quiropráctica (A.E.Q )
Unión Europea de Quiropráctica
Federación Mundial de Quiropráctica
Federación Internacional de la Quiropráctica del Deporte
American Chiropractic Neurology Board
Specialist fellow of the European Academy of Chiropractic (FEAC)
 

Attachments

  • leg-exercises-21.jpg
    leg-exercises-21.jpg
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  • Lumbar spondylolisthesis: retrospective comparison extension flexion.pdf
    105.9 KB · Views: 0
I just talked with the doctor and friend who was passing through the Islands for a race and gave me a quick examination and his feeling is that the spondy is a long term thing that I have and the pain is actually radiating from the SI joint, but they didn't MRI that! :( At least I now know I have a spongy issue to work through and maybe SI joint.

Now, can one work on spondy issues & si joint issues at the same time without aggravating the other one?
 
The orthopedic doctor looked at my MRI & me yesterday. He believes my back pain to be coming from
~ isthmic spondylolisthesis (vertebra slip that occurred due to a stress fracture when I was younger)
~ the symptoms from these stress fractures tend to develop in adulthood
~ disc slippage is 5-10% and he does not anticipate additional slippage or surgery

He did a number of tests to determine that my SI joint is not injured.

I will start rehab this week (strengthen & stabilize the area) and I can go back to normal life & sports as pain allows. I visited the chiropractor this morning and he has come to the same conclusion. I go to a "physical therapy" doctor tomorrow and she will set me up for a rehab program with a PT.
 
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Sounds great!
The orthopedic doctor looked at my MRI & me yesterday. He believes my back pain to be coming from
~ isthmic spondylolisthesis (vertebra slip that occurred due to a stress fracture when I was younger)
~ the symptoms from these stress fractures tend to develop in adulthood
~ disc slippage is 5-10% and he does not anticipate additional slippage or surgery

He did a number of tests to determine that my SI joint is not injured.

I will start rehab this week (strengthen & stabilize the area) and I can go back to normal life & sports as pain allows. I visited the chiropractor this morning and he has come to the same conclusion. I go to a "physical therapy" doctor tomorrow and she will set me up for a rehab program with a PT.
 
Just by way of follow up, I have gotten the input of at least 5 doctors (from chiropractors, orthopedic, sports medicine, family doctor, rehab doctor, etc.) and the weight of opinion was that ...
~ I suffered a stress fracture when younger which caused the vertebra slippage (ith. spondy)
~ normal disc degeneration (and over doing with poor lifting technique) created my current situation
~ sports like running will not worsen my condition/slippage and pain should be my only brake to how much I do
~ my core is already strong enough, but I will continue to work on my core and I need to focus on good body mechanics at all times and activating my core

Three books revolutionized my thinking and processing of endurance sports and my back situation which I have been reading during the last few weeks ...
~ Indian Running (classic from the 1980s) and Geronimo: Leadership Strategies of an American Warrior, which both had the message that the ability to work past discomfort & even pain are what made Native Americans amazing endurance athletes.
~ Healing Back Pain: The Mind-Body Connection, which Barefoot Dan Lutes from Indiana recommended, focused on the psychological/mental aspect of pain and our ability to overcome & remove pain.

Results: I have trained gingerly with care and was able to pace my wife through a marathon this last Sunday without almost any back pain.


THANKS for all your input and ready get back to the thoughtful paced process of transitioning to barefooting.
 
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Sounding even better!
 

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