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OT- Can you look at my MRI spinal scans. See L5-S1

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dirtrunr

Sep 18, 09 15:15

Post #26 of 34 (293 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [CURRY] [In reply to]	Can't Post

The character of his spine. He has DDD at L5-S1 and a retrolisthesis of 5 on 1 from the looks of his pic. Where do you disagree? What else are you seeing? Based on that retro slip, I would not force him into extension based movements when he clearly has an unstable segment.

dirtrunr

Sep 18, 09 15:41

Post #27 of 34 (276 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [sperera] [In reply to]	Can't Post

No problem man. Good luck with your prognosis. It may hurt like hell now, but one thing to keep in mind is that there are backs that look a hell of alot worse than your's in pictures that live in people that are having no pain. The best thing to do is to get on a good program and stick to it religiously (when you're hurting, and most importantly, when you're not).

CURRY

Sep 18, 09 16:01

Post #28 of 34 (268 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [dirtrunr] [In reply to]	Can't Post

Makes sense. Thanks.

I like your thought process; my only picky point I wonder about is calling it 'clearly unstable at L5-S1',...I think the only way to determine instability would be seeing excessive translation between the two segments with a flexion-extension study. Mind you, in practice I often use the term instability liberally, more or less to describe weakness/vulerability suggesting a need for improvement in core strength/intersegmental m. activation,...so with this, I can't be critical. Unfortunately, with all the images and history given, you still can't nor shouldn't comment on whether spinal manipulative therapy could be of benefit. If however, you believe the segment is truely hypermobile purely based on the fact there's a grade one retrolistesis,...I can appreciate why would wouldn't want to manipulate it - however, I would not be comfortable saying so without definitely determining truth in this deductive reasoning.

http://www.bikeforest.com/scott

orthogirl

Sep 18, 09 16:36

Post #29 of 34 (343 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [docjeter] [In reply to]	Can't Post

this is good advice.

OP--post some axial cuts at 5-1

unlikely to be unstable; grade 1s rarely progress, need flex-ext views to confirm either way though

TDR too new for long term, although spine probably has a couple. indicated for persistent single level disease. discograms, while painful and of limited utility in most cases, can help to confirm level and presence of single-level sx.

5-1 fusion would work, but adjacent level deg is pretty likely. and agreed, you are pretty far from this step.

ESI, PT, chiropracter if you are into that, are all good options in the absence of leg symptoms. chronic radicular sx bear consideration for diskectomy, but hard to eval without axial cuts.

good luck. lbp sucks.

<O><O><O><O><O><O><O><O><O>

"But it ain't about how hard you hit, it is about how hard you can get hit and keep moving forward, how much can you take and keep moving forward. That's how winning is done!" -Rocky Balboa

dirtrunr

Sep 18, 09 19:58

Post #30 of 34 (321 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [CURRY] [In reply to]	Can't Post

Fair enough, and certainly point taken. At this point, it's really all mental masturbation, but may be of benefit to the original poster to see a clinical thought process in action. In all reality, neither one of us can say what we would do without getting our hands on him. Theoretically, I wouldn't expect him to see much of a benefit to extension on movement testing, as that motion is simply forcing the segment further posterior. I very well may utilize SMT (manipulation) myself with his case because he may present with a locked up segment, SIJ issues, etc and benefit in the short term from it. Long term, I dont think that will fix his problem. I do think that core stability will be of huge benefit long term. Also, like you said, just because it's a grade 1 doesn't necessarily mean it's hypermobile. Odds are, a good number of the general population are walking around with much worse with no back pain at all.

Of course, I probably wouldn't have half the patients I do if everybody spent a little bit of time everyday doing core stabilization and maintained a healthy weight! (Of course, my practice would grow huge if folks slammed out as many crunches as they could handle daily! lol)

mharris

Oct 10, 09 14:20

Post #31 of 34 (266 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [docjeter] [In reply to]	Can't Post

docjeter, I seem to be in a similiar situation. MRI this week shows 2 mild bulging disks and one large. Back to the doc next week for the review. I took the season off thinking I had a hamstring tear that would not heal. I'm thinking that my issue is sciatica caused by the bulging disks. been on PT for a month, lotsof McKenzies etc. What I can't seem to find an answer to is... Will the PT cure completly the bulges and get me back to normal, or uis this typically a lifetime issue now that core strenghthening will only help to control. Can't imagine life without racing :(.

Your thoughts and anyone elses are appreciated.
M

mharris

Oct 29, 09 17:43

Post #32 of 34 (225 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [dirtrunr] [In reply to]	Can't Post

"Of course, I probably wouldn't have half the patients I do if everybody spent a little bit of time everyday doing core stabilization and maintained a healthy weight! (Of course, my practice would grow huge if folks slammed out as many crunches as they could handle daily! lol) "

dirtrunr, could you please elaborate on your comment about "crunches"? I beleive you are referring to back pain brought on by performing incorrect crunch motions, rounding the back. But if there is more to it, please share.

dirtrunr

Oct 30, 09 2:48

Post #33 of 34 (191 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [mharris] [In reply to]	Can't Post

Yup, you got it. The majority of spine injuries are caused by repetitive loading into flexion causing the force to be absorbed by the disc alone rather than the whole spine or the whole spinal segment mechanism. If you add rotation into the motion, the risk for injury goes up a good bit more. This is mimicked by a crunch motion (especially a crunch with rotation). There are enough isometric core stabilization exercises out there that there's no real need to utilize this motion to train the muscles.

Some leading people in the strength training industry (Mike Boyle and that school of training thought) do NO spinal flexion. This includes squats, pilates, some yoga moves, etc. I'm not this militant about it, depending on the specific case of course.

mharris

Oct 30, 09 16:20

Post #34 of 34 (142 views)

Re: OT- Can you look at my MRI spinal scans. See L5-S1 [dirtrunr] [In reply to]	Can't Post

Thanks dirtrunr. I'm finally getting to the bottom of my personal hell hole here. Various injuries kept me from running and swimming so I hit the weights consistantly. Lots of crunches including obliques, always felt uncomfortable around the lower back but needed to get the reps out, damn it!

The knee gets a rest while the back gets worse and worse till MRI reveals 2 large bulging disks. Lowered aero bars didn't help either.

So its been McKenzies and various plank positions for a couple of months now plus an epidural. Guess I'll stick with it.

Live and learn

Thanks again. Mike

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