Member Case Study: Spondylolisthesis and Triathlon Training

author : AMSSM

comments : 2

Will I ever be able to run again? Will any type of exercise/physical therapy fix this? I would love to commit to a therapy regimen that would help this if there was some hope of doing more running.

Question from misogi

I have been diagnosed with spondylolisthesis. Will I ever be able to run again? Will any type of exercise/physical therapy fix this? I began training for my first sprint triathlon in January 2007. I am a reasonably healthy at 53 years old, and I was able to train 5-6 days a week following a “Couch to Sprint” training plan. In my late 30's I was running 18-22 miles a week until I suffered two sprained ankles, and I had worked out on stair-type machines since then.

In training, my running progression has lagged behind the other sports, but was sufficient to have a great time at my first triathlon in May 2007. Buoyed by the progress and loving the sport, I kicked up my training for a longer sprint and quickly began having hip, lower back, and ultimately lower leg problems. I have had the hip and back problems before but it did not hold me back. I was told not to run for a month, do some back exercises, take some non-narcotic ant-inflammatory medicine and see if it got better. The pain subsided but was not eliminated, and I still have periodic burning in my lower right leg.

I would love to commit to a regimen that would help this if there was some hope of doing more running in the next sprint, but the doctor had none other than simple back exercises that they give everyone - which I do.... Thanks!!

Answer from Hamish A. Kerr MD, M.Sc.

Member AMSSM

Spondylolisthesis is a slippage between two of the vertebrae in your spine, usually in the lumbar (lower) spine. Some people do not have any symptoms, and the diagnosis is simply made when a spine X-ray is taken. Some people do experience symptoms, including back pain, especially if the slippage increases. Most cases don’t initially progress---some studies show that only 30% of those with a minor degree of slippage tend to progress. Spondylolisthesis can be acute or chronic. It occurs frequently with degenerative change to the structure of the spine with age. In athletes and children, it is often related to a stress fracture in a small piece of the vertebrae called the pars interarticularis. When it is degenerative in nature, spondylolisthesis is more often associated with pain that goes down your leg (sciatica). This is due to nerves being irritated near the slippage.

The best treatment to reduce symptoms associated with spondylolisthesis really depends on the cause, and how severe it is. Minor slips usually respond to core strengthening of muscles such as your external obliques (abdomen), iliopsoas (hip flexor), and other postural muscles that help maintain spinal alignment. Working with a physical therapist to teach proper technique can facilitate building sufficient strength in these muscles. Avoiding exercises that arch the spine (bending you backwards) is important. Swimming is usually well tolerated, and biking may be easier, too, as long as your positioning and bike fit is appropriate (arching the spine tends to aggravate this condition, whereas flexing forward tends to provide relief). Once your core strength is sufficient, a return to running may be possible. Some people choose to use a lumbar brace for support, but this practice is a bit controversial and should not take the place of core strengthening.

Spondylolisthesis of a greater severity may warrant a more invasive approach. The use of pharmaceutical medication for pain control and anti-inflammatory effect can be beneficial. Injections of corticosteroid into the area near any nerve irritation or inflammation can also help sometimes. Some orthopedic surgeons advocate for a procedure to fuse together the two vertebrae that have slipped, while a decompression of the area irritating a nerve is also performed.

Hamish A. Kerr MD, M.Sc.
Sports Medicine, Albany Medical Center, NY.

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date: December 11, 2007