Spondylolisthesis

You are probably looking at my blog title and saying...spondyloli-what???
Well, I have been seeing this condition more often in the clinic lately and so I thought I would write a blog about it since I "had" the condition.

Spondylolisthesis sounds like a big word, however breaking it down makes it more simple. Spondylo- refers to the "spine" and -listhesis refers to "slippage of". Put it together and it means a slippage of the spine. Spondylolisthesis is the condition where one vertebrae (bone of your spine) slips forward on an adjacent one. This usually occurs in the lumbar spine (lower back). The slippage can be present at birth, occur in early childhood, or appear at any time later on in life. It can be the result of a structural deformity, trauma, or degeneration of the vertebrae. It is common in dancers, gymnasts, javelin throwers, divers, football linemen, weight lifters with improper technique. It can be easily diagnosed with an x-ray. Sounds scary, doesn't it? Well, it can be, but I had one and I live to tell so it can't be that bad, right?

Here is my story...
I have been dancing since I was 5 years old (jazz, tap, theater dancing) and playing sports since I was 9 years old (basketball and softball mostly). In high school, I picked up a new hobby...throwing a javelin. Random, I know. The track and field team at my high school needed more athletes and my friends were on the team. So, I joined so I could hang out with them after school and pass time before dance practice at night. I quickly learned to throw discus, shot put, and javelin. Those of you who know me probably cannot picture me throwing a shot put (haha). Hey, I never said I was actually good at throwing shot put, however, I was decent at discus and very good at javelin. When I graduated, I went to college and threw javelin there as well. I had a blast doing it, until one day I woke up with severe back pain. Long story short, I had to stop throwing javelin once my physician discovered that I had a spondylolithesis. Just like most of you when you read the title of this blog, I said spondyloli....whhhaaaat?!? So, needless to say I had to give up throwing javelin. I decided to workout as often as I could and focus on my core in order to keep my back feeling strong and decrease the amount of "ache" on an everyday basis. Unfortunately, my spondy (as I like to call it) become more unstable and slipped from a 25% in 1999 to an 85% in 2004. I required surgery known as spinal fusion in order to stabilize my spine. Many people live with spondylolisthesis from 25-50% and are very functional with minimal pain. I was living with an 85% with minimal pain, but an 85% slippage is too unstable to "play it safe". I received spinal fusion surgery in 2004. They fused three of my vertebral levels in my lumbar spine (lower back). Following surgery, I received physical therapy 3x/week for 3 months (what my insurance would allow) and I also did my exercises on my own. Physical therapy is essentially what brought me back to "normal function" again. I was able to be the energetic and active person I have always been. The true test was working Rutgers football camp the summer (a year and 2 months) after my surgery. I made it through with flying colors! I cannot tell you how happy and relieved I was. I never said it was easy or that I had no aches and pains throughout the way, but I took good care of my back and made it through with a huge smile on my face. I am currently a full-time physical therapist and it definitely helps my back having such an active job. Prolonged sitting and standing are still not something I can tolerate for longer than an hour or two. I feel so stiff as well as muscle tightness and ache if I sit or stand for too long. I must work out my core, stretch, and keep my body strong in order to counteract back pain. If I stop being active/training my body feels like I have aged 10 years! It's amazing what a difference exercise and stretching can do for back pain. I barely notice my back when I am on a consistent workout schedule. So, I make time in my busy schedule to keep active (working on my patients all day helps with this too!).

So now that you know a little more about me and my condition let's talk about you.
Back pain is not an end to life the way you know or knew it. The pain is grueling, extremely depressing, and it may feel as if you have an annoying little devil riding on your back 24/7, but I promise you there is hope. You NEED to seek professional medical help. Don't Google your symptoms and expect an answer. Don't print out stretches and exercises online until consulting with a medical professional first because they may not be the right exercises for you. When it comes to back pain there are certain motions that should be avoided depending on the condition. Many of these exercises contain all different motions and you may harm yourself more and not know it.

Here are common symptoms of a spondylolisthesis (that I have had or patients with this condition have explained to me):
- general ache in lower back region
- in some cases, sciatica pain, numbness, tingling, or weakness in the leg(s)
- aching pain in lower back when lying flat on stomach
- aching pain when lying flat on back with knees straight (usually unable to tolerate)
- intermittent muscle spasms on one side/both sides of the spine (usually in the lower back)
- pain when bending backward/with back extension (in standing/sitting/lying down)

Tips on how to prevent further slippage and decrease back pain if you have spondylolisthesis:
- avoid hyperextension of your spine (excessive backward bending) - try to keep your spine in neutral during sitting, standing, and exercise.
- avoid lying or sleeping on your stomach - if you are lying on your belly place 1-2 pillows underneath your hips and a bolster/rolled towel under your ankles.
- avoid lying or sleeping flat on your back with both legs straight - try keeping your knees bent or placing 2 pillows underneath your knees to relieve the pressure off of your lower back.
- DO stretch your lower back muscles (sit with pillow on your lap and lean forward 3 x 30 sec./perform Child's pose stretch), hamstrings (back of your thigh), hip flexors (front of your thigh), glutes (buttocks)/piriformis.
- DO perform core strengthening exercises everyday. Your core should be activated during everything that you do!!
-DO seek advice from a medical professional if you believe you have this condition. Don't be afraid. A year from now you will be happy you did what you did today.

Any questions please email me (sara@mavenpt.com) or comment on my blog.

Just Breathe...

Sometimes when life gets stressful and busy we forget the most important thing to do and that is to BREATHE. Over the past week my life had gotten pretty hectic. My daughter was sick for the first time and being a first time parent I was so worried about her. It turned out to a common virus that many children under two catch called Roseola. Roseola causes high fever in children under the age of two for five days and on the fifth day they break out in a rash. So after doctors and ER visits we finally figured out what it was.

During this stressful week I had to constantly telling myself, "Sara, don't forget to breathe". Sounds silly, doesn't it? Well, it's not. Breathing provides the oxygen that our mind and body need to function optimally. Without, oxygen we allow more carbon dioxide and other toxins to invade our bloodstream which promote fatigue and decreased concentration/alertness. This can cause us to make poor decisions. At this time when I am making decisions for my little girl, the last thing I needed was lack of focus.

Here is a simple breathing exercises that I use and that I often teach my patients:

Lie on your back and place one hand just above your belly button and the other hand on your chest.
Take a deep breath in through your nose and focus on your bottom hand that is just above your belly button rising as you fully breathe in. Your top hand should only move slightly at the top of the breathe; it should not be the first and only hand to move while taking in your breathe.
Breathe in 1...2...3.
Then exhale through your mouth as if you are trying to fog a mirror feeling your bottom slowly lower (moving towards your spine/back).

Initially, you can perform this exercise for 5 minutes and then try to increase your time. Eventually, you will breathe like this without having to think about it.

Good luck and DON'T FORGET TO BREATHE. =0)

Weight Loss Tips: What worked for me

In lieu of this weekend's seminar I wanted to give you a weight loss tip that has worked for me in the past. Two years ago I worked with a personal trainer three times per week. My goal was to tone up and lose weight. That I did, but not without hardwork, sacrifice, and commitment.

My personal trainer wanted me to keep a food journal. I laughed at him. He said he was so serious and he handed me a notebook and a calorie counting book that was small enough that I could carry it everywhere I went. It was perfect for me because it had every restaurant/cafe you could ever imagine (i.e I loved that it had two of my favorite places; Starbucks and Houlihan's) so I never had to wonder how many calories I was consuming.

During our initial assessment, he figured out how many calories I should consume in order to lose weight and wrote that number on the inside of the notebook. He also instructed me that I shouldn't eat after 6pm. You can imagine how wide my eyes got when he said that!! Every week I had to hand in my book to my personal trainer like homework. This also helped me stick with the journal because he would really get on my case if I didn't stick to the plan. The trick to the food journal is to write down the calories down BEFORE you eat them. Oh boy, was this a reality check! I remember when I was about to eat a cookie and I wrote down the calories in my food journal. I immediately crossed it out and decided against eating that cookie! I then chose a snack with a more reasonable calorie count.

I worked out with him three days per week for 45 minutes of resistance training and 15 minutes of stretching at the end of the session. I did 30-45 minutes of cardiovascular training (I most did elliptical, upright bicycle, recumbent bicycle with rowing) 3-4 times per week. I logged all of my workouts because it helped me organize my week and see what I had accomplished. It felt really good to write down my exercise in my workout journal.

In the end, I ended up losing 13.5 lbs and became toned and flexible again! It was such a great feeling and I was extremely proud of myself.

My weight loss tips:
1. Buy a notebook and start a food journal.
2. Purchase a calorie counting book or log on to a website that works best for YOU.
3. Write down the calories before you ingest them. Then decide if you want to still ingest them.
4. Start eating early aka eat breakfast and then don't eat late (after 6pm or 7pm).
5. Buy a notebook or use the food journal notebook and start a workout journal.
6. Find a person who you see weekly that you must hand your food journal over to in order to keep you on track.
7. Don't cheat because you're only cheating yourself!
8. Perform resistance training 3x/wk for 45-60 min.
9. Schedule 10-15 minutes at the end of your workout to stretch the muscles you just worked.
10. Perform cardiovascular training 3-4x/wk for 30-45 minutes.
11. Believe in yourself and don't give up!

Video Gaming and Back Pain

'Tis the season or 'tis always the season for video games!

After the holidays, I have had a handful of patients with increased back pain. They complain of tightness in their lower back, hamstrings (the back of the thighs), and hip flexors (the front of the thighs). I ask them, "What have you been doing differently?" Their answer is usually, "Well nothing really strenuous. I have just been sitting around playing video games for hours at a time." And there you have it! That's where their back pain is coming from. Due to the fact, that the cord to the controller is very short, you must sit on the floor in front of the tv. This puts the body in a position of poor posture and if sustained for periods of >10 minutes will cause tightness of the muscles and joints of the shoulders, back, knees, and hips.

Video games, just like being on the computer, can be time consuming and somewhat addicting. According to the Bureau of Labor Statistics, information received from the American Time Use Survey revealed, in 2008 "individuals ages 15 to 19 read for an average of 0.2 hour (10 minutes)per weekend day while spending 1.0 hour playing games or using a computer for leisure".
Amazing how times have changed. What did we do before video games and computers? I remember playing manhunt outside with my friends all day only to come inside to eat dinner. Unfortunately, life for most kids isn't like that anymore.


Playing video or computer games is setting our young population up for poor posture, which will eventually lead to injury in their future. Here are some suggestions on how to prevent back pain and other injuries in your future.

1. First, limit your playing time. Make a point NOT to sit in front of the tv playing video games for hours. It is not good for your posture, your eyes, your nutrition, or your well-being.

2. Second, get a "video rocker" also known as a "gaming chair". These are somewhat ergonomically correct (well anything is better than sitting on the floor in indian style, right?) chair that is made specifically for gaming on the floor. However, you must still be aware of your posture while sitting in this chair also. Trying not to slouch forward. Tuck your chin back and pinch your shoulder blades together.

3. Third, stretch your muscles after you have been sitting for a while. My suggestions are to stretch your hamstrings (at the back of your thighs), lower back muscles, and pectoralis (chest) muscles for at least 30 seconds for 3 sets each.

4. Last, but not least, consult with a professional on your posture and how to improve it. A physical therapist or physician will be able to look at your posture and advise you whether your posture requires improvement and specific techniques on how to improve it.

If you can't seem to pull yourself away from the tv then try to break your gaming up by using a Wii or Wii Fit. These video games will keep your muscles active and you burn calories while you play. Remember, the Wii is a very dynamic game and it is very similar to a gym work out or playing a recreational sport. Warming up for 5-10 minutes beforehand and stretching will help prevent injury. You don't want to end up in Wii-hab. =)

Happy Gaming!!

Ice vs. Heat

This is probably the most commonly asked question that I hear in the clinic. Should I use ice or heat on my injury and for how long?

When an injury or trauma occurs such as a muscle strain (tear), a direct blow, fracture, etc. inflammation occurs due to rupture of tiny blood vessels surrounding the injury site. The increased volume of blood around the site causes pain, swelling, and bruising of the injured body part. Here are some FAQs regarding when and when not to use ice/heat for an injury.

ACUTE (NEW) INJURY:

Question: Should I use ice or heat?
Answer: Ice. Ice causes your blood vessels to constrict (narrow) in order to draw blood and inflammation away from the site of injury, which decreases pain and swelling. When using an ice pack be sure to place one layer of protection in between your skin and the ice pack (i.e. pillowcase). There are other forms of ice available for use instead of the traditional ice pack. These include ice cup or ice bath. The ice cup can be made by filling up a medium sized Dixie cup with water and freezing it. When ready to use you can rip the top half of the cup off so that the ice is exposed. Then, apply ice to injury site and massage the area by making small circles with moderate pressure for 6 minutes. The ice cup penetrates deeper than the traditional ice pack and is great for quick on-the-go application. The ice bath is very effective, however most are unable to tolerate placing their extremity in a bucket of ice water. First, you fill the bath or a bucket of water with ice and then place your affected extremity into the water for 4-6 minutes.

Question: How many minutes should I keep the ice on my injury?
Answer: You should use ice for 10-20 minutes max. If ice is used for more than 20 minutes it actually does the opposite of what we want it to do. It causes the blood vessels to dilate (widen) allowing increased blood to enter the area of injury. You can use this schedule when icing: 20 minutes on, 1 hour off and repeat 4-8 times per day. Also, make sure to periodically check your skin for ice burns.

Question: How many days should I use ice on my injury?
Answer: The inflammatory phase of healing last 2-4 days, therefore ice should be used up to 4 days following injury.

RECOVERY FROM INJURY:

Question: When I am recovering from an injury, when can I begin to use heat?
Answer: Heat may be applied to injury after day 4. Heat is excellent to use before exercise and/or stretching in order to increase blood flow and relax the muscle.

Question: How many minutes should I put heat on my injury for?
Answer: 10 minutes of heat will suffice prior to exercise. If you want to use it to relax your muscles you may also submerge your body or injury site in a nice, warm, relaxing bath for 20 minutes, twice a day. The water temperature should be between 92 to 96 degrees Fahrenheit.