As an osteopath, I see a lot of spinal based issues be it neck, mid or lower back problems. The most common spinal issues seen in clinic include disc herniation, degenerative disc disease, ligament sprains and spondylolisthesis. One of these patients is shown in a case study below:
Case Report

Mr J was a 42 year old Engineer who came to see me following a long history of low back pain, possibly from a career in martial arts and being thrown onto the floor multiple times.

He had pain waking him at night when turning in bed, lying down and standing around for long periods and his pain was relieved by yoga/pilates. He described his pain like a tight band across the lower back which radiated into his buttocks and the front of thigh. He had no pins and needles, altered sensation or numbness in the legs.

After trying conservative treatment, he was advised he needed surgery to fuse/stabilise the area and improve his quality of life. Mr J wanted to exhaust all available treatment options before commiting to surgery, as most spinal surgery has an associated risk of paralysis of around 0.1%, or one in a thousand cases. Why go straight for surgery when there are other treatment options which are risk-free?

Mr J had an osteopathy session once a week to treat the severe back pain, which responded very well to treatment. Now, Mr J comes around every 2 months for maintenance treatment involving soft tissue massage, mobilisation of the mid, lower back and hips, acupuncture and manipulation of his mid back.

Mr J finds that he can maintain his great function and pain relief with daily back exercises, which, in his case, avoids extension. He practices mindfulness meditation for sleep.

Now, Mr J is usually pain free and is only left with an occasional ache if he does too much lifting in work.

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L5/S1 Lytic Spondylolisthesis
This standing lateral radiograph (X Ray) shows the defect which
has allowed the slippage to occur. The percentage slip of x/y%
makes this a 20%, or grade 1 slip.

What is Spondylolisthesis?

Spondylolisthesis is a condition where a vertebrae slips forward, most commonly L4-S1, as a result of degeneration, trauma or congenital abnormalities. Signs and symptoms can include nerve pain (like sciatica), referred pain into buttocks, groin or legs, stiffness in the lower back, tight hamstrings and a step or excessive curve in the lower back, however the condition can also be asymptomatic (show no symptoms).

The most common types of spondylolisthesis are:

  • Degenerative – where the facet joints at the side of the spine wear and the big strong ligament that supports the area becomes weakened (ligamentum flavum).
  • Isthmic – the most common with 90% being low grade (grade 1-2) and can have 3 sub-types: pars acute fracture, pars fatigue fracture and pars elongation due to multiple healed stress fractures.
  • Traumatic – e.g. from a fall or sport

There are also four grades of spondylolisthesis – grade 1 <25% slippage of the vertebrae forward, grade 2 25-50% slippage, grade 3 50-75% slippage and grade 4 >75% slippage.

Diagnosis of a spondylolisthesis is usually confirmed via standing x-ray or MRI scan. Once diagnosed, your treatment can vary from physiotherapy or osteopathy, steroid injections and exercises, through to surgical stabilisation of the area affected.

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MRI of the lumbar spine
The L5/S1 disc is sheared by the L5/S1
spondylolisthesis. Note the slippage appears
less on the MRI, because the spine is lying down
and, therefore, not loaded.

 

How can osteopathy help me?

Osteopaths treat a wide range of people from sports persons to office workers and from retired gardeners to pregnant ladies. We can treat conditions such as arthritis symptoms, back, neck, foot, ankle, hip, knee, shoulder, elbow pain and headaches. This is not an exhaustive list however and new evidence is coming out as the professional continues to grow.

Osteopaths use a combination of movement, stretching, targeted deep tissue massage and manipulation of a person’s muscles and joints to improve function, relieve pain and aid recovery .They can also use further techniques such as acupuncture, taping and exercise prescription, thus giving the patient a complete package.

Osteopaths work on the theory that the body has the natural ability to maintain itself and, by helping this process, an osteopath can promote restoration of normal function. The principle of osteopathy is that the wellbeing of an individual relies on the way that bones, muscles, ligaments, connective tissue and internal structures work with each other.

References

In Wollowick, A. L., & In Sarwahi, V. (2015). Spondylolisthesis: Diagnosis, non-surgical management, and surgical techniques.

Institute of Osteopathy | Osteopathy works. (n.d.). Retrieved from http://www.osteopathy.org/

Kalichman, L., & Hunter, D. J. (2007). Diagnosis and conservative management of degenerative lumbar spondylolisthesis. European Spine Journal, 17(3), 327-335.

Nemani, V. M., Kim, H. J., & Cunningham, M. E. (2015). Anatomy and Biomechanics Relevant to Spondylolisthesis. Spondylolisthesis, 17-23.

Thornhill, B. A., Green, D. J., & Schoenfeld, A. H. (2015). Imaging Techniques for the Diagnosis of Spondylolisthesis. Spondylolisthesis, 59-94.

Visiting an osteopath – General Osteopathic Council. (n.d.). Retrieved from http://www.osteopathy.org.uk/visiting-an-osteopath/

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