Lower Back Pain caused by Fracture of the Lumbar Vertebrae
Lower back pain is commonly caused by disc bulging however in some cases lower back pain may be caused by a condition known as Spondylolisthesis. Spondylolisthesis occurs when the upper vertebra (L5) slips forward on the S1 vertebrae bone underneath due to a fracture of the pars articularis of the vertebra hinge bone leading to a step deformity appearance. Patients commonly complain of a persistent ach in the lower back coupled with a weak or tired feeling. The condition can also affect the upper lumbar vertebrae.
It can be caused by: a) a deformity of the lower spine since birth, b) can occur due to degenerative changes in the facet (hinge) joints between each vertebra as seen in older patients, c) occur due to a fracture of the pars articularis which is a small section of the lumbar vertebra that joins the facet (hinge) joints to the body of the vertebrae. The fracture of the pars articularis segment of the vertebra leads to one vertebra bone slipping or becoming displaced in relation to the vertabrae bone below it.
Signs & Symptoms
Chronic achy pain in the Lower Spine that worse when standing
On examination, a step deformity can be felt in the lower spine at the crest of the sacrum (lower spine)
Sciatic pain such as buttock and lower leg pain may be present
Increased curvature in the lower spine
Tender vertebra (bone) in lower spine
Reduction in forward bending of the spine
May have a ‘Bent knee stance’ when standing
Tightness or spasm in hamstring muscles
Management & Treatment
Spondylolisthesis is diagnosed by x-ray analysis and its severity is graded between 1-5. Early grades of Spondylolisthesis can be managed by a Physical therapist by incorporating segmental spinal control exercises that stabilise the excessive bending segment of the lumbar spine. This needs to be progressed towards strengthening of the whole spine in a neutral spine position. The use of a lumbar brace can also help to speed up recovery and reduce painful episodes. The patient should avoid manipulation treatment and stretching exercises as they will worsen the condition. Higher grades of forward slippage may require surgical intervention.
Tomás Ryan is a Registered Physical Therapist (MIAPT) with The Irish Association of Physical Therapy and is based in Thurles.
Contact Number: 0504 26672
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