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spondylolisthesis causing nerve impingement
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spondylolisthesis causing nerve impingement - February 8, 2008 3:29:23 PM
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Kaden
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Hey everyone,
I have a patient with stenotic like symptoms created by a spondylolisthesis of L5-S1 unilaterally.
What are thoughts of others on trying grade 1/2 mobs to gap and release/decrease nerve impingement in the face of some instability.
My thought was to go for it as gentle 1/2 mobs won't reach any barrier but wanted thoughts from those out there who have had success or not mobing these type of patients.
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RE: spondylolisthesis causing nerve impingement - February 8, 2008 4:50:59 PM
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Tom Reeves DPT ATC
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If they have a spondy and stenosis, flex them. abdominal training, elastic binder, iliopsoas stretching, rectus femoris stretching, knee to chest etc. I would not do any PA mobs since that would push them further toward an extreme position and it is that extreme position that causes their pain.
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RE: spondylolisthesis causing nerve impingement - February 8, 2008 5:27:05 PM
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Kaden
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Thanks Tom,
I have been doing flexion, stabs, etc. He still seems to have some NR compression I feel most likely from inflammation. I would not do a PA but was considering some gentle gapping and local traction.
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RE: spondylolisthesis causing nerve impingement - February 8, 2008 6:12:43 PM
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Tom Reeves DPT ATC
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sorry if I came off like a dink. I would still worry about moving essentially a fracture. gapping the facet/opening the neural foramina is a good thing but I don' think i would mobilize them. You could gap just by positioning. the traction wouldn't last much but if you could teach them to get into a similar position then it would be helpful.
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RE: spondylolisthesis causing nerve impingement - February 9, 2008 9:53:23 AM
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PTupdate.com
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I will usually position these patients, and move them as well, in directions that alleviate their chief complaint.. ....of course that is usually flexion, but not always.
I always mobilize the hypomobile segments around the problematic, more hypermobile involved segment. My feelings are that each lumbar segment should be contributing it's "fair share" to extension movements. Once one level does all the work, pain and damage progression occurs. This is often where we will see that fulcrum effect in a high school kid, where all their extension occurs at one level, and then nobody is surprised when that level suffers the stress fracture.
As far as the involved level(s), there should be no problem performing oscillatory low grade mobilizations in an attempt to provide pain relief or inhibition
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John M. Duffy, PT
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RE: spondylolisthesis causing nerve impingement - February 9, 2008 11:43:41 PM
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bonez
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I have trouble with the concept of unilateral spondylolithesis. If the pars defect is truly unilateral and they are lithesed then other pathology has to contribute to the shift.(facet wear etc). Otherwise we are dealing with a spondylolysis.
True bilateral isthmic defects are most often stable and will respond to many of the mentioned techniques plus some not mentioned. There is an old technique done in the prone position not unlike skin rolling with a small hvla "tug" A to P which will mobilize/cavitate the L5(or what ever level) facets If this is a source of the symptoms.
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RE: spondylolisthesis causing nerve impingement - February 10, 2008 3:02:12 AM
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Kaden
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bonez,
I have seen that technique and like it. Thanks for the advice. Sorry, I should have clarified that the stenosis in unilateral not the spondy. I agree with your comments about the unilateral spondy.
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RE: spondylolisthesis causing nerve impingement - February 11, 2008 9:49:17 AM
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Shill
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From: Madison WI USA
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Kaden,
What is the grade of the spondylolisthesis? When these are present, one can assume that this is the cause of symptoms. Unless other tests have been done as well, there could be other stuff taking up space in that neural foramen as well. There are studies available that show that grade 1-2 spondylolistheses can be normal variants. I can try to cite them, but so can anyone else with access these days. We are sometimes taught to believe that there is a block teetering on the edge of a cliff, and if we extend them (or mobilize them PA) it will fall over the edge of the abyss, only to cause severe pain and disability. This is likely not the case, and, if one follows John Duffy's advice, and moves someone carefully in order to look for a directional preference, it is also not likely that the patient would be harmed in any way. My opinion would be that mobilizations are fine too, you are not going to push them off the cliff, unless you stand on the patient, do some elbow drops from height, or do something else that might be considered a bit extreme.
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RE: spondylolisthesis causing nerve impingement - February 11, 2008 11:44:52 AM
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Kaden
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Shill,
I am not sure of the grade. He was diagnosed with it 15 years ago. I have asked him to inquire about x-rays so we know grade and what type.
It is good to see that many of you don't take the "edge of the cliff" approach as we are taught in school. I was taught that too but have often found many of these spondy's fairly stable.
I often get patients, especially with degenerative type spondy's that are very stable as these often never progress past a grade I.
In general, I have been mobing these types of patients and since this goes against the wisdom (or sometimes lack there of) in school I wanted to see what others thought.
Thanks
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RE: spondylolisthesis causing nerve impingement - February 12, 2008 10:53:19 AM
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ptim
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He was diagnoses 15 years ago, but probably has had since a teenager, and probably doesn't move so don't worry about it. Spondy's and Stenosis are radiographic findings, move him and see what happens to his leg symptoms.
Look at extension as well as flexion
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RE: spondylolisthesis causing nerve impingement - February 12, 2008 11:09:56 PM
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eam
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I also mobilize these patients-it all depends on what you find on the initial eval. I often find that looking at the hip is helpful as they are often limited into extension. Regaining some extension below will help. Also, look at thoracic spine - see if you can get something moving up in that part of the spine as well. There was a piece written about a couple of years ago by the EIM folks- (Fritz et al) about manual therapy and lumbar spinal stenosis-not sure if spondy was a sub group here. (but I also find that grade I's are fairly benign here). Not only did they mobilize these patients they manipulated them as well. All with good results. I have the paper at work. I am not so great at posting this stuff on the web! Check their web site-it should still be there!
Erica
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RE: spondylolisthesis causing nerve impingement - March 3, 2008 6:02:02 AM
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bbronk
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I say the spondylo is irrelevant. it's really a muscle pull to a weight bearing joint. and yes I know it feels everything like a nerve and nothing like a muscle. when you pull a surface muscle you can identify it as muscular. when you pull a muscle in direct support of a weight bearing joint it's more like an earthquake.
had a spondylo case awhile back. she was forced in by someone I'd fixed and didn't really want to be there. chronic pain for about a year affecting every aspect of life. she seeing the best orthopedists, they showed it to her right there on x-ray, what can I possibly do about that?
simple, it's been there all along. if it's been there all along, why wasn't she in pain all along? because the muscles supporting it were holding stable.
all I need is a chance, though she wasn't about to give anything up until absolutely positive. I can tell when people getting better, I'd ask her how she doing, and she'd be like, I don't know, can't tell. in time she finally had to give it up and admit she couldn't believe how much better she felt.
see ****.com for more info.
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RE: spondylolisthesis causing nerve impingement - March 3, 2008 6:45:02 PM
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ptim
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bbronk
stop typing!
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RE: spondylolisthesis causing nerve impingement - March 3, 2008 9:29:09 PM
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bbronk
Posts: 26
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From: CA
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I've been around a long time, studied from too many false prophets claiming to have the answers, and as skeptical as anyone, there's tons of bs out there.
just check out my website. your bs meter won't budge, cause there isn't any. I promise you I'm the genuine article. (and I'm not the genius, just a messenger)
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RE: spondylolisthesis causing nerve impingement - March 3, 2008 11:34:17 PM
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Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
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Hello Dr. Bronk. I checked out your website. I am impressed. I do not think I have ever seen so many fabulous testimonials/case descriptions/anecdotes on one site. Well done!
A teensie question: When you were at your chiropractic school, did you sleep through every neurophysiology class? And was the "Understanding scientific principles 101" class too far to get to?
Oh, a flat tire on the tricycle...I see.
_____________________________
Mundi vult decipi
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RE: spondylolisthesis causing nerve impingement - March 4, 2008 12:57:19 AM
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bbronk
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"experts" once thought the earth was flat too. you know how that turned out.
yes, we are rewriting the book on back pain. many of our currently held models are absolutely inaccurate.
why do you think surgery is so unsuccessful? the flaws in disc theory are NUMEROUS and well documented.
I stand behind EVERY word I say.
again, I'm not the genius, just a messenger. I've no ego involved. by dumb luck I've stumbled across a great truth. it's ok if you're not interested.
those who seek the truth will find it here: ****.com
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RE: spondylolisthesis causing nerve impingement - March 4, 2008 12:58:43 AM
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bbronk
Posts: 26
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From: CA
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one day you're all going to look REAL dated.
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RE: spondylolisthesis causing nerve impingement - March 4, 2008 1:24:32 AM
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steve
Posts: 470
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From: Canada
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Bbronk,
I think everyone is looking for you to engage in some real discussion with, at the very minimum, some sound physiological reasoning behind your intervention and a thourough description of what it is you do. At present, you just sound like you are hosting a very poor infomercial.
As for being dated, the posters here are using the best evidence to guide clinical practice and are for the most part changing clinical patterns as new evidence emerges. I could replace the words "Snakeoil" with "Deep muscle therapy" and no one would even notice...
Steve
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RE: spondylolisthesis causing nerve impingement - March 4, 2008 2:20:58 AM
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bbronk
Posts: 26
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From: CA
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this is quite unbelievable. if you can't look at my website and see that I'm NOT a snake oil salesman I don't know what to say.
if you can't understand the sound arguments I make on the website, I don't know what to say.
if you think I'm going to write a book here to teach try and teach you the technique, think again.
while it may be possible, it's very difficult to appreciate in words. it's very much a feeling thing. and very exacting. the best way for you to learn is for me to demonstrate a stroke on you and have you do it on me. you learn it in segments. you might be good on the neck but clueless in the low back. each area has it's own intracacies. (spelling?) I can't tell from watching if a good stroke is being performed. you can be right on top of it and not getting it right.
and again. I stand by each and every word I say. what I have to share is solid gold.
I will submit to a polygraph test if anyone wants to pay for one.
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RE: spondylolisthesis causing nerve impingement - March 4, 2008 7:21:05 AM
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Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
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LMAO. I have no doubt you believe yourself; a polygraph. Now there's a new one - this will REALLY convince me. "a feeling thing". Uhuh.
Bye bye, Bronk. Those men in white coats are really nice.
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Mundi vult decipi
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