Case study/ lower back pain(4) ~lumbar spine was sifted backward~

Hello!


My name is Ikuko Murata, I'm a physical therapist and personal trainer (Tokyo).


Today, I will also explain about Mr. S's lower back pain, which is currently being serialized.


In the last three articles, I explained about the right & left shift of her lumbar spine.


Contrary to that, today, I will explain about the forward & backward shift.


This is a different topic from the last three articles, so you can understand this article alone. Today's information would be useful for those who are worried about the lower back pain and round back, especially those who have been diagnosed as "lumbar spondylolisthesis" by orthopedics doctor.



<table of contents>


1. How was her lumbar spine misaligned?


2. Why did her lumbar spine slip backward?


3. What will happen in the future if her lumbar spine remains misaligned?


4. The progress. Misalignment improved!


5. Summary




1. How was her lumbar spine misaligned?

Ms. S's lumbar spine was displaced backwards.


Before that, I will briefly explain about the nomal lumbar spine.


There are five "lumbar bone" (sometimes six),


and they are stacked as L5, L4, L3, L2, and L1 from the bottom.


If these lumbar spine are lined up properly,


there is no particular unevenness when you touch on the spine.




But in her spine, I felt the aria that is unevenness when I touch.


L4 was displaced backwards a little bit against L5.


L3 was also backwards with L4.


←Like this



In the medical word, it is "L4 spondylolisthesis". (maybe...)



However, since there is no her X-ray information, it is not certain that the L4 is really shifted backwards.

(The spinous process of L4 may just be large.)


But... I had the impression L4 was displaced.

(In addition, L2 was a little forward. However, I was not so worried about it because there was not so big unevenness in between L2/3 compared to L4/5.)



And here, if you are familiar with the field of orthopedics,


you might have wondered, "L4 is backward? Not forward?".


In this slip disease of the lumbar spine, there is a common pattern that "the upper vertebral body slides forward against the lower vertebral body".

And in addition, "L4 forward slip" is often happen is the age of 40-50 in women.

So, that's exactly her age.



In fact, I have also encountered the "L4 forward slip" many times.


So she is a rare case, but her L4 was in the back.


(There is a great variety of spine misalignments, so always I try to check carefully & carefully when assessing the spine, but even that still I make mistakes sometimes.)


2. Why did her lumbar spine slip backwards?

So, why did her lumbar spine slip backwards?


The cause seemed to be greatly influenced by her forward leaning posture.


She has a strong habit of forward tilting.


She pushes forward her ribcage, so that her center of gravity is in forward.


With this forward leaning posture, when I tried to correct L3-4 that displaced backward, it hardly moves.


In other words, even if I tried to correct L3-4 to the normal position, it was difficult.



Next, I tried after correcting the forward leaning posture.


I felt that L3-4 can be moved a little bit.


What do you think this means?




This means "there is a possibility that the lumbar spine move backwards to correspond to a forward leaning posture."



In other words,


She has a habit to push her ribcage forward

   ↓

She falls forward(゚Д゚;)

   ↓

 OMG(゚Д゚;)

   ↓

Why doesn't she put her ribcage back?(・∀・)

   ↓

It's difficult, since it's her habit(・ω・)

   ↓

In order to keep the balance, she has to shift somewhere else other than the chest to the back

  ↓

Okay, let's move the lumbar spine back (゚ Д ゚) ノ


This is expected in her body.




← In this way,

the forces are offset by the opposite vector

and stability is obtained by the moving of chest forward and the lumbar spine backward.




This means

if you want to correct the position of L3-4,

without correcting the position of chest, you cannot get a good result.


Rather, we should aim for L3-4 to be automatically corrected by correcting the position of the chest.

(Because it is dangerous to approach the lumbar spine directly, especially in her case, the approach of pushing L4 forward carries the risk of pushing L5 forward.)



And, of course, at this time if the lumbar spine is bent to the right, it will be difficult to correct the forward & backward direction, so to correct the right & left distortion is essential matter. (→The article of her left-right difference problem in her lumbar spine)



3. What will happen in the future if her lumbar spine remains misaligned?

Now, she is 50's.


What will happen if she continue to apply this force for another 30 years?





As a physiotherapist who has seen many elderly patients (up to 108 years old!), I will try to predict her future. (Please read it lightly as it uses a little medical terminology.)



First of all, L4 will shift further back.


And she unknowingly suffers a compression fracture of L4.




And L4, which has slipped back and has a compression fracture, may even sink into L5, rarely.


After that, L5 will suffer a compression fracture also.


While doing so, L3 will also have a compression fracture.


The L4 and L3 vertebral bodies and the L3 / 4 and L4 / 5 discs also compress the posterior nerves, risking spinal stenosis.


She will have a numb leg after walking even for 5 minutes.


However, since the compression stress on the L4 / 5 facets is not strong, nerve root symptoms due to osteophyte formation and intervertebral foramen stenosis are unlikely to occur.

(But L2 / 3 may cause nerve root symptoms.)


If she see an orthopedic doctor after the onset of numbness in her leg, surgery may be recommended.


At this stage, in fact, there are limits what I can help.

Of course I can tell her the exercises to improve her posture, but I can't remove the tissue itself (bones and cartilage) that is compressing the nerves.


I can help her not to make it worse, but I'm honestly not confident that her symptoms will improve.


And if unfortunately the cauda equina symptom becomes really serious and urination and defecation disorders appear, surgery will be inevitable...





Yes, I tried to threaten!


But, in my clinical experience, it's quite real.


To prevent this, she should do her best now on in her 50s!


4. The progress. Misalignment improved a little!

At the third session, her lumbar spine misalignment has improved a little.


The approach we did is:


① Leveling her pelvis with the insole (second time)


② Correct the position of the chest (online group lessons almost every week)



As I mentioned earlier, it was a bit risky to approach the lumbar spine directly, so I didn't do anything to the lumbar spine directly.


To be honest, I was a little surprised that online lessons are quite effective 8->.



Sometimes we have to give up on the anterior slip of the lumbar spine,

but I reconfirmed this from her case:

・ the backward spine slip can be expected to improve a little

・ we can approach the lumbar spine indirectly from other parts


5. Summary

・Her L4 is displaced backward

・Her leaning forward posture slid L4 backward

・Insole and chest exercise could improve her L4 malalignment!

・ She was in her 50s, so she could improve, but if she was in her 60s...8->  Early prevention is important!



I explain about this article in youtube also(in Japanese).


About the information of left & right distortion of her lumbar spine is in these article↓

Case study/Ms.S's lower back pain(1) ~her lumbar spine is not straight~

Case study / Ms.S's lower back pain(2) ~pain appeared after exercising~

Case study / Ms.S's lower back pain(3) ~Comparison with insole and without insole~



I would like to post another article about the common L4 forward slip sometime soon, not rare case like her.




Thank you for reading.

I hope this article will be a helpful information to improve your body!


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