This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2022. For the original video go to
Brad: We’re going to do this on back pain associated with these four diagnoses. They are probably the most difficult for me to pronounce, and different people pronounce them differently. So if you get diagnosed with either spondylolysis, spondylolisthesis, spondylitis, or spondylosis, don’t worry. For the majority of these diagnoses, it’s not necessarily serious. It can be, but we’re going to go through them one at a time.
Bob: I would say for the majority, it’s not serious. You know the thing is that they all sound similar because they all involve spondy, which is?
Brad: The spine. I don’t know if it’s Latin or Greek but it’s one of those. Once you understand these, it’s not so bad with any luck. So, spondylolysis is typically in the low back. It doesn’t have to be though. We’re going to look at it in the low back because many of these are. What we are going to do, let’s say we pick out 1,2,3,4 on the 5th vertebra is where you have this diagnosis with spondylolysis, it’s a stress fracture in the vertebra. Often times it’s from multiple movements, something of that nature. You don’t really know what happened, it just starts to hurt. It’s typically found with a C-scan, not an X-ray. Although, you can see if with an X-ray but that’s beyond our capabilities. If we look at the 4th vertebra on this model, and we’ve got the pelvis, the sacrum. We are right above belt level. Vertebrae are basically all the same, from the lumbar to the neck, they’re just shaped a little differently.
Bob: Yeah, they are.
Brad: They have the same parts. If you look at this line right here, that is the pars interarticularis. That is where you have the stress fracture, right there. The spinal cord is right here. We’ve got the peripheral nerves here. So, it’s close to a lot of important structures.
Bob: Fortunately, it’s only on one side.
Brad: Right. There’s no real physical movement there, on the vast majority.
Bob: Right, the spine, the vertebra stays stable.
Brad: Typically, you have back pain with this. The back pain is typically worse when you extend backward, so you avoid that. 1 out of 20 people has this diagnosis. Often times it’s asymptomatic. Typically, it goes, and people live their life with some back pain. They avoid extension, it’s not a real big deal.
Bob: It might not even give them any pain.
Brad: Right, exactly. Let’s go to the next one. Now, this is a mouthful. I’m really particular to this one because I have this diagnosis and have a good model of it. Spondylolisthesis. This is where, it’s the same fracture of the par interarticularis, except the fracture is not just on one side, it’s on both sides. The 'thesis' is the movement, so you actually have movement of one vertebra on top of the other. So, these are vertebra coffee cups. They start out, lined up like they’re supposed to, and one shifts forward like this one. L4, L5 are the most common ones that are moved. This is what I have. There are four grades, 1, 2, 3, 4.
Bob: So, grade 1 would be very slight, by the time you get to 4, it might need surgery.
Brad: They’ll put in typically, hardware, something to stabilize it with surgery. It doesn’t get to that point very often. 5%-7% of the population have this to a certain degree, they estimate. It can be asymptomatic or non-painful. Oftentimes, it does result in back pain. Mine, at this point, the disc actually disintegrates, or it’s fused.
Bob: So, the L4 vertebrae become fused to the L5 vertebrae.
Brad: That doesn’t happen overnight.
Bob: You had symptoms at one point where you couldn’t run. You had pain all the way down the legs.
Brad: Yep, because what will happen is that the gap changes and you get some pinching on the nerve and you get some sciatic symptoms with it.
Bob: You could also get pinching on the main spinal cord.
Brad: Yeah. I don’t know if that’s quite as common, but sciatica is more common. If you have this, you should see someone. We’ve got great videos on it. There are some specific exercises you can do to help curb this. Mine has stabilized over a few years. I’m back to running. I ski. I do a number of things. But I’m careful, relatively. So, that’s spondylolisthesis. There is such a thing as retro-spondy, where the vertebrae actually move in the opposite direction. It’s not near as common but people do ask for that. We do have a video on it.
Bob: But it actually, the symptoms are the same, going back, is going to hurt?
Brad: No, I think you flex forward on that one. I’d have to look at my video, but I did do research on that, and the videos are out. I didn't refresh my memory though. Typically, I do want to mention if you’re younger and you have this like gymnasts often have it when they land, or you jump off a higher level like off a back of a pickup truck and you land with your back arched that you can spur this on. Mine I think started either in wrestling with a really silly move that I hope they outlawed by now or made it illegal.
Bob: You getting pinned?
Brad: No, no, if I show you, you will not believe they allowed that move where you arch back. Anyways, knee boarding is where I really arched it hard. Where you jump the wake, and your knees are strapped down anyways.
Bob: It sounds like waterboarding.
Brad: Yeah, it’s a little different than that but it definitely hurt. Anyways, if you’re younger, usually 4-6 weeks of serious therapy and exercises and you should be ready to go back to the event.
Bob: Really kind of showing you what you can do and what you can’t. Also, how to manage things when things go bad.
Brad: Exactly. So, the next one’s spondylitis. So, 'spondy' means spine, and 'itis' means inflammation. So, it's simply an inflammation of the spine. This often time occurs around the facet joints where arthritis can set in and cause inflammation. There are other reasons for inflammation; there are up to eight forms of spondylitis. So, if you have this, you need to talk to your doctor and get details.
Bob: The most common is ankylosing spondylitis. In that case, it’s the entire spine that gets affected. It gets a bamboo appearance. If you look at the spine, especially from the front view, it looks like bamboo.
Brad: I think part of that is because there’s degeneration of the disc and then the bones start to fuse together. They get very rigid and stiff. So activity and gentle stretching, pretty much on all of these, is important. You just need to know which direction to stretch and which direction not to stretch.
Bob: What I remember about ankylosing spondylitis it would affect the shoulders and the hips too.
Brad: Sure, it’s one of those things that may be a little systemic. Again, refer to your doctor on that and make sure you understand it. Spondylosis. This is probably the vaguest term because 'spondy,' spine, and 'osis' just means a lesion or a pathology of the spine. Typically, it’s a degenerative spine disorder. It gets worse with age. It’s like getting gray hair. You might get this diagnosis and it’s because you have a spine that’s degenerating, but it’s not unusual.
Bob: It’s like arthritis really. It’s just degenerating and not being what it was.
Brad: Right. For example, in the United States, 3 million people are diagnosed with this every year and they’re living a life relatively normally. They probably have some pain, and they are taking some over-the-counter meds oftentimes. It can get worse. It can get to the point at the serious end, where the spinal cord goes in and is actually getting compressed and causing some problems. You’ll know about that. Your doctor will definitely talk to you about that and approach that accordingly.
Bob: A friend who had the cervical spine and they called it cervical stenosis and he was getting symptoms out into his legs.
Brad: It’s not a common one like you said, but it can be so be aware. Keep in close touch with your doctor if you have that. So, you can clear that out and they’ll let you know. So, there you go, we have the four spondys. They are a mouthful. Good luck with your back and we hope that everything goes well.
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