I wrote a topic a while back about training with a 10 year old L5/S1 fusion in which you responded it was safe to train with squats and DL’s. I have had intermittent low back pains for the past 10 years anyways, and after the first month of LP, my anticipated increase in LBP has been pretty good. I did have a pretty rocky start during the first month however. I have what I would describe as “autofusing” of L3/L4/L5 as evidenced by a bony protrusion of the L2 spinous process when I flex forward. My feeling is that this is a stable spondylolysthesis. It is also easily palpable when I am at rest. This does not typically bother me…just means I can’t do sit ups without digging the spine into the floor. When I saw my PCP this year for a physical, his first statement, even before I discussed the spine issue was that I should not be lifting at my age (36) as it is bad for my spine. He didn’t believe me about the spine issue until he felt it. He then immediately stated I should see a spine specialist but when I pressed him that the local orthopedic surgeons can not help me as they typically treat spine trauma and not a “sports” population, he said he didn’t know where to send me. We both agreed that as I am a competitive athlete and do not want to give up weight lifting, that I needed to see someone who is trained in weightlifting in order to make an accurate assessment.
My hope was to get a set of flexion/extension and A-P X-rays to determine a current baseline and then have repeats done in the future to determine the stability/nature of it. My PCP did not want to do this stating it would not likely give him or myself any real information and that I should have someone else interpret the results. I have seen enough X-rays, including my own, to see what has changed and what is the same. The real question now is, does this sound like a reasonable approach and if so, do any of you know any ortho spine docs in the NH or Boston area? I don’t mind a little travel from my current spot in NH but I’d hate to waste the trip to hear “you should stop weight lifting because it is bad for your spine”. Thanks for any input.
I do not know of any sports med docs in that area at this time, as my friend who did his sports med fellowship at Mass General left for warmer weather. I am certain however, that in that densely populated area there are many sports med docs and likely a few who are spine specialists.
THAT BEING SAID, what you describe does not sound like an issue I would order imaging for or potentially even refer you to a spine specialist for further workup without additional information. Yes, it is safe to train with a spine fusion. A bony change of the L2 spinous process does not necessarily sound like spondylolisthesis (at all) either and I would STRONGLY suggest abstaining from self diagnosing at this point, as it likely increases anxiety without therapeutic advantage. What I mean by that is you’re probably going to worry about some condition (that you may or may not have- currently without proof) that is not best treated by any surgical intervention based on your presentation/description and subsequently would be best managed by training.
Further, I don’t know what your doc “felt”, but I wouldn’t auto-refer for a spinous process change without other symptoms. I would not manage your spine with imaging as you described either, as it wouldn’t change management. If you have severe, persistent low back pain that has not resolved- I would get a referral to a sports medicine doc (primary care) for further workup. I cannot guarantee that they are 100% pro lifting, but they should still be able to put you on the right track.
I do not feel that the spinous process itself has changed, more like the vertebra itself is sitting more posteriorly than the one above it. Following my lifting, I do not have any lower back pain (as in around the L5 region), it is a bar of pain across the back around L2. I can usually palpate the pain across that level and based on the length of time since my surgery, there is a decent amount of hypertrophy and muscle change from L2 down throughout the paraspinals. My rationale was to get a baseline. My pain is typically well managed with stretching of my lower back.
I supposed a follow-up question would be when would it be appropriate to get an updated X-ray? I would obviously like to find a provider in advance to save me the run around in the future so I will continue to look.
Yea I just don’t think an xray is indicated from here. It really depends how bad the pain is and the history of it. A baseline of anything other than a fracture or bony deformity (like scoliosis or similar) is not useful. A slight rotation in your position introduces all sorts of artifact.
Basically, this is kind of a symptomatic management here and unless we suspect a fracture or larger herniation requiring herniation, I don’t know if I’d opt for imaging unless I figured it would change management.
I recently heard that from another doctor. Don’t get imaging unless it’s necessary for diagnosis of your symptoms, you know what actions you’d take based on the results and would actually take those actions if indicated by the results.