30 years old, 210lbs, 6’2".
I have played rugby and weight-trained since I was fourteen years old. I have had persistent “tightness” in my lower back for the past five years but have been able to continue training without too much difficulty - occasionally I will reduce my session RPE, change to exercises that reduce axial load (low bar back squats replaced with belt squats or lunges, etc.), or reduce the ROM.
This last year the back pain has become substantially worse, so much so that even bodyweight lunges, empty bar RDLs and light hamstring curls leave me unable to finish my workout and with acute pain for two-three days post workout. This is happening on a weekly cycle whenever I attempt to train lower body and occasionally during upper body sessions too. I used to enjoy playing golf as well but have now had to give this up entirely.
Despite visiting multiple physios who followed the same pattern of asking questions about what exercises I do until they could find a movement pattern or individual muscle I was not specifically targeting and claim that it was weakness in ‘x’ muscle and therefore I need to do ‘y’ exercises to strengthen the area, this never helped and I have begun to feel a bit hopeless. I have found ways to train, but progressively less productive, more frustrating and more uncomfortable.
After visiting a sports medicine doctor I was sent for an MRI and have since been diagnosed with a grade I-II anterolisthesis of L5 on S1, estimated at approximately 6mm (L5-SI spondyolysis and spondylolisthesis). There is disc desiccation with endplate Modic type 1 changes, and moderate neural foraminal narrowing. While explaining that there a few options available to me (hydrocortisone injections, prolotherapy and PRP injections) the doctor was most in favor of surgical intervention.
I have read the Barbell Medicine “Spondy” article and found it incredibly helpful. I am reluctant to have surgery given that the spondylolisthesis may not even be the cause of my back pain, but after exploring what feels like all other options and spending the last twelve months altering my training to try and build my way steadily back to lifting I feel like few avenues remain open to me. Also I am concerned about potential degeneration in my surrounding disks if this issue is not resolved.
I am not looking for specific medical advice, but any suggestions of things I need to consider before choosing a form of therapy would be incredibly helpful. Thanks!