I’m a 25yo male with grade 2 spondylolisthesis L5-S1. Been lifting for 5-6 years recreationally, strength training for the last year or so. Doing some trunk exercises and squatting/deadlifting has made the issue manageable, as long as I am always mindful of my low back positioning. A few questions:
I have read/heard a few times that one shouldn’t wear a weightlifting belt super tight. For example, I’ve heard of people that use the method of finding the tightest hole they can get on the belt, then go one less. I feel more comfortable with going to the very tightest hole on the belt I can fit in. Is this an issue?
Taking a combination of curcumin and peperine (to enhance the bioavailability of the curcumin) seems to have helped with the inflammation I get. As far as you know, is there good data to support the use of these supplements.
You guys don’t seem to recommend a lot of stretching for general strength athletes. Does that general recommendation change for people with spondylolisthesis? Hamstring stretching seems to be recommended a lot for spondy patients.
Do you have other recommendations from any previous work with athletes with spondylolisthesis?
Hey Matt, I’ll try and take your points one at at time.
In regards to a spondy, belt fit is not an issue. As far as fit is concerned there is no “hard data” on what constitutes the proper fit and most often the fit that feels best for you is what I would recommend. If you feel better with the tightest hole (within reason of what that is) that is perfectly fine.
There is no good data to support the use of these supplements. Often trying to “help with inflammation” is a bit of a misnomer as the primary process we need with which to heal/adapt is inflammation. We inherently would not want to do anything that overly limits that process.
That recommendation does not change for individuals with spondy. Unfortunately searching for recommendations on what to do on the internet and forums (I fully recognize the irony of this statement) yields a lot of suggestions not backed by evidence. The truth is that a spondy would not change anything in a training paradigm if I knew an athlete were asymptomatic. There is a high prevalence of spondylolisthesis in certain athletic populations and we have evidence that they rarely progress and often will show signs of regression. The problem more often is that knowing a structural “flaw” exists tends to become a self limiting diagnosis. I can happily provide some of those articles for you if you would like as I do not want to be guilty of what I just alluded to in making unsupported claims.
My main recommendation for training with spondylolisthesis is no difference than for someone without. Work within tolerable loads, gradually increasing resistance. Don’t overreach too often, and be consistent in training.
Thanks so much for your detailed response. I very much appreciate it. Here are a couple follow-ups/responses:
Ok, great.
This may be getting into a more general topic on inflammation and pain, but my understanding was that one of the issues/symptoms with spondylolisthesis can be a chronic, unproductive inflammation at the site that persists and causes pain without generating any beneficial adaptation. Because of this, one of the treatments that some patients receive (after PT is given a go) is an epidural steroid injection, to reduce the inflammation. Is this the wrong way to look at it? I do understand that inflammation is generally a healthy and necessary response to certain stresses on the body, but are there not instances and pathologies in which inflammation itself becomes the primary issue and it is actually desirable to reduce it?
It was kind of along these lines that I started with curcumin, because it does look like it has been established that it can act as an anti-inflammatory. To your point, though, I couldn’t find anything solid on curcumin specifically helping with spondylolisthesis-related pain, although this review article does claim that “In addition, turmeric is a powerful anti-inflammatory, easing conditions such as bursitis, arthritis and back pain”.
Haha yeah, the internet is full of a lot of dumb answers. Another issue that makes things even more frustrating is that licensed Physical Therapists and even doctors can be pretty misinformed when it comes to strength training, too. That’s part of the reason I’m here seeking answers from an internet stranger - you guys are the most credible sources I have without going shopping for PTs/Doctors or reviewing the literature myself. I can do the latter to some extent, but what’s important is the whole picture of what all the combined research is saying, rather than just an individual study, and seeing that big picture is hard for me.
“There is a high prevalence of spondylolisthesis in certain athletic populations and we have evidence that they rarely progress and often will show signs of regression.”
Could you send me any research you’ve read on this? I found this study that looked at freshmen football players at University of Indiana and concluded a higher prevalence in the players than the general population, but if you have more research to point me to on incidence in other types of athletes or larger studies, I’d be interested.
The last thing I’ll say is that you mentioned that you wouldn’t change anything in asymptomatic athletes, but what about athletes that are symptomatic or at least sporadically symptomatic? For example, I will have “flare-ups” every once in a while, sometimes because I overreached but sometimes they are unpredictable. The way that I have adjusted my training is that I avoid exercises that put my low back in extension, because they usually end up causing pain. Examples of exercises that I avoid are back extensions and even power cleans, because the explosive hip extension ends up putting the low back in at least a slight extension. Do you have any thoughts on the adjustments I’ve made? Does anything about your previous answer change for the symptomatic or sporadically symptomatic athlete with spondylolisthesis?