Chronic back pain - seeking advice

[Aaron Hutson]

Male
34 years old
6’-1”
240 lbs
Squat- 305x5x3
DL - 385x5
Press - 150x5x3
BP - 225x5x3


I have had on/off lumbar back pain for about 15 years now. Some days I’m fine, some days i’m not. High impact movements hurt. I don’t run or jump or power clean for this reason. I had a visit to the bone and joint clinic and had MRI and xrays performed. The follow up notes were as follows:


There is a transitional anatomy with a segmented S1-S2 level. For the purpose of this dictation, the lowest segment the level is labeled S1-S2. The first non rib bearing vertebral body is labeled L1. The conus terminates at T12 and appears unremarkable. There is 7mm anterolisthesis of S1 on S2. There is probable bilateral S1 spondylolysis. There is no significant narrow edema. No destructive bony lesion is seen. The inferior endplate of S2 demonstrate irregularity with proliferate changes, suggestive of chronic remodeling. No significant edema is seen. Limited visualization of the retroperitoneal structures appear unremarkable.
At T12-L1, unremarkable.
At L1-L2, unremarkable.
At L2-L3, unremarkable.
At L3-L4, unremarkable.
At L4-L5, mild posterior disc bulge without significant central canal or foraminal stenosis.
At L5-S1, there is focal central disc protrusion superimposed on disc bulge as well as mild bilateral facet arthropathy. No significant central canal or forminal stenosis. No evidence of nerve root compromise.
At S1-S2, there is probable bilateral S1 spondylolysis with 7mm anterolisthesis of S1-S2, there is also broad-based posterior disc protrusion. There is decompression of thecal sac without significant central canal stenosis. There is mild bilateral foraminal stenosis.

Complaint:
back pain.

Reason:
1. Transitional anatomy with segmented S1-S2 level as noted above. Correlate carefully for future surgical planning.
2. Probable bilateral S1 spondylolysis with 7mm anterolisthesis of S2. Broad based disc protrusion at S1-S2, resulting in mild foraminal stenosis. Chronic appearing bony remodeling of endplate of S1 and superior endplate of S2.
3. Focal central disc protrusion at L5-S1 without significant central canal or foraminal stenosis

Of all the things mentioned above, including the “extra” vertebrae, the spondylolysis concerns me the most. From what I *think* I understand, this means that one of vertebrae has “slipped” forward and could potentially slip further, causing nerve damage or paralysis.

Is there anyone here that can unpack all of this info and provide me with any tips or advice as I move forward with my slow but steady training? Anything helps. Even if it’s “just deal with it and keep training.” Or “don’t be a pussy”

Thanks!

[Will Morris]

Of all the things mentioned above, including the “extra” vertebrae, the spondylolysis concerns me the most. From what I *think* I understand, this means that one of vertebrae has “slipped” forward and could potentially slip further, causing nerve damage or paralysis. This is not what this means at all. We have covered this multiple times on the board, in lectures, presentations, etc.

Is there anyone here that can unpack all of this info and provide me with any tips or advice as I move forward with my slow but steady training?

There is. I happen to be one of them, but this is too much of a situation to provide this level of coaching for free. This would require a professional consultation.

[Aaron Hutson]

I understand completely. I posted this in a state of personal frustration and I should have done more research beforehand. I've searched the site and found 2 very good articles on the specific subject. As always, they are very informative and have addressed many of my concerns. Thank you for your help.

[Will Morris]

I understand completely. I posted this in a state of personal frustration and I should have done more research beforehand. I've searched the site and found 2 very good articles on the specific subject. As always, they are very informative and have addressed many of my concerns. Thank you for your help.

Do you understand why the anterolisthesis is not going to slip and sever your cauda equina?

[Aaron Hutson]

Do you understand why the anterolisthesis is not going to slip and sever your cauda equina?

My understanding is that it simply can’t just slip forward due to the mechanical interaction of the vertebrae, facet joints and foramina. Also, the vertebrae are surrounded by and attached to dense muscle layers. From what I gather from your lecture about training with back pain part 2, around the 28 minute mark, my circumstance would be considered a “stable lesion.”

Weight Training with Low Back Pain, Pt 2 | Will Morris

[Will Morris]

My understanding is that it simply can’t just slip forward due to the mechanical interaction of the vertebrae, facet joints and foramina. Also, the vertebrae are surrounded by and attached to dense muscle layers. From what I gather from your lecture about training with back pain part 2, around the 28 minute mark, my circumstance would be considered a “stable lesion.”

Weight Training with Low Back Pain, Pt 2 | Will Morris

You are absolutely right, sir. Spondylolisthesis is a fairly common finding on MRI / radiographs, but it’s clinical significance is fairly low. It is most appropriately addressed when someone has imaging which demonstrates a lesion, then on subsequent imaging, the severity has increased. This would indicate an unstable lesion. This is much the same with scoliosis that is found on imaging. Scoliosis is not that important, but an unstable scoliosis changes the game.

Now, we need to address the “extra vertebrae”. What do you make of the finding of a transitional vertebrae?

[Aaron Hutson]

You are absolutely right, sir. Spondylolisthesis is a fairly common finding on MRI / radiographs, but it’s clinical significance is fairly low. It is most appropriately addressed when someone has imaging which demonstrates a lesion, then on subsequent imaging, the severity has increased. This would indicate an unstable lesion. This is much the same with scoliosis that is found on imaging. Scoliosis is not that important, but an unstable scoliosis changes the game.

Now, we need to address the “extra vertebrae”. What do you make of the finding of a transitional vertebrae?

I may very well be the "Missing Link." The transitional vertebrae being evidence of the evolutionary bridge from primate to human...

In all seriousness, I'm not sure what to think. I'd like to think that there is a lot riding on the term "transitional" and not "extra". From what I understand, I have a vertebrae-ish anomaly and disc between my L5 and Sacrum. I assume this would introduce the need for precaution and additional stabilization when performing any type of lumbar extension.

[Will Morris]

I may very well be the "Missing Link." The transitional vertebrae being evidence of the evolutionary bridge from primate to human...

In all seriousness, I'm not sure what to think. I'd like to think that there is a lot riding on the term "transitional" and not "extra". From what I understand, I have a vertebrae-ish anomaly and disc between my L5 and Sacrum. I assume this would introduce the need for precaution and additional stabilization when performing any type of lumbar extension.

The term transitional simply means you had a hiccup in development. Where the S1 and S2 vertebrae should have been coded to fuse, they only fused marginally. Had you never been imaged, you would have lived the rest of your life in relative ignorant bliss. This really doesn’t necessitate any additional precaution. You may have some relatively mild increased lumbar range of motion, but it shouldn’t be anything that prevents you from being able to train.

One thing I don’t think I covered in the topic of spondys during my lecture was you still have the anterior and posterior longitudinal ligaments that run on the anterior and posterior, respectively, aspects of the vertebral column. These ligaments are probably 1/4 - 3/8ths of an inch thick. They are exceptionally tough and would also serve to prevent further slippage of the vertebrae in most instances.

[Aaron Hutson]

The term transitional simply means you had a hiccup in development. Where the S1 and S2 vertebrae should have been coded to fuse, they only fused marginally. Had you never been imaged, you would have lived the rest of your life in relative ignorant bliss. This really doesn’t necessitate any additional precaution. You may have some relatively mild increased lumbar range of motion, but it shouldn’t be anything that prevents you from being able to train.

One thing I don’t think I covered in the topic of spondys during my lecture was you still have the anterior and posterior longitudinal ligaments that run on the anterior and posterior, respectively, aspects of the vertebral column. These ligaments are probably 1/4 - 3/8ths of an inch thick. They are exceptionally tough and would also serve to prevent further slippage of the vertebrae in most instances.

This makes much more sense, especially looking at the x-rays. Its frightening how the surgeon initially explained this to me. It was in a fashion like you mentioned in your latest video on Training Barrier Construction. Very direct, absolutist and without any type of explanation in laymen’s terms. I feel much better about this now. I’ve known about the lumbar issues since 2010 but this is the first time I’ve actually understood it. I look forward to progressing with my training without so much worry and hesitation. I will keep doing what I’m doing, with occasional form checks and hopefully some future coaching. If I start having neurological symptoms or radiculopathy, I know to get to the doctor but until then, I plan to focus on getting stronger. I am sincerely thankful for all of your help and insight on this matter. It truly means a lot to me and I am very grateful.