Living With Spondylolisthesis by Rebekah Cygan | June 07, 2018 with Mark Rippetoe I am Rebekah Cygan. I wanted to share the story of one of my clients who has seen great success in overcoming his history of back injury with consistent training. Doug Straus, 47, of West Fargo, North Dakota is an active father of seven who had been diagnosed with Grade 2 (14 mm) Spondylolisthesis 15 years ago. Doug has been working with Starting Strength Online Coaching for one year and has made dramatic improvement. Spondylolisthesis is a slipping of a vertebral segment forward relative to the segment below it. This slipping is caused by a defect or fracture of the pedicle, the overlapping posterior component of the segment that holds it in place. The amount of displacement is given a “grade” depending on its severity (the distance it has slipped). The defect can be congenital, or the result of a trauma. Aside from surgical vertebral fusion, the typical treatment for this condition is the strengthening of the abdominal and low-back musculature, along with the apparently contradictory advice to avoid stressful activities and take it easy. This was a problem for Doug, who enjoyed hunting, water skiing, competitive shooting, and being an active father to his family. Doug tried the conventional medical treatments, including prolotherapy injections into the soft tissue, with no change in his back symptoms. He would feel okay for a while, but then experience debilitating episodes of “his back being out” every month or so. These episodes would leave him inactive for days and in great pain. Spondylolesthesis Illustration by BruceBlaus [CC BY-SA 4.0], from Wikimedia Commons. Doug found Starting Strength. He tried working through the program and had some success with training on his own, but he knew he had not quite gotten far enough. He was able to train with lighter weights, but his back was not tolerating the progression. Every time he would get to squatting around 200 pounds or deadlifting 225 he would injure his back, and deal with days of pain down the legs, barely able to stand up out of bed. Doug heard about Starting Strength Online Coaching through The Art of Manilness podcast and decided to sign up. His short term goal was to “improve low back strength because my L5-S1 area feels unstable and weak. I am currently only able to do maintenance weights.” His long term goal was to return to his hobbies without worrying about the risk of injury. Doug started in June of 2017 with his workout: Squat 135x5x3 Press 85x5x3 Deadlift 135x5x1 Chin ups 2-3 reps Bodyweight 215 One of the things I encounter when I train folks with chronic back pain is the fear of putting the back into lumbar extension, and loading the back with a weight. Patients are told “Don't over do it.” “Don’t lift too heavy.” “Don’t bend your spine.” “Don’t bend over.” But the thing they fear is the very thing that can change their lives. Back pain happens to all humans, whether they lift weights or not. And training with back pain does not make it worse – in fact, in the vast majority of cases it makes it either markedly better or it goes away completely in a couple of weeks. Some injuries like a spondylolisthesis or scoliosis do not heal, and virtually everybody has degenerative changes in their spine by the time they are 30. In all these cases, a strong injured back is better than a weak injured back. Thanks to the medical community, people have to learn that loading the back does not make it hurt more. Many people who walk into my gym are afraid of injuring themselves, because they have been taught to associate lifting with their back pain. The hardest part is convincing them that the barbell lifts will help them learn to control their back, and make their back more resilient for everyday life. Doug had his fears too, but he was very coachable and whole-heartedly approached the bar each session. The very cool thing about Doug is that he had already tried all of the traditional stuff and realized it didn’t work. He felt better when he trained, but he knew that sometimes he moved wrong and he wanted to learn how not to do that again. Doug had already come to the conclusion that building a stronger low back was the only way to return to the things he loved without the fear of injury. So Doug began to train and add weight to the bar. And I watched every rep via video. I could see some very basic form issues that were keeping him from progressing. His back angle was always too vertical – he was hesitant to hold his back in extension with a more horizontal back angle, as a result of having been told to not bend over. As a result he was not adequately loading either his back or his hips. With a spondylolisthesis, spinal stability is of paramount importance. The injury is not a problem if the position of the segments doesn't change, and strong back and abdominal muscles keep this from happening. To strengthen this position, it must be loaded gradually and progressively, and it cannot be loaded if the position is avoided. We changed his stance and knee position, and he learned to sit back into the correct back angle when he squatted while keeping his spinal position under control. Doug started slowing adding weight to the bar again. This time his back didn’t hurt. In the beginning, Doug probably had the most fear of the deadlift. After watching him pull I could see a subtle but important error: Doug was trying to begin his pull off the floor by opening his hips. He was not letting his knee extension start the movement while holding his back stable. I taught him how to hold his back and push the floor. We worked on fixing the placement of the bar over his mid-foot. Doug was amazed as he flew past 225 without any back pain. Correcting his form was only part of his success. Doug Straus is a man of his word. Over the last year he has been training with me, he has only missed a handful of workouts due to family emergency. He is ultra-consistent. He is fearless and he works hard in the gym. Doug had one episode of his “back going out” in month 2 of our training after he had been water skiing. We worked through this setback and he kept training. Doug’s most recent lifts: Squat 275x5 Press 140x2 Bench 210x5 Deadlift 330x5 Weighted Chins 22 pounds x 3 Bodyweight 212 I am happy to say that Doug has been pain-free for the last 10 months. When a person adds 100 pounds to his deadlift strength and 75 pounds to the squat, his back is more stable. He can waterski, hunt, and shoot without “I hope I don’t hurt myself” in the back of his mind. If you are someone who is afraid to train for strength because you have a history of back pain, I hope you will hear Doug’s story and be afraid not to.
