Why use the back block?
I had an e-mail this week from a blog reader who asked whether the Sarah Key exercises I've blogged so far would be good for spondylolisthesis.
Spondylolisthesis is a condition which affects 3-6% of the population in which one vertebra - most commonly the L4 or L5, at the bottom of the spine - slips forward on the one below it. Left uncontrolled, it produces a more exaggerated curve of the low back, like those you often see in men with really big tummies or pregnant women. The grade of spondylolisthesis is determined by an X-ray to see how far the upper vertebra has slipped - a grade I being a forward slippage of 1/4 of a vertebral body, grade II being half, and so on. Surgeons tend to get involved with grade II+ spondylolistheses as the slippage is more likely to be a danger to the spinal cord.
There is a fair amount of evidence in the literature for strengthening the core muscles of spondylolisthesis patients, particularly the transversus abdominis which acts like an internal corset, and the multifidus which acts like the guy ropes of a tent to shore up and stabilise the slipped vertebra. I'll go through some useful exercises for these in future posts as they are excellent for any form of instability, but incidentally this is one situation where I think exercise methods such as Pilates can be really useful.
As well as core exercises, I really rate the back block for spondylolisthesis patients. Traditional physiotherapy extension exercises are carried out from the prone (face down) position, where the patient pushes up onto elbows or hands to extend the spine. I don't use this for spondylolisthesis patients because gravity, as you can see from the top diagram, acts on the vertebrae to produce an anterior (forward) shear - exactly the same force that causes spondylolisthesis! Lots of physiotherapists have therefore moved away from prescribing extension exercises to spondylolisthesis patients.
By contrast, however, the back block exercises are done in a supine (face up) position. This results in gravity pulling the vertebrae towards a position of backward shear, as you can see in the lower diagram - and thus into a more neutral position away from the spondylolisthesis slip.
The effect of this tends to be (gradual, cumulative) better alignment of the spondylolisthetic segment, and also reduced muscle spasm and reduced pain.
Of course, not every case is that simple: longstanding spondylolisthesis problems often lead to altered muscle control and movement patterns, as you start to compensate for the discomfort of the injury. Using a back block doesn't replace a proper assessment and treatment plan in every case. But if your physio isn't already getting you onto a back block, it might be something to discuss.
Please feel free to ask questions - either here on the blog or by e-mail - or get in touch to arrange an appointment.
Blog for Victory
Hi, I'm Nell Mead. I'm a former Army physiotherapist and I specialise in sports medicine and back pain. This is my blog, where I write about issues that are on my mind. Some of these are about issues that are specific to particular injuries or medical conditions but I will also be updating you on events occurring inside Victory and in the wider world of medical rehabilitation. I also publish guest posts by Victory's other therapists whenever I can persuade them to sit still for long enough to write something!
When we're not writing, we're offering appointments at The Foundry in Liverpool Street. We'd love to see your comments on our posts - and we'd love to meet you even more, so do pop by and meet the team.
spondylolisthesis sufferer
Posted by Anonymous at 13:41 on 23 May 2011
hi there, thanks so much for this post, i just found your site by googling my condition which causes the lower back pain i've had for nearly a year now; this is very useful info thank you as i was considering a back block - one of the few things i haven't tried yet...
and i look forward to reading some more of your posts.
thanks again.
spondylolisthesis sufferer
Posted by Anonymous at 13:42 on 23 May 2011
hi there, thanks so much for this post, i just found your site by googling my condition which causes the lower back pain i've had for nearly a year now; this is very useful info thank you as i was considering a back block - one of the few things i haven't tried yet...
and i look forward to reading some more of your posts.
thanks again.
spondylolisthesis sufferer
Posted by Nell Mead at 09:23 on 26 May 2011
Delighted to be of help - do ask if you have any other questions I might be able to answer. Otherwise, please just keep reading, and tell your friends!