Your Chronic Low Back Pain Could Be Instability of the Spine Lurking in the Shadows

By David Coletta, MPT, CMPT
david@excelptmt.com

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While 80% of all US citizens will experience some level of low back pain during their lives, 10.2% (2006 US Survey) of all adults in this country have suffered from chronic low back pain that limits activity for an extended period of time.  As a physical therapist that specializes in treating the spine, I often have chronic low back pain patients that struggle to understand why their condition exists.  Many clients arrive for an evaluation after years with severe bouts of low back pain that comes and goes with minimal cause or explanation.  Trips to the doctor for medication, days missed from work, and visits to various types of practitioners are common with this diagnosis. My experience has found that some of these chronic low back pain patients have spinal instability as the source of their condition. 

Spinal instability or excessive vertebral segmental motion is a possible cause of chronic low back pain.  General wear and tear, previous injuries, and congenital abnormality of the vertebrae can be factors that lead towards instability.  Looking at the spine with the muscles removed, there is a beautiful structure that is present which allows for movement, but also provides stability from one spinal segment in relation to its neighbor (above or below).  The discs, ligaments, and vertebrae themselves provide this passive stability.  Compromise to these structures can lead to instability or an excessive amount of movement.  The muscles of core and deep spine provide protection and smooth movement between the vertebrae and the low back in general, which is termed dynamic stability. When passive stability is lacking, dynamic stability is in greater need.  However, dynamic muscular stability of this level is often lacking in spinal instability patients.  With these individuals, acute low back pain bouts arise when an activity, such as shoveling snow or even bending over to pick up a pencil from the ground, overloads the available passive and dynamic stability.

Perhaps the most common form of low back instability is an anterior spondylolisthesis or a slippage forward of a lumbar vertebra in relation to the vertebra below it.  This diagnosis can be picked up through a detailed and specific physical therapy evaluation and then confirmed with a specialized x-ray of the lumbar spine.  A spondylolisthesis has various grades, depending on the degree of slippage measured on the image. A mild or even moderate spondylolisthesis is best treated with specific core stabilization exercises and teaching the patient how to safely lift, given this diagnosis.  Higher grades of spondylolisthesis may require surgical spinal fusion to stabilize the segments. Many patients go years or decades without understanding the true source of their chronic low back pain.  In some cases, instability or spondylolisthesis is the culprit lurking in the shadows.

 

As the founding owner of Excel Physical Therapy, David Coletta, MPT, CMPT strives for our clinics to deliver unprecedented excellence with patient care in the Gallatin Valley. David established Excel PT in 2001 on the principles of specialization, advanced education and customer service. David specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions. 

A considerable amount of David’s advanced training occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT, and he has received advanced training in dry needling techniques for the spine and extremities. David is a Certified Clinical BikeFit Pro Fitter.

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