I had been having some SI joint pain, no radiation or anything. finally went to my friendly Chiro who x-rayed and it showed some spondylolisthesis - I looked at the x-ray myself, pulled up similar online, and that is clearly what it appears to be. Chiro says it is ablout 10%.
The Chiro didn’t think it was that big of deal and that it was a combination of congenital tendecy, age, and 25 years of triathlons. Other than a shoulder I hurt in a bike wreck everything else is fine.
So, what group advice/experience is out there? can I reverse this thing? Limit its progression? do things like inversion tables etc work or have any applicability to this.
Not a spine surgeon, but, as I understand it. If you aren’t having nerve pain in the lower extremities just spend a lot of time on core strength.
Wanna know what helps my SI pain (which I’ve had for 38.5 yrs), besides core strength (especially your back muscles) try suspenders with looser waisted pants, so there is no pressure on your lower back muscles.
I found out about my spondylolisthesis (1.3 cm @ L4-L5- likely old post-traumatic from jumping out of ski-lifts and dump trucks) in 2003 a few weeks after doing my 4th Ironman. I had pain, stiffness and weakness in my left leg. I had 7 months of effective physio and continued doing Ironman races and have done 4 since. I am a 51 year old family physician and have seen people at work who are quite restricted by this condition and initially that frightened me. There are 3 important positive things to remember about your lower back -
60 % of what holds you up is muscle (so do your core stuff)
unlike joints like knees, your lower back is made of multiple linkages and therefore may be “easier to tame”
there are lots of other people out there who have this condition, are physically active and do not even know they have it (I had no back pain battling the wind and rain @ Ironman USA 2003 2 months before diagnosis)
Since 2003 I have had some flare ups of back pain and always have slightly increased tone in my left calf, occassional calf fasiculations and and some foot numbness. But I have noticed this is usually worse the less I exercise.
So here are my tips and observations-
swimming bothers it the most for me(I think because of the slight rotation of the lower back)
I initially switched to a road bike with aerobars and have gradually concluded that a proper (ie 77 degree or steeper) tri position is easier on the back (at least for me). If you are too stretched out you will fatigue your lower back. Read Bikesport Michigan and Slowman’s stuff about proper tri position, and if you do this make sure your elbow angles are correct so you can get weight on the pads. Tom has some good photos on Bikesport Michigan of positioning. I have also lowered my saddle to 76.5 cm with a 34.25 inch inseam. This is important as many people with this condition have constant high hamstring tone (and a high saddle WILL NOT STRETCH IT OUT as the extended phase of the pedal stoke is too brief to help). I suspect that the chronically tight hamstrings when combined with a high saddle leads to pelvic rocking and back pain. I try to avoid riding 2 days in a row. If you go for a fitting make sure they know what your condition is, expect to have to tweak your fit frequently. I ride with a 5 mm Allen key for my seatpost.
I only run twice weekly and do it mostly on cinder trail. Wednesday is short and fast, Saturday is long and slow. I have found a swim-run brick on Saturday morning leaves me with a supple back for my long ride on Sunday, so that is how I prep for Ironman (max out @ 3k swim followed by 3 hours of running)
a couple of years ago to decided to try chiropractic (traditional , purely manipulation, no machines) and have found this to be a big help and efficient at quickly dealing with bad spells. I go every 3 weeks when things are good and yup, my back needs about 20 days to stiffen up.
seriously- get a big screen TV to watch while you do all that core and stretching (mainly legs) so that you will be compliant with it. After all you can not hold a book and stretch properly and stretching is boring.
what is on my feet whether @ work or exercising makes a big difference in how my back feels. Orthotic adjustments may help or worsening back pain/stiffness. Do not make footwear changes of any type close to your A race.
I would like to hear how things go for you.
Brent Stoker
Thanks for taking time to send such a complete response. Mine is at L4-5 too. I am trying to get better at stretching. I ride w/ my bike seat at the higher end of the spectrum, but have never had any pain biking - would pain be the indicator? My position has been fairly constant and dialed in since about 1990
What got me to even looking into this was several months ago it started hurting when I would roll over in bed at night - enough that it wakes me up. My workouts have actually gone fairly well. I do need to improve on my stretching.