Eszter has instability from retrolisthesis the Guru explains that pathology seen on MRI does not always equal pain and dysfunction.

July 15, 2015

Hi Guru,

Could you please advise me if – based on your experience – you think the instability caused by a retrolisthesis of 4 mm on the MRI (at L5-S1) is possible to improve if the disc between those 2 vertebras is dehydtared and has a small but central hernia..(with no impact on the nerves)

There are some additional issues like i have assimetry in the movement of my shoulders, the lordisis at my neck and upper back is flattened a bit and it is bigger at the lumbar part with a sharper angle between the sacrum and L5. I am 34 – a desparate mom of an 8 months old .I had no back pain before but in the last 3.5 months my condution worsened to the point that i am unable to walk more the 20-30 minutes.

My leading symptom is not back pain but tightness feeling in my leg.It started at my right calf – now it is mostly in the hamstrings. My condition worsened from “not being able to carry my kid to not being able to walk:(((Recently i also started to have back pain…sometime soreness sometime i think inflammation with muscle spasm. As per the MRis the slippage did not increase in 3 months.i do physio for 2 months..but it doesnt seem to work ( core stability and strength excercises with balls, rolls etc- I learnt only now that i should have started with activation..).

My question is if there is a way back from here? How long would i need to move over to see if it is possible to turn around at all?

Not looking for any big statements…as i know all spondys are different and depends on a lot of things but wondered if you could advise if i have a slight chance at all…thank you for your answer in advance!!!

July 15, 2015

Hi Eszter

Don’t dispare, hang in there!

There is an awful lot of “scary” information which may, or may not be relevant to your symptoms.

By the sounds of it you’ve only had low back pain for there last few months, and judging by the dehydrated disc  – which is either a product of the spondy (or the other way around), you’ve had this for an awful lot longer. Pathology seen on MRI does not always equal pain and dysfunction.

You need to understand more about the why you’re like this rather that the what’s causing it.

I’m afraid I can’t give timeframes, but the Physio regime your are currently undertaking needs to address the cause and not just the symptoms. I think if you’re not seeing any discernible change in your symptoms in the 4 weeks of treatment, or your getting worse then I’m not sure the treatment you’re doing is helping very much and it may be worth trying an alternative.

I believe that having adequate thoracic spine mobility is key in getting lumbar spine stability – you can’t have one without the other….

The Guru

Six Physio

Estzer got back to the Guru:

Hi Guru,
Thanks a ton for your answer it was very helpful..and prompted 3  questions..

  • in sixphysio how do you identify movement issues?eg the fact that pain occurs if i walk..probably means that i have improper use of muscles …at sixphisio does FMS help to detect what it is or there are more detailed screening opportunities?(the places i tried said FMS is not detailed enough once the injury occured…
  • When you say i need to understand why i am like this..what does that mean as oppose to what causes?if you could pls give an example?
  • if i feel better the next day after PT but it is not causing a long term improvement…does it mean, those are not the right excercises or not addressing all of it/ the root cause?

Thank you ever so much again for your answer in advance

Kind regards,

The Guru responded:

It’s a pleasure Eszter.

Hope these answers make sense.

Lots of people in pain, but without any significant trauma display pretty similar patterns of learnt movement. So much so there are only a few, say 10 things that can go “wrong” with the body, but they may give 10,000 different symptoms. It’s why it’s important to change the cause and not chase the symptoms.

We you have pain you move with poorly controlled, yet fairly predictable patterns. FMS is great if you have no pain, but pain changes everything and so despite being predictable it’s the subtle changes that make the difference. I guess experience and execution are key…

If you don’t know what’s causing the issue and why, then despite what anybody tells you, you just won’t get better. Physio is an active modality – you need to get yourself better. The body is great at healing itself. We’ve just got a issue with not knowing what’s wrong and so don’t know how to allow the body to sort it self out. If you’ve got a cut on your arm and don’t scratch or pick at it, it’ll get better. If however you do do poke it, it won’t.

Feeling better is not the same as getting better. I think it’s more important to come back to a session feeling better rather than leaving the session feeling good. The cause and not just the symptoms need to be looked after.

Hope this helps.

The Guru

Estzer appreciates the response but would like to ask a couple more things:

Thank you very much for the answer, i am getting closer to understand the keys to get better, i think.
Please allow me to nag you with just a few more questions:

Which of the sixphisio clinics or team members would be best to visit if i hope to get help in finding out what is it..out of the ~10 things that are causing my dysfuntion and pain…and how to treat it? Are there individuals specialized/experienced more in the area if spine instability(after childbirth)?

When you say 10 things..then it means …lumbar instability is the result..and so an expert would be able to tell what caused it by seeing how i move…and trying a few things..and see what helps and what not?

At sixphisio – how could i envision the work – one needs to go for an initial assessment and visit for follow up sessions every now and then based on how the situation improves…more frequently at the beginning?

Thanks a ton again!

The Guru replies:


All the clinics should be able to look at this with a different pair of eyes.

We’ve got women’s health Physios who also specialise in post pregnancy “stuff”.

I think the most obvious 1 of 10 things is that you don’t have adequate thoracic spine mobility – and this is key. If you do come in, do let me know and I’ll give a heads up to your treating Physio.

You’re spot on about lumbar instability – you don’t just wake up with this, it happens because of something else, and this is the cause. This is the stuff that needs dealing with.

Treatment frequency is tricky to predict, but is set around the individual. It should (must!) make total common sense to you. This is your body and you need to own it. We just help you along the way!

The Guru

Guru Responded

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