Dear Dr. Roach: I was recently diagnosed with grade 1 spondylolisthesis. I had been a runner for most of my life and had lifted weights for a number of years. Could these two activities have been the culprits?
I have a little numbness at times down my left leg and around my ankles. As long as I don’t arch backward, I don’t feel any pain. The doctor prescribed meloxicam for two weeks to reduce inflammation, but I stopped after four days. I don’t take any medications, and I didn’t like how it made my stomach feel.
I have an upcoming physical therapy session, but I am wondering how exercise can possibly correct this issue. Once a bone moves forward, can it move back? Can you shed any light on spondylolisthesis?
T.O.
Imagine your spine as a bunch of boxes stacked up on top of one another. Now imagine putting a sponge in between each box to represent the intervertebral disks. Spondylolisthesis is when one box doesn’t exactly line up over the one underneath it. The “grade” is determined by how much subluxation (“slippage”) there is. Activities like running and weightlifting probably have no effect on the development of spondylolisthesis.
For grade 1 spondylolisthesis (by definition, less than 25% overlap), conservative management is indicated, especially physical therapy. It does not fix spondylolisthesis, but it does improve symptoms. Physical therapy improves the flexibility and strength of the spine muscles and other soft tissues, allowing the muscles to better support and stabilize the spine.
It’s critical to remember that the goal is an improved quality of life, not to have X-rays with perfectly aligned bones. Anti-inflammatories like meloxicam can be helpful for many people, but older people often get side effects like your stomach symptoms. Long-term use of these medicines slightly increases the risk of heart disease, so they should only be used long-term if necessary.
With more severe spondylolisthesis, surgery is considered, sometimes with fusion, which uses a rod or screw to keep the bones rigidly in place. However, studies have not shown a consistent benefit to fusion surgery over regular surgery. The decision to operate is based on a person’s symptoms after a thorough trial of nonoperative therapy, rather than the results of imaging studies.
Dear Dr. Roach: I moved to Florida from New York about three years ago. Ever since, my sinuses are very active; my voice gets really low; and I am unable to stay outside for more than a short time due to my inability to breathe. Do you think there is less oxygen in Florida, maybe as a result of the soil?
J.R.H.
No, oxygen spreads all over the globe very quickly, and the amount of oxygen in the air is exactly the same in Florida as it is in New York (at the same altitude). There is something else in the air that’s bothering you.
The time course of three years or so is right in the expected range for a person to become allergic to something in the new place they live. I can’t tell you if it is a grass, tree, weed or mold allergen, but I am fairly certain that’s what’s causing your sinus, voice and breathing symptoms.
You might try taking an over-the-counter antihistamine. If this doesn’t work, see your doctor or an allergist, who can treat you with other nonspecific treatments or test you to see what you might be allergic to.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
