Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

20Aug/090

The dorsiflexion link to spondylolysis

I saw someone today who drove 7 hours to get an answer about her chronic back pain. That is some kind of pressure at the end of a long day.

She has had the pain for over 3 years. It all started when she was training for a triathlon. Left lower back pain with radiating symptoms into the L gluteal and thigh region. She felt it most when running. The pain persisted, causing her to undergo an L5/S1 fusion. That was in the summer of 2006. The pain has not gotten any better.

So, here is what I found...

She actually had severe tightness of the L gastrocnemius. This was picked up with the gravity drop testing with rotation to the R. So much so that the limitation in dorsiflexion has caused the beginnings of a hallux valgus deformity. She also had a trigger point on the L lateral gastrocnemius and L iliopsoas.

She performed a 1/2 squat prior to increased R knee valgus and L knee varus. Her sidelying thoracic rotation test revealed 50% rotation to the R, normal on the L. Her subtalar joint mobility was normal. She presented with a (+) FABER's test on the L, which was normalized following ITB soft tissue release and counterstrain to the iliopsoas tendon.

Now, if you are a bit confused, that is to be expected. This case leaves one a lot to think about. But see if you can picture this:

A lack of ankle dorsiflexion will result in a shortened opposite stride stance. In this case her tight L gastrocnemius was a major possible cause for this. This shortened opposite stride is linked to the trigger point in the L iliopsoas tendon. During gait, when the R foot is in front, the trunk is also rotated to the R.

In this case, lack of L gastrocnemius and iliopsoas flexibility has caused a functional rotational deficit to the R (notice her R sidelying thoracic rotation test). If you look at a model of a spine and cause the lumbar spine to rotate to the right, you can see how excessive R lumbar rotation actually causes facet joint compression on the L, a possible cause for spondylosis and spondylolysis.

The fix lies in restoring normal functional rotation to the R. I have prescribed stretching to the L iliopsoas, L gastrocnemius, L medial reach w/ contralateral arm at waist level to open up the ITB and restore normal L hip rotation (remember the positive FABER test?) and then work on strengthening the R gluteus maximus and medius (remember it is the overpronated side, potentially causing more supination on the L and perpetuating the already tight L iliopsoas)

If you have any questions, let me know. This is the third time I've seen a "spondylo" with radicular symptoms caused by improper rotation to the opposite side due to tightness in the ipsilateral gastrocsoleus and or hip flexor.

Worth noting...

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