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  • Littleton
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    Post count: 2

    Dear Dr. Corenman,
    This all started after a 3,000 feet ascend hike up to Booth Lake in Vail end of July…. Gorgeous hike, but it hasn’t been good for my spine! 4 weeks ago the pain intensified into severe sciatica like pain all the way down in the left leg, when I stand still or walk. No pain if I sit. I have no back pain, neither sitting or standing. Started PT last week (incl. dry needling: gluteus muscles, QL and lower back muscles were all very tight). I obviously stopped running & hiking for the past 4 weeks and the past 10 days I also stopped walking and I try not to stand.
    Just got the MRI back:
    “Minimal grade 1 anterolisthesis of L4 on L5. Pars interarticularis defects are not demonstrated, but there is facet arthropathy and ligamentum flavum hyperthrophy and fluid in the facet joints at this level. There is mild edematous change in the pars margin at the L4 level, but no spondylitic break is noted.” No bulged disk or disk herniation.

    From PT I got core exercises, exercises as used for spinal stenosis and 2×10 min daily cardio on a stationary bike. That all feels very (!) good. I’m planning on continuing that. I also take 2 Aleeve in the morning and use a pillow at night lying sideways.

    My question is: do you think I should ice the L4/L5 location for 20 minutes several times per day? Or alternating ice and then a hot bath for my tight muscles? Then ice again on L4/L5? I must have inflammation going on, but I also have very tight muscles. There are many opinions about ice and heat, but I would really value your opinion! Thank you for your time. Hopefully I will be back to hike in Vail. From Littleton, CO

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Based upon your description of your MRI, it sounds like you have a degenerative spondylolisthesis of the L4-5 level. “Minimal grade 1 anterolisthesis of L4 on L5. Pars interarticularis defects are not demonstrated, but there is facet arthropathy and ligamentum flavum hyperthrophy and fluid in the facet joints at this level. There is mild edematous change in the pars margin at the L4 level, but no spondylitic break is noted. No bulged disk or disk herniation”.

    You have no pain when you sit, no lower back pain with any activity and “severe sciatica” when you stand and especially hike. This condition sounds to be classic stenosis, either foraminal or central (see website). Biking causes flexion which opens the spinal canal. Hiking down from Booth Falls causes extension (center of gravity is shifted backwards) which narrows the spinal canal and typically aggravates this condition.

    Pain and swelling respond better to ice. Muscular tightness and spasm responds better to heat. Be careful with both as I have patients in my practice who have burned their skin using both methods.

    Dr. Corenman

    Littleton
    Member
    Post count: 2

    Thank you so much for your response, I very much appreciate it. I’m very careful when I ice it (have a friend who got severe burn on her face after icing) and my bath is warm, not super hot.
    Thanks for your help!

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