An inquirer recently asked for advice following his MRI scan, here’s what I wrote…(hopefully this real-life reply with be more helpful to others out there, than all those “click bate tick tock and insta videos!):
I’ve looked over your MRI report., as you know it reveals some signs of damage, a small disc protrusion at L5/S1 (last disc in spine), IDD decompression therapy, especially with it’s patented oscillatory function and precise angling and ability to target specific disc spaces, should be able to help improve the health of the disc and improve any pain directly associated with the disc compression. Since the report is saying the protrusion is not contacting the nerve roots but is nevertheless a focal protrusion, in IDD terms you are probably somewhere between a category one and category two disc lesion, and therefore would require a course of between 24 and 30 sessions for maximum improvement (though you might feel some improvement inside 6 sessions and 12 at most).
However, the report also mentions a small retrolisthesis of this segment (shift in position of the vertebra). This is most likely associated wth the disc degeneration seen. A significant question here is whether the restrolisthesis is stable or dynamic i.e. the shift moves in or further out of place in certain positions or when under load. In this scenario the ligaments of that segment will most likely be slack as a consequence and or as a cause of the disc damage.
The best way to confirm if a “dynamic retrolisthesis is present is either with standing X-rays, in flexion and extension or most ideally with an upright MRI including flexion and extension views (bending forward and back). (Upright) MRI would be best because there is no radiation exposure, one can see the behaviour of the disc under load (X-rays don’t show the disc itself only the disc space) and one obtains “axial views” (cross sectional views of the disc, nerves, muscles and ligaments).
Upright and Dynamic MRI’s are provided by places such as provided by the London upright MRI centre, the Birmingham upright MRI centre or Medsereena’s branches in west London or Manchester. Dynamic MRI’s cost around £800. I’m just passing on the gold standard info here, I’m not saying you need to rush out and now get an upright MRI, as I strongly suspect you will have at least some ligamentous instability contributing to the degeneration of your L5S1 disc.
What I am trying to say here is for the very best outcome you don’t just want to be thinking about decompressing the disc but also restoring segmental stability. One way this is achieved is via making your core muscles (especially “transversus abdminis” and “multifidus muscles” as strong as they can be for which our of the shelf Core Zero to Core Hero Program would be a good place to start. Unfortunately, your MRI report has not mentioned how well your multifidus muscle are developed at the L5S1 segment, as MRI reports tend to be written for surgeons rather than physical therapists. I would need to review your MRI images myself to provide an insight into the health of your multifidus muscles and potentially other aspects of your spine that have not been included on the MRI report. Nevertheless, whilst pain often causes some localised / segmental switching off of these muscles, I suspect as a regular gym enthusiast they are not too bad in your case, particularly as deconditioned multifidus muscles are more likely cause forward slipped (spondylolithsis) rather than a backward slippage of the vertebra (retrolisthesis) as in your case. Therefore you most likely will want to be aiming to improve your ligament / strength / stiffness alongside decompressing your disc. A course of IDD “might” help to plump up the disc a bit and there make the ligaments a little more taut but the other thing we can offer that should improve the collagen density / quality of the ligaments in your lower back, is shockwave therapy (particularly “focused” shockwave therapy, which we are one of the few clinics in the UK equipped with…in fact we have swiss doloclast focused SW which is the only focused SW machine independently proven to produce true shock waves). The thing that would be EVEN BETTER (or rather in addition) for improving ligamentous integrity would be a course of three or even four sessions of prolotherapy, for this I would highly recommend my colleague Dr Simon Petrides at the Blackberry clinic in Milton Keynes.
You were asking me which exercises are best to avoid I would suggest for now refraining from heavy axial loading of the spine (heavy standing overhead presses, barbell squats and especially heavy deadlifting), I would also suggest refraining from “McKensie extensions” (a popular You Tube exercise that can be useful for certain problem types of disc problems (mainly central “wet” prolapses, but much less likely in your case as it is likely to be accentuating and encouraging the retrolisthesis.
The decompression (traction) exercise you are doing at home is fine though won’t be achieving the same sort of decompression of improvement in disc hydration as the IDD machine.
I hope this information is useful.
Kind regards
Robert Shanks
Director Spine Plus
Lecturer in the interpretation of Spinal MRI for manual therapists
Spinal MRI Course: Click Here