Mechanical vs. Inflammatory Pain

spondylolisthesis back pain

If you have been searching for answers for your spondylolisthesis or spondylolysis pain then you have probably come across information on both a cortisone shot and physical therapy.

A cortisone shot is an example of something that is designed to improve your inflammatory pain.

While manual therapy or many kinds of rehab are designed to improve mechanical pain.

Understanding the difference between the two and how they work can be an important process to your spondylolisthesis or spondylolysis recovery.

Please check out this article I ran across on the TPI (Titleist Performance Institute) website. They go into detail about the difference of the two and why each may have some benefit.

This article will help you understand more about mechanical and inflammatory pain and why you may need to focus on both methods to improve your spondy.

Click HERE to read this article at the Titleist Performance Institutes website. 

After reading the brief article, take a quick second and answer these questions in the comment section below…. 

Have you had a cortisone shot in an attempt to help your spondy pain? Was the relief long lasting or did it return soon? I would love to hear about it.

I get a ton of emails about cortisone shots and I would love to be able to get opinions from those who have had this experience.

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Leave A Reply (12 comments so far)

  1. Leslie
    4 years ago

    Hi, I have spondylolysis and have had multiple corticosteroid shots from which I saw no improvement in my pain. In fact, sometimes I think it made it worse. I have found that physical therapy and Mobic work best for me.

    • Spondy
      4 years ago

      Hi Leslie,

      Thanks so much for sharing your experiences!

  2. salo
    4 years ago

    Hi. One of the things I was suggested to deal with the inflammatory isuue was to avoid sugar intake in the morning. These raise insulin at a time when cortisol is high thus promoting an inflammatory cascade. You could substitute the sugar with stevia.
    Thanks for the great website

    • Spondy
      4 years ago

      Hi Salo,

      Great point and I agree with you on this. Many studies have shown a long list of problems that a high sugar diet can have on the body. Although I have never seen any studies directly mentioning spondylolisthesis or spondylolysis to sugar intake levels, I do believe eating a healthy diet has a lot to do with how your body is able to control and manage inflammation. Great tip and thanks for posting for others to see!

  3. Alicia
    3 years ago

    Just found out two weeks ago that I have spondylolisthesis. I was given a corticosteroid shot last week although I didn’t like the idea since it was for pain not for correcting anything. But I was glad to find on here that getting the inflammation down is really critical, so I went through with the shot. However, it doesn’t seem to have done much, maybe made it worse. The constant “burning” pain has been replaced with just intense pain that feels a bit more localized. There have been some brief moments when I thought I didn’t have any pain at all (like half a minute or less) usually when I stopped doing what I was doing and switched to something else like sitting/standing/walking/stopping/lying down/getting up/etc. but it always returned quickly. Because I can’t seem to do anyone activity for more than 5-10 minutes I certainly feel that my overall functionality seems to be decreasing at a rapid rate since the shot.

    • Spondy
      3 years ago

      Hi Alicia. Thanks for sharing your story. I had a discussion once with a doctor about these shots and he made it pretty clear to me that they are by no means the answer to the long-term problem (as you mentioned in your comment). For some they can be a way to help reduce inflammation and the pain that is sometimes associated with it. However, the doctor also stated that these shots do not have a very high success rate. And the results very greatly from person to person. Getting the inflammation under control is a big first step and unfortunately there is no set in stone path for everyone to follow for success. Due to the many variables involved with spondy’s, the success depends on the individual and their personal weaknesses/strengths. Thanks again for sharing and best of luck!

  4. linda
    3 years ago

    my daughter has level one isthmic/congenital spondy. she got 2 rounds of facet blocks a few years back. the first one did not help and actually made it hurt more. the second one (30 days later) gave her significant relief after a week or so. (we were told that it might take up to 3 shots in a series to get relief). We did not have time to get the 3rd shot as she was starting college at the time but she was able to go 6 years with manageable and quickly dissipating pain when walking. Now she is back in pain more than she would like and she may try facet blocks injections again. A rhizotomy has been suggested but since they also dont give long term relief- estimated 6-9 months- i can’t figure out why she would want to do that? Have any of you tried a rhizotomy?

    • SpondyInfo
      3 years ago

      Hi Linda. Thanks for sharing your story. I understand as a parent myself how stressful and worrisome this condition can be when you have a child or close loved one suffering from the pain. I never really understoond how hard it must have been for my parents (to go through seeking help for me and my spondy) until I became a parent myself.

      I cannot really answer your first question as to why your daughter would want to go the rhizotomy route. That is a question that would be best answered by her. I can tell you that these types of procedures on the surface look great for the patient. They advertise how they are minimally invasive, quick, easy and have a fast recovery time. Personally I have not had a rhizotomy for my spondy nor have a talked to anyone who has had one. So I cannot speak upon their long-term success.

      My thoughts are that both your daughters attempts of improving how she feels -that you mention-have been through attempting to block the nerve roots that signal pain to the brain. A simple piece of advice would be to consider what is causing these pain signals in the first place? Most likely it is inflammation, irritation and some disturbances in the tissues and joints surrounding the spondy perhaps caused by the slippage or break in the vertebra. Now, take it a step further…what causes these irritations? It could be poor movement caused by a prior injury, some tightness’s, some weaknesses, muscular imbalances or other movement related issues. Or it could be something else. In my opinion the facet blocks and attempts at blocking the nerves are like a band-aid fix. They may briefly help relieve the pain due to blocking out the signals to the brain, but they will not help improve upon what may actually be leading to this pain.

      To find long-term relief it is important to address the cause of this discomfort.

      You mention she has a grade 1 isthmic spondy (same as me) which through studies has been shown to have good success rates of improving through a proper rehab plan. Has your daughter had her movement evaluated or attempted any type of rehab to perhaps look at and address any of her movement related issues? This is just my two-cents and by no means the right and only answer – but it is where I would look at if she is interested in long-term relief. I have seen many grade 1 spondy patients improve my addressing their movement and the role it plays in creating stress on the spondy. Over the years I have talked to many spondy patients and none of them have had permanent relief from facet blocks or nerve blocks. It may briefly stop the pain and discomfort, but once the source of the pain surfaces again and the blocks wear off, the pain and discomfort are quick to return.

      Give this post a read Linda as it may help you better understand how movement can affect spondy pain:

      Also, make sure to sign up for our FREE Ebook as it will teach you more about this concept. Best of luck!

  5. Maria
    1 year ago

    Hi! I just have a question as to whether is normal for ‘spondy’ sufferers to experience spams/super-tightness and burning pain on the lower bad and tingling on the legs. I was wondering if bad movement could cause muscle spams and then the burning. Is this inflammation type of pain or more nerve pain… maybe is difficult to tell the difference. Thanks

    • SpondyInfo
      1 year ago

      Hi Maria. To be honest, it really is hard to use the word normal when describing spondy pain. The reason being that there are so many symptoms that can present themselves in combination with the various characteristics that make each individual unique. The pain you explain is a pain that I have heard other spondy patients describe. The burning pain could be a result of various things, one being a pinched or impinged nerve. Bad movement is one of many possible causes of muscles spasms. This could lead to inflammation and the inflammation could lead to nerve impingement. This is all guess work though without being examined by a professional. It really is like finding a needle in a haystack when trying to guess what is going on internally with a very complex system. To be 100% sure I would seek a movement specialist or seek opinion from a doctor who can assess the area with some kind of MRI or X-ray. Thanks for the question!

  6. Gisela
    6 months ago


    My story started 3 years ago with acute sciatica pain on my right buttock and right leg with lots of pain and numbness. I want to say it was from lifting heavy objects. I ended up in the ER where as a coincidental finding I was diagnosed with renal cell carcinoma right kidney. I month later I had R kidney removed. I am happy to say I have not had any more problems with this to date.

    But my back/sciatica pain is another story. The MRI and CT scans done at the time showed a synovial cysts compressing my root never at the L-5 as cause for the pain. While initially in the hospital I had my first epidural shot that was the only one that gave me some relief – it allowed me to go from wheelchair as I was unable to walk from the pain, to walker, to walking without assistance. I do occasionally still trip over my own toes. My numbness in the right foot has never gone away and I want to say it is worse. Plus I now also have numbness and tingling in my left foot. I’ve had two more epidural shots, plenty of physical therapy and stretches, more MRIs with pain on and off. Due to the fact that I now have one kidney I am not allowed to take any anti inflammatory medication so when medication is needed I take Medrol cortisone packs.I am followed by my primary doctor and a DO back and spine specialist. Initially had a neurosurgeon consult where I was told my condition did not require surgery.

    With this last flare up, I decided to see an orthopedic spine specialist and was for the first time diagnosed Grade 1 spondyloisthesis at L4/5 from an xray he took. He is recommending decompression surgery and spinal fusion which I am not too keen about. Just had MRI again and awaiting results. Started another round of PT about 4 weeks ago and pain is better but not the numbness or tingling. Having read your information I do plan on seeing other doctors. I’m 68 years old, walk a lot and do stretches daily which give me relief and otherwise in good health. I am a bookkeeper so I do a lot of sitting at computer but use lumbar roll which eases pain and keeps me upright. My question – do you know if there is anything that would take away the numbness and tingling of the nerve problem? I know how to deal with the pain but the numbness is driving me crazy plus I feel it has changed my gait and I tend to stumble over my own feet. I have come across a study of medication that may help. Its from Brazil and is a combination of Uridine Triphosphate, cytidine monophaste and Vit B12. Its manufactured under the name Etna Capsules. Do you know if this has helped anyone with the numbness. Here is the link to the study- . Sorry this is so long. Thanks for any possible reply.

    • SpondyInfo
      6 months ago

      Hi Gisela,

      Thanks for sharing your story. I am glad to hear you have had no further problems to this date and hopefully this trend continues. As far as your numbness goes, I have to be honest, I am not familiar with that medication so my I cannot really offer much information. I can tell you that I have been working with a patient for a while who had a bone spur that was affecting his nerve root in his spine. His symptoms where almost identical to yours. Tingling, weakness in one leg,ankle and foot and discomfort. We have been working diligently on his movement. Improving weaknesses that he had with his hip/pelvic complex, strengthening the core and hips and improvement various movement patterns. He has seen a fantastic improvement. He is an avid tennis player, hiker and walker. He is in his late 60’s as well.

      I would highly recommend searching for someone who can look at your movement as well to see if this is an approach that would help you. I encourage you to read these two articles for more information:

      I hope they help and best of luck!

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