Spondylolisthesis refers to the forward slippage of one vertebra on another due to an injury of the boney structures that keep the vertebra aligned one on top of the other. The bony structure becomes compromised due to repetitive forces or sudden forces occurring at that segment or due to a genetic or congenital defect. This weak link of the spinal vertebra typically occurs around a thin bony bridge on the back portion of the spine bone called the Pars Interarticularis.
Once this structure is damaged, the spinal bone affected can start to slip forward because the boney integrity is decreased. This change can lead to increased strain on the disc and ligaments which are taking on additional forces to resist the slippage. Over time, pressure on these structures can cause even further damage to the area and lead to increased slippage of the vertebrae which may result in pain and disability. Conservative management can significantly help to optimize function in these individuals and prevent pain, disability and support a healthy, active lifestyle. It is important to seek the care of a qualified physiotherapist or chiropractor who can educate you and provide treatments to alleviate pain and strengthen the supporting musculature in the region.
What are the Different Types of Spondylolisthesis?
Terminology regarding this condition can get confusing and the words used to describe this condition can seem like tongue twisters. There are two important definitions that you should understand. The difference lies in the severity of the condition and whether or not the vertebra has slipped forward:
- Pre-Spondylosis: This is an asymptomatic stage where some degenerative changes have begun but not enough to stimulate the pain receptors (C.Gunn IMS)
- Spondylolysis: This is a fracture of the Pars Interarticularis which ultimately results in the degenerative narrowing of the canal where the nerve root exits the spine
- Spondylolisthesis: This is a break of the Pars Interarticularis with the forward slipping of the vertebra
There are a few different types of Spondylolythesis each describing a different underlying cause for the condition.
- Congenital Spondylolisthesis: This refers to abnormalities in the bony structure since birth.
- Spondylolytic Spondylolosthesis: In this case, a fracture of the pars interarticularis is due to repetitive strain on the segment. This typically occurs in younger age groups and can manifest in a variety of ways from no symptoms at all to very debilitating symptoms. This condition is quite common in gymnast’s due to the repetitive leaning back motions required in this sport.
- Degenerative Spondylolisthesis: This type is most common over the age of 50 and occurs due to degenerative changes and marked osteoarthritis that occurs in the joints of the spine with wear and tear.
- Traumatic Spondylolisthesis: This type is rare but can occur with high impact injuries to the spine especially those causing overextension.
- Pathological Spondylolisthesis: This type of spondylolisthesis is due to bone diseases or cancers that weaken the bone.
Symptoms and Diagnosis of Spondylolisthesis
A person who has spondylolisthesis will commonly present with achy central low back pain. Sometimes this condition can lead to squeezing or pinching of the nerve roots and if that is the case, the symptoms can also include pain or numbness into the legs. The pain will have some unique characteristics such as, it increases with standing, walking or any movement that extends the back. Pain may improve with bending forward or hugging knees to chest. X-ray’s and MRI can be used to confirm the diagnosis of Spondylolisthesis as well as identify the exact location and severity of the injury.
Physiotherapy and Chiropractic Treatment of Spondylolisthesis
If you suspect you have Spondylolisthesis you should seek professional diagnosis from a physiotherapist, chiropractor or sports medicine doctor. Once your Spondylolisthesis has been properly assessed, your physiotherapist or chiropractor will use a combination of soft tissue mobilization, modalities and hands-on treatment to optimize your function and decrease your pain. Your physiotherapist, chiropractor or sports medicine will also educate you on specific positions to avoid and positions that will help to relieve your pain. Learning about your postural habits and how to correct your posture will also be an important aspect of your treatment. Most importantly, the physios or chiros you work with will develop an individualized core strengthening program for you so that your muscles can support your spine in a better alignment.
How can I Treat Spondylolisthesis at Home?
In a very acute stage, you can try a lower back support brace for a very limited amount of time (2-3days). This will help to settle the inflammation and should not be worn 24/7 but when you are going to be walking and or required to engage in light lifting. It should be supplemented with gentle core engagement, anti-inflammatory medication, ice and rest.
In later stages, training your core muscles and learning how to engage them properly during functional movement is the most important strategy. You also might want to incorporate a daily stretching regime focused on your lower back, pelvis and hip mobility.
Best Exercises to Help with Spondylolisthesis
Your physiotherapist or chiropractor will educate you on what the core is and how to target these muscles properly. The core muscles create a natural corset for your spine and help to stabilize it so that there is increased support around the area of injury.
Below are some gentle stretching and strengthening exercises that may be helpful to start at home as long as you can manage to do them without worsening pain.
Knees to Chest
Lying relaxed on your back, pull both knees up into your chest. Hold 30sec repeat 3x
Bird Dog core exercise
Perform this exercise in 4-point kneeling with your hands directly under your shoulders and knees under hips. Make sure your core is firing by keeping the natural curves of your spine and drawing your belly button up and in. From there extend your opposite arm and leg away from you. Be sure to breath. Hold 5 seconds, do 10 reps
Stretch your piriformis muscle with the figure 4 stretch and also hip flexor in standing. Make sure you are not arching into your back, you do not want to put additional stress on the injured area.
What Should be Avoided if I have Spondylolisthesis
- Arching your back backwards, or any sport, posture or activity that promotes this ie. Cobra in yoga.
- Heavy lifting, especially combined with rotation
- Prolonged standing or walking maybe painful, try to understand your tolerance and rest before pain increases
How Long Does it take to Recover from Spondylolisthesis?
Depending on the type, stage and severity of your condition, your recovery time will vary.
Best case scenario, with some education, exercise and lifestyle modifications you will be feeling better in 4 to 6 weeks after starting treatment.
In a more severe case where there is a fracture and slippage your recovery may take longer (3 to 6 months) and your response will vary based on how well your body can adapt to changes and whether or not you are able to make the required lifestyle changes.
Core strengthening can take 6-8 weeks before you see the effects so stay committed to your exercise program and be patient. You will see results but they will take some time and regular practice.
- Orthopedic Division Manual of the Canadian Physiotherapy Association
- Dr. C. Gunn IMS Manual