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Spondylolisthesis

What is a Spondylolisthesis?

A Spondylolisthesis is an instability of the spine in which one vertebrae shifts forward on the vertebrae below it. The most common shift in lumbar or lower back is L5 on the sacrum (S1) because of the downward slope of the sacral base on the top of L5 (the last lumbar segment). This can be exaggerated by the forward pull of a tight psoas and weight bearing positions.

Clinical Presentation

A person may first experience an achy low back with periods of sharp pain as a young adult, made worse with prolonged sitting. Young adult athletes are particularly vulnerable when they have a weak core and rely heavily on their psoas muscle to stabilize their spine. They often rely on lumbar extension for spinal stability. They often look very upright or stiff during athletics. During times of rapid growth the core can become even weaker and make young adults more susceptible to a traumatic extension injury resulting in a spondylolisthesis. This can become a problem again in adulthood with either daily activities, exercise, or pregnancy. Other signs may include tight hamstrings, +Eli’s test, and a palpable step-off spinal deformity. The psoas muscle can cause a stiff or achy back, while sharp pains can result from shifting of the vertebrae during athletics or other daily activities. Common sports that can cause a young person to experience sharp pain from a spondylolisthesis are baseball, golf, or lacrosse where there are rotational forces on the spine. The result is a sharp pain in the spine with forward bending because of an unstable segment of the spine.

Misdiagnosis of Spondylolisthesis

X-rays may not show a spondylolisthesis deformity because they are usually performed with the patient lying down (supine) instead of in standing (which provides a better view of a vertebral shift). Additionally, the vertebrae can be reduced on x-ray if the patient no longer presents with symptoms, thus giving a false negative.

Treatment of a Spondylothesis

Patient education is important to learn the “do’s and don’ts.” Manual therapy is used to open up the affected vertebral facets to allow the vertebrae to shift back into neutral. The patient also learns how to engage their core, live in a neutral spine, perform corrective exercises and perform strengthening exercises specific to their level of weakness. We teach athletes how to weight lift, sprint, jump, and perform sports specific training without flaring up the spine. Patients with a spondylolisthesis have structural instability, therefore they must learn how to manage this throughout their life. Teaching a patient how to self treat their spondylolisthesis is imperative for long term success.

General Do’s

1. Strengthen the core.
2. Stretch hip flexors and hamstrings.
3. Side sleeping or supine with a pillow under the knees.

General Don’ts

1. Avoid lumbar extension until lumbar stability is good.
2. No stomach sleeping.
3. No high impact sports until lumbar stability is good.
4. No heavy weight training until lumbar stability is good.