A spondylolisthesis is also known as a slipped vertebra. Vertebrae are the bones in the spine that sit atop one another in a column. Each (except the first two bones in the neck) segment has an intervertebral disc providing cushion between the bodies of the vertebrae. When one of the vertebrae slips forward atop another it is called a spondylolisthesis. Spondylolistheses are graded based on severity:

• Grade I: 1-25% slippage
• Grade II: 26-50% slippage
• Grade III 51-75% slippage
• Grade IV: 76-100% slippage
• Grade V: >100% slippage; also known as spondyloptosis

WHAT CAUSES A SPONDYLOLISTHESIS?

Vertebrae are held in place by support structures such as ligaments and intervertebral discs. Anything that weakens the support structure of the spinal column can predispose someone to developing a spondylolisthesis. They are most common in the lumbar or lower spine but can occur sometimes in the neck and rarely in the mid back or thoracic spine. Below are causes of spondylolisthesis:

• Degenerative changes in adults
• More common in women than men
• Pars defects
• Most common in youth and adolescents
• Congenital defects
• Trauma
• Scoliosis
• Connective tissue disorders

SYMPTOMS OF A SPONDYLOLISTHESIS

Symptoms of a spondylolisthesis typically worsen as the grade of slippage progresses. Because the spinal nerves and spinal cord are surrounded by the bony vertebrae, slippage of a vertebrae can cause pressure or compression on the sensitive nerves.

• Localized low back (or sometimes neck) pain
• Discomfort when pressing on or palpating the involved spinous process
• Low back pain accompanied by radiating pain into the buttocks or thighs
• Pain with spinal motion such as bending backwards, twisting
• Reduction in pain with sitting, slouching or bending forward
• Muscle spasms around the affected vertebrae
• Difficulty walking or standing
• Tightness in the leg muscles
• Pain with activities like sports or manual labor
• Weakness in the legs

DIAGNOSING A SPONDYLOLISTHESIS

When evaluating for back pain, your physical therapist will perform a physical exam. Positive findings on a cluster of clinical tests may point to a spondylolisthesis:

• Straight leg raise test: Passively raising one leg straight off the table elicits symptoms in the back or radiating symptoms into the buttocks or thigh
• Step off sign: A step off (noticeable increase in depth of the spinous process of one vertebrae) can indicate a spondylolisthesis
• Tenderness over the spinous process of the affected vertebra
• Limited back range of motion into flexion and extension
• Pain with single limb stance and lumbar extension

If you decide to work with a physical therapist to help correct your Spondylolisthesis issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized rotator cuff physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your rotator cuff PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR A SPONDYLOLISTHESIS

Conservative management such as physical therapy is typically the first line of treatment for spondylolisthesis. A small percentage of young patients with lower grade spondylolistheses may fail conservative treatment and need surgery to limit or correct progression of slippage.

While your physical therapy plan of care to treat a spondylolisthesis will be individualized, here are some common treatments used to manage this condition:

• Guidance on rest and activity modification to reduce aggravating motions and activities while symptoms are present
• Pain reduction techniques
• Anti-inflammatory modalities and techniques to reduce inflammation on local nerves
• Stretching of the lower extremity muscles and other techniques to reduce forces that pull the lower back into extension which can exacerbate the spondylolisthesis and symptoms
• Deep abdominal and trunk stabilizing exercises to control the spine
• Lower impact aerobic exercise to promote fitness and blood flow
• Prescribed exercise to minimize loss of fitness and muscle performance in unaffected areas of the body
• Address underlying causes of the injury such as hyper or hypomobility, motor control or strength impairments in preparation for return to sport or work activities
• Optimize movement patterns to decrease risk of re-injury and facilitate return to sport or work activities
• Provide adaptations as necessary for those with higher grade spondylolisthesis to continue to participate in their activities
• Facilitating returns of global strength and muscle performance to support return to activities

SCHEDULE AN INITIAL EVALUATION FOR SPONDYLOLISTHESIS TODAY

While the symptoms of a spondylolisthesis can certainly interfere with you or your child’s daily life and favorite activity, physical therapy can help. If you or your child have been diagnosed with a spondylolisthesis or are noticing uncomfortable symptoms in the spine, call us today to learn more about our services and schedule an evaluation with one of our physical therapists.

Resources: Tenny S, Hanna A, Gillis CC. Spondylolisthesis. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430767/