Sports Medicine
Sports Injury Prevention & Rehabilitation

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What is a spondylolisthesis?
The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. These joints are designed to support body weight and enable spinal movement.
A spondylolisthesis refers to the slipping of one vertebra forward on another. This typically occurs due to defects in the bone which usually develop during childhood and is most commonly seen in children between the ages of 9 and 14. The defect is due to an absence of a section of bone on each side of the vertebral column which assists in holding the vertebra in alignment. This section of bone is known as the 'pars interarticularis'. Although uncommon, a spondylolisthesis may also occur due to stress fractures in each pars interarticularis. This may occur due to excessive athletic or sporting activity involving repetitive hyperextension of the spine.

A spondylolisthesis is graded according to the degree of slip of the vertebra relative to the vertebra below.
  • Grade I slip indicates a slip of less than 25%
  • Grade II – 50%
  • Grade III – 75%
  • Grade IV > 75%

Signs and symptoms of a spondylolisthesis

Patients with this condition generally experience an increase in pain during activities that straighten or extend the spine, especially if these activities are repetitive, excessive, or, maintained for long periods of time. Conversely, activities that bend the spine (e.g. sitting) tend to ease symptoms. It is important to note, that many patients with a Grade I spondylolisthesis may experience no symptoms and be completely unaware of the defect. Patients with a Grade II spondylolisthesis or higher, however, more commonly experience lower back pain with or without associated leg pain.

Diagnosis of a spondylolisthesis
X-ray investigation is usually required to confirm diagnosis of a spondylolisthesis. This is best performed in the position that reproduces the patient's pain.

Treatment for a spondylolisthesis
Treatment of patients with this condition is determined by the severity of symptoms and grade of injury. Typically, treatment involves rest from aggravating activity combined with abdominal and lower back strengthening exercises. Once the patient is pain-free, a gradual increase in activity and exercise can occur provided symptoms do not increase. Wearing an appropriate brace during activity may be helpful. If symptoms do recur upon resuming sport, then that activity should be ceased. Patients with a Grade III or IV spondylolisthesis should avoid high speed or contact sports altogether.
Alternative exercises placing minimal force through the lower back should also be performed to maintain fitness provided they do not increase symptoms. Better activities include: cycling, cross trainer, rowing, water running and clinical Pilates. Patients should also perform flexibility, strengthening and core stability exercises to ensure an optimal outcome. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Contributing factors to the development of symptoms of a spondylolisthesis

There are several factors that may contribute to the development of symptoms in patients with this condition. These need to be assessed and corrected with direction from a physical therapist and may include:
  • poor posture
  • poor core stability
  • muscle weakness
  • poor flexibility
  • joint stiffness
  • Technique adjustment should also be made to restrict the amount of extension during sporting activity.

Physical therapy for a spondylolisthesis
Physical therapy treatment for patients with this condition is vital to hasten the healing process and ensure a safe return to activity. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • bracing
  • mobilization
  • dry needling
  • education
  • activity modification advice
  • biomechanical correction
  • clinical Pilates
  • hydrotherapy
  • exercises to improve flexibility, strength and core stability
  • a gradual return to activity program
Other intervention for a spondylolisthesis
Despite appropriate physical therapy management, a small percentage of patients with this condition fail to improve adequately or deteriorate. When this occurs, other intervention may be required. This may include further investigations such as X-rays, CT scan or MRI, or assessment from a specialist. Although it is rare for a slip to progress, spinal fusion surgery may be indicated if there is evidence of progression. The treating physical therapist can advise if this may be required and can refer to the appropriate medical authority if it is warranted clinically.