What is Spondylolisthesis

Spondylolisthesis is when one of the bones in the spine (vertebrae) slips forward and out of place. This most commonly occurs in the lower back (lumbar spine), but it can happen anywhere along the spine.

A vertebra may move out of place due to a previous back injury. In some cases, the injury may go unnoticed until the vertebra moves out of place later in life.

Spondylolisthesis may also be caused by an injury or a condition that affects the bones.

What are the causes?

This condition may be caused by:

• Injury (trauma). This is often a result of doing sports or physical activities that:
  • Put a lot of strain on the bones in the lower back.
  • Involve repetitive overstretching (hyperextension) of the spine.
• A condition that affects the bones, such as osteoarthritis or cancer.
• Changes in the spine that happen due to age-related wear and tear.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Participating in sports or activities that put a lot of strain on the lower back, including:
  • Gymnastics.
  • Figure skating.
  • Weight lifting.
  • Football.
• Having a condition that affects the bones.
• Being older than age 50.

What are the signs or symptoms?

Symptoms of this condition may include:

• Mild to severe pain in the legs, lower back, or buttocks.
• An abnormal way of walking (abnormal gait).
• Poor posture.
• Muscle stiffness, specifically in the hamstrings. The hamstrings are in the backs of the thighs.
• Weakness, numbness, or a tingling sensation in the legs.

Symptoms may get worse when standing, and they may temporarily get better when sitting down or bending forward. In some cases, there may be no symptoms of this condition.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
  • Your health care provider may push on certain areas to determine the source of your pain.
  • You may be asked to bend forward, backward, and side to side so your health care provider can assess the severity of your pain and your range of motion.
• Imaging tests, such as:
  • X-rays.
  • CT scan.
  • MRI.

How is this treated?

Treatment for this condition may include:

• Resting. This may involve avoiding or modifying activities that put strain on your back until your symptoms improve.
• Medicines to help relieve pain.
• NSAIDs to help reduce swelling and discomfort.
• Injections of medicine (cortisone) in your back. These injections can to help relieve pain and numbness.
• A brace to stabilize and support your back.
• Physical therapy. This may include working with an occupational therapist or physical therapist who can teach you how to reduce pressure on your back while you do everyday activities.
• Surgery. This may be needed if:
  • Other treatment methods do not improve your condition.
  • Your symptoms do not go away after 3–6 months.
  • You are unable to walk or stand.
  • You have severe pain.

Follow these instructions at home:

If you have a brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.

Driving

• Do not drive or operate heavy machinery until you know how your pain medicine affects you.
• Ask your health care provider when it is safe to drive if you have a back brace.

Activity

• Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid activities that take a lot of effort (are strenuous) for as long as told by your health care provider.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have questions or concerns about safety while taking pain medicine, talk with your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• You have pain that gets worse or does not get better.

Get help right away if:

• You have severe back pain.
• You develop weakness or numbness in your legs.
• You are unable to stand or walk.

Spondylolisthesis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your hips and your back. These exercises may also help to relieve pain, numbness, and tingling.

Exercise A: Single knee to chest

1. Lie on your back on a firm surface with both legs straight.
2. Bend one of your knees. Use your hands to move your knee up toward your chest until you feel a gentle stretch in your lower back and buttock.
   1. Hold your leg in this position by holding onto the front of your knee.
   1. Keep your other leg as straight as possible.
3. Hold for __________ seconds.
4. Slowly return to the starting position.
5. Repeat this exercise with your other leg.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Double knee to chest

1. Lie on your back on a firm surface with both legs straight.
2. Bend one of your knees and move it toward your chest until you feel a gentle stretch in your lower back and buttock.
3. Tense your abdominal muscles and repeat the previous step with your other leg.
4. Hold both of your legs in this position by holding onto the backs of your thighs or the fronts of your knees.
5. Hold for __________ seconds.
6. Tense your abdominal muscles and slowly move your legs back to the floor, one leg at a time.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your back. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Pelvic tilt

1. Lie on your back on a firm bed or the floor. Bend your knees and keep your feet flat.
2. Tense your abdominal muscles. Tip your pelvis up toward the ceiling and flatten your lower back into the floor.
   1. To help with this exercise, you may place a small towel under your lower back and try to push your back into the towel.
3. Hold for __________ seconds.
4. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Abdominal crunch

1. Lie on your back on a firm surface. Bend your knees and keep your feet flat. Cross your arms over your chest.
2. Tuck your chin down toward your chest, without bending your neck.
3. Use your abdominal muscles to lift your upper body off of the ground, straight up into the air.
   1. Try to lift yourself until your shoulder blades are off the ground. You may need to work up to this.
   1. Keep your lower back on the ground while you crunch upward.
   1. Do not hold your breath.
4. Slowly lower yourself down. Keep your abdominal muscles tense until you are back to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Alternating arm and leg raises

1. Get on your hands and knees on a firm surface. If you are on a hard floor, you may want to use padding to cushion your knees, such as an exercise mat.
2. Line up your arms and legs. Your hands should be below your shoulders, and your knees should be below your hips.
3. Lift your left leg behind you. At the same time, raise your right arm and straighten it in front of you.
   1. Do not lift your leg higher than your hip.
   1. Do not lift your arm higher than your shoulder.
   1. Keep your abdominal and back muscles tight.
   1. Keep your hips facing the ground.
   1. Do not arch your back.
   1. Keep your balance carefully, and do not hold your breath.
4. Hold for __________ seconds.
5. Slowly return to the starting position and repeat with your right leg and your left arm.

Repeat __________ times. Complete this exercise __________ times a day.

Posture and body mechanics

Body mechanics refers to the movements and positions of your body while you do your daily activities. Posture is part of body mechanics. Good posture and healthy body mechanics can help to relieve stress in your body’s tissues and joints. Good posture means that your spine is in its natural S-curve position (your spine is neutral), your shoulders are pulled back slightly, and your head is not tipped forward. The following are general guidelines for applying improved posture and body mechanics to your everyday activities.

Standing

• When standing, keep your spine neutral and your feet about hip-width apart. Keep a slight bend in your knees. Your ears, shoulders, and hips should line up.
• When you do a task in which you stand in one place for a long time, place one foot up on a stable object that is 2–4 inches (5–10 cm) high, such as a footstool. This helps keep your spine neutral.

Sitting

• When sitting, keep your spine neutral and keep your feet flat on the floor. Use a footrest, if necessary, and keep your thighs parallel to the floor. Avoid rounding your shoulders, and avoid tilting your head forward.
• When working at a desk or a computer, keep your desk at a height where your hands are slightly lower than your elbows. Slide your chair under your desk so you are close enough to maintain good posture.
• When working at a computer, place your monitor at a height where you are looking straight ahead and you do not have to tilt your head forward or downward to look at the screen.

Resting

When lying down and resting, avoid positions that are most painful for you.

• If you have pain with activities such as sitting, bending, stooping, or squatting (flexion-based activities), lie in a position in which your body does not bend very much. For example, avoid curling up on your side with your arms and knees near your chest (fetal position).
• If you have pain with activities such as standing for a long time or reaching with your arms (extension-based activities), lie with your spine in a neutral position and bend your knees slightly. Try the following positions:
  • Lying on your side with a pillow between your knees.
  • Lying on your back with a pillow under your knees.

Lifting

• When lifting objects, keep your feet at least shoulder-width apart and tighten your abdominal muscles.
• Bend your knees and hips and keep your spine neutral. It is important to lift using the strength of your legs, not your back. Do not lock your knees straight out.
• Always ask for help to lift heavy or awkward objects.