How to treat Spondylolysis/Spondylolisthesis

In general to treat this condition one would use lumbar stabilization exercises for the transversus abdominis and multifidus muscles.

The exercise picture below is for the transversus abdominis. One should draw their belly button from the spine and keep the back flat. Then you march your knees up and down 30 x slowly.

tran-abd

The next exercise picture below is called a bridge for strengthening the multifidus muscles.  You lift up your buttocks 10 x slowly.

mult

A common condition in those that have spondylosis and spondylolisthesis is excess lumbar lordosis or an arched back. One possible cause of this is very tight hip flexors and quadricep muscles. They pull the pelvis into an excess anterior pelvic tilt. To help reduce this and the shear force on the area that is fractured stretching the quads and hip flexors can be helpful.

This picture shows stretching of the psoas /hip flexor muscles. Perform 3 x 45 seconds.

hip_flexor_stretch

 

This picture shows stretching of the quadriceps muscles. Perform 3 x 45 seconds.

quads

There is some research that states that a patient should have surgery for these conditions. A general guideline for surgery may include…

  1. Symptoms down the leg of weakness, numbness, decreased reflexes
  2. If the patient has a grade 3 or greater ie >50% slippage of the spine with spondylolisthesis they do not respond well to non conservative treatment
  3. One must stop smoking and lose weight if they are overweight

Things to avoid…

Excess lumbar extension /bending backwards and rotation of the spine

 

Below is some major research articles to address these 2 conditions with surgery and with exercises.

A previous review examined exercise interventions in these 2 conditions,15 while this review included bracing, activity restriction, and surgical procedures. This review suggests surgical intervention is more effective than nonoperative treatments for pain and functional limitation in patients with spondylolisthesis when directly compared with each other. Studies that did compare the various nonoperative treatments revealed a variety of conclusions, ranging from no improvement with lumbar flexion exercises and bracing25to significant improvement with lumbar flexion exercises5 and significant improvement with specific muscle strengthening exercise.18

Previous studies supported the use of various braces with children and adolescents involved in sport. Case series by Sys et al28 and Iwamoto et al8 each found a high percentage of return to sport (89.3% and 87.5%, respectively) with nonoperative treatment and bracing.

Repetitive extension and hyperextension, along with rotation, are risk factors for developing and aggravating spondylolysis and spondylolisthesis.11,26,27 The highest levels of stress on the pars interarticularis were found with lumbar extension and rotation.2 Some patients have greater improvement with extension.25 Older subjects may have had simultaneous disk pathologies that responded positively to repetitive extension exercises and bracing.

Sports Health. 2013 May; 5(3): 225–232.

 

 

 

 

Spine (Phila Pa 1976). 1997 Dec 15;22(24):2959-67.

Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis.

O’Sullivan PB1, Phyty GD, Twomey LT, Allison GT.

Author information

 

Abstract

STUDY DESIGN:

A randomized, controlled trial, test–retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up.

OBJECTIVE:

To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis.

SUMMARY OF BACKGROUND DATA:

A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised.

METHODS:

Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner.

RESULTS:

After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up.

SUMMARY:

A “specific exercise” treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.

 
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