The Role of Physical Therapy in Treating Spondylolisthesis

Spondylolisthesis can be extremely debilitating for some people and result in them taking days off work, skipping social events, and even suffering from depression. There are many ways to help manage the pain and symptoms of spondylolisthesis and one of the most effective is physical therapy.

This guide will focus on the role of physical therapy in treating spondylolisthesis with summaries of other forms of treatment that can also prove effective. Additionally, we will also consider the next steps if treatment is unsuccessful, such as surgical options like lumbar decompression, spinal fusion, or mechanical devices like the Premia Spine TOPS System.

What is Spondylolisthesis?

Spondylolisthesis is a condition that refers to when one or more of the vertebrae slips forward and becomes displaced. This is often caused by a spinal fracture such as those suffered in a car accident or playing high-impact sports. Spondylolisthesis can cause pain and other symptoms when the vertebrae come into contact with the surrounding nerves, other vertebrae, or the spinal cord. 

Symptoms can range in severity, with some people experiencing no symptoms whatsoever. Here are some of the most common symptoms caused by the condition:

• Lower back pain
• Muscle tightness, particularly in the hamstrings
• Numbness or a tingling sensation in the buttocks and thighs
• Tenderness/ inflammation in the affected area of the spine
• Weakness in the legs
• Stiffness when moving and flexing 
• Difficulty walking and standing for sustained periods
• An irregular posture such as leaning forward
• Sciatica
• A loss of bladder or bowel function

Types of Spondylolisthesis

There are 5 types of spondylolisthesis which can develop in different ways. 

1. Dysplastic spondylolisthesis: This is caused by a natural defect when the spine doesn’t form properly before a baby is born, resulting in misaligned vertebrae. 
2. Degenerative spondylolisthesis: This is the most common form of spondylolisthesis and is caused by cartilage degeneration, often due to osteoarthritis. 
3. Isthmic spondylolisthesis: A result of repetitive trauma that is common among athletes and sports people whose bodies are regularly subjected to hypertension. 
4. Traumatic spondylolisthesis: A type caused by a vertebral fracture, such as a broken facet joint, lamina, or pedicle.
5. Pathologic spondylolisthesis: A form of spondylolisthesis that directly results from a bone defect or an abnormality such as a tumor. 

Physical Therapy for Treating Spondylolisthesis

Physical therapy is a primary treatment of spondylolisthesis and can be extremely effective at reducing pain symptoms. A physical therapist will design a rehabilitation program to help patients build muscle strength and become more flexible. 

By building healthy muscle balance in the back and other body parts, the spine can better deal with any strain, offering better protection to the vertebrae. Alleviating this strain can help ease pain symptoms and help the body naturally adapt to any vertebral slippage to provide a long-term cure. 

Creating an Exercise Program

A physical therapist will recommend a range of exercises to perform frequently to improve a person’s physical condition. These exercises will range from gentle, flexibility-based ones that can performed daily, activities to improve cardiovascular fitness, and more strenuous exercises to build strength. 

• Exercises to improve core stability: Developing a stable core is essential for pain management, and building muscle strength in the lower back to better protect the spine and reduce pressure on the vertebrae. 
• Stretching exercises: Stretching works to strengthen muscles and reduce the impact of any hyper-extension to the lumbar spine. Stretching also reduces muscle tightness in the back, hamstrings, and hip flexors to boost a person’s mobility. 
• Cardiovascular exercises: Cardio exercises help a person to lose weight and generally involve low-aerobic impact activities like walking, swimming, or cross-training. If a person is overweight then these exercises are important to lose excess weight and reduce any additional pressure on the spine. 
• Flexion exercises: Flexion exercises involve stretches and twists to help a person become more flexible and more effectively manage pain symptoms. 
• Gait training: Gait training improves a person’s ability to stand and walk and is often required if a person suffers from a condition such as spondylolisthesis, or has suffered a spinal fracture. To assist with this, a person may also be asked to wear a back brace. 
• Balance training: This involves training on unstable devices to improve coordination and help a person walk and stand normally. 
• Endurance training: This type of training can involve exercises such as deadlifts or squats, or activities such as walking for long periods. Endurance training is typically recommended when a person has built up their muscle strength and mobility over many months. 
• Closed-chain-kinetics: Exercises that use elastic bands, typically from a lying down position are an excellent way of strengthening muscles and improving flexibility. 
• Hydrotherapy: Hydrotherapy is very effective at reducing pain and stiffness in the muscles and joints. It involves performing therapeutic exercises in a pool, providing gentle resistance to avoid strains. 

Other Treatments for Spondylolisthesis and Surgery

Physical therapy is just one part of an overall jigsaw when it comes to managing the effects of spondylolisthesis and working toward a long-term cure. A doctor will also prescribe medication such as over-the-counter painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), and possibly even epidural injections that administer steroids or nerve blocks directly into the spine. 

However, exercise is the key to recovery and to improve spinal health long-term, even though the process may take many months. Following a healthy diet is also strongly advised to not only lose weight but to also provide the spine with more nutrients. Avoiding fatty and high-sugar content food can reduce inflammation and naturally lower pain. A person who has spondylolisthesis should focus on eating oily fish, grains, nuts, leafy greens, and other anti-inflammatory foods. 

If treatments prove unsuccessful then the final course of action would likely be surgery, in an attempt to cure the condition permanently. This will likely involve lumbar decompression surgery and may be followed by spinal fusion or a mechanical spinal device like the TOPS system to provide stability to the affected area. Spinal devices are considered a better solution to spinal fusion as they allow patients to retain full mobility in their spine and have faster recovery times. 

Thanks for reading. We hope to have provided some helpful insights into physical therapy and its impact on treating spondylolisthesis.  

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