Spondylolisthesis occurs when a piece of the spinal bone (vertebrae) slips out of alignment and onto the bone below it.
This can be caused by degeneration of the vertebrae or disc, trauma, fracture, or genetics. It most commonly occurs in the lower spine. According to a 2009 article in the peer-reviewed journal Spine, it occurs in about 6 to 11.5 percent of the adult population.
Specific exercises may help reduce pain and increase the function and quality of your life.
Symptoms include lower back pain that gets worse with standing and hyperextension. Other symptoms include:
- hamstring tightness
- posterior buttocks pain
- neurological changes like numbness or tingling down the legs
After a thorough evaluation, your physical therapist will be able to provide you with a personalized home exercise program to help decrease pain due to spondylolisthesis.
This program often includes lumbar flexion exercises, core stabilization exercises, and exercises or stretches for the muscles of the back, hamstrings, and hips. Low-impact exercise such as cycling or swimming is also recommended to promote healing and decrease pain.
Pelvic tilt exercises help decrease pain by stabilizing the lower spine in a flexed position. Pelvic tilts are done in different positions depending on pain and the patient’s preference.
- Lie face up with your knees bent and feet flat on the ground.
- Start by flattening your lower back against the ground, engage your abdominal muscles to hold the position.
- Hold for 15 seconds before relaxing.
- Repeat 10 times.
Weak abdominal muscles often contribute to instability and cause pain in those with spondylolisthesis. You can strengthen your abdominal muscles with a crunch exercise. Move slowly and focus on proper form by engaging your core muscles before starting any movement. Even small movements make a big difference. Do not force your body to move through full range of motion for these exercises as it may increase pain and slow your recovery.
- Start by lying on the ground with your knees bent, feet flat on the ground and arms folded over the chest. If necessary, you can support your head with your fingers behind your ears, but do not pull on your head as you go through this movement.
- Slowly lift your head and shoulders off the floor until a contraction in the abdominals is felt.
- Hold for 3 seconds, and then lower to starting position.
- Repeat 10 times.
Double knee to chest
Working the deep core muscles of the torso will help decrease instability and improve pain associated with spondylolisthesis.
- Start by lying face up with your knees bent and feet flat on the floor.
- Engage your stomach muscles by drawing the belly button to the floor.
- With the assistance of the hands, pull both knees up to the chest and hold for 5 seconds.
- Relax and repeat 10 times.
The multifidus muscles are small but important muscles that lie next to your spine. They help with twisting and bending movements, and they increase stability of the spinal joints. These muscles are often weak in patients with spondylolisthesis. You can find and activate your multifidi by lying on your side and reaching your top hand around to feel the vertebrae of your lower back. Slowly move your fingers to the side until they slip into the groove beside your spine.
- Activate your core muscles by imagining you are pulling your thigh to your chest, but do not actually move your leg.
- This contraction should cause the multifidus muscle to bulge under your fingers.
- Hold this for 3 seconds, and repeat 10 times on each side.
For patients with spondylolisthesis, spinal instability often causes tension in the hamstrings, the large muscles that run down the back of the thighs. Tight hamstrings can pull on the lower back, increasing pain or discomfort.
- Sit on the ground with your legs stretched directly in front of you, toes pointed towards the ceiling.
- Slowly lean forward and reach for your toes. Don’t worry if you can’t touch your feet — just reach until you feel a stretch down the back of your legs.
- Hold for 30 seconds and repeat 3 times, trying to get a little further each time.
Conservative treatments of spondylolisthesis, like pain medication and exercise, are preferred over surgery. A 2013 systematic review in Sports Physical Therapy identified multiple studies that found exercise to be beneficial to patients with spondylolisthesis, and resulted in improvements in pain and function with mild to moderate conditions.
Treatment depends on the severity of symptoms, age, and overall health. Your doctor may discuss both surgical and nonsurgical treatment options with you and may refer you to physical therapy. According to an article in the Journal of American Association of Nurse Practitioners, many patients improve and recover with conservative treatment.
Always consult your doctor before starting a new exercise program. Never perform exercises to the point of pain. If an exercise causes an increase in pain, stop immediately and seek assistance.
Symptoms such as tingling or numbness, shooting pain in legs and feet, or muscle weakness all require medical attention, and may warrant a more thorough evaluation.
The goal of these exercises is to increase stability in the lumbar spine, and minimize pain during daily activities.
Natasha Freutel is a California registered and licensed occupational therapist. She specializes in geriatric rehabilitation, orthopedic rehabilitation, and workplace adaptations. She enjoys helping adults modify everyday activities to promote independence and decrease pain. She is an advocate of preventive healthcare and believes in a holistic approach to health and wellness.