Spondylolisthesis is forward slipping or displacement of a vertebrae (back bone) on the one below it. There are 5 types of Spondylolisthesis including: dysplastic, isthmic, degenerative, traumatic and pathologic.
Degenerative Spondylolisthesis is the most common type and that’s the one we will focus on for the remainder of this article.
Simply stated, in degenerative spondylolisthesis, the forward slipping of the vertebrae is caused by degenerative changes in the spine that occur with normal aging.
Note: With degenerative spondylolisthesis you will not see a fracture of the pars interarticularis. This pars defect is commonly seen with other types of Spondylolisthesis, which can help differentiate this type from the other 4 types.
- Degenerative spondylolisthesis can be caused by general wear and tear that comes along with aging, such as loss of disc height which can cause the spine to become unstable.
- Degenerative spondylolisthesis is strongly associated with an older population (40+) in both men and women.
- Gravity and postural muscles can make a spondylolisthesis that is present better or worse.
- Increased body weight increases the risk for degenerative spondylolisthesis because it increases the load on the spine.
- Orientation of Facet Joints and their lack of support
- Tilting of the discs in the spine
- Joint laxity
- Insufficient muscular stabilization (muscles aren’t holding things steady)
- A lower intercristal line (a horizontal line drawn across the hip bones from their highest points which usually goes through L5 in women)
Here’s an image showing how the spine Degenerates over time:
Symptoms of Spondylolisthesis
Some symptoms that may be present are:
- Back Extensions may cause low back pain
- Extension of the back may cause radicular pain (a sharp, shooting pain down the legs) from a nerve root being compressed
- Neurogenic claudication which is also associated with spinal stenosis
- Pain, numbness or weakness in the legs
- Abnormally rounded lumbar (lower) back called lumbar kyphosis to relieve symptoms
- Tight hamstring muscles
- Patients may stand with increased flexion at hips and knees
- Muscle spasms in the back (Paraspinals muscles)
Spondylolisthesis can be treated with conservative or surgical measures depending on the degree of slippage. Non-surgical treatment should be tried first.
Treatment can include rest, pain reduction, bracing, core strengthening and stretching – and should be used especially for grades I and II before considering surgery. If non-surgical treatment doesn’t work, surgery may be considered.
In addition to the following exercises you want to avoid activities that require you to bend, lift or twist your spine as this can cause increased pain. Bending forward, or flexing your spine may be more comfortable, but bending backwards, or hyper-extending your spine may cause pain or flare up your symptoms, and should be avoided.
Exercises for Spondylolisthesis
Before starting any of the exercises below, make sure to tone down your pain symptoms.
Exercise 1: Drawing in maneuver
- Begin by lying on your back with your feet positioned flat on the floor (with small gap under your low back)
- As you Inhale, draw in your abdominal muscles by drawing your belly button down towards the floor (reducing the gap)
- Hold for 1-3 second at the bottom, and then exhale and let your low back rise up off the floor
- Repeat the drawing in maneuver again
- Aim for 10 repetitions
Exercise 2: Hamstring Stretch
- Use a dog leash or a towel and hook it around the middle of your foot.
- Lie down on the floor and pull the banded leg (knee first) towards your chest creating a 90 degree angle, and extend the other leg on the floor.
- Slowly extend the banded leg to straight, while holding the band with your hands.
- You should feel a stretch in your hamstrings (back of your thighs)
- Hold 20-30 seconds x 3 reps
Tip: If you do not have a towel or leash you can hook your hands around your knee and pull your leg back towards your head for the same stretch.
Exercise 3: Knees to Chest
- Begin by lying on your back on a mat with your knees bent and feet placed flat on the floor.
- Position your right hand behind your right knee and slowly pull your right knee in towards your chest and then bring your left knee in towards your chest.
- Hold this position for 15 to 20 seconds.
- Relax and slowly lower one leg at a time to the starting position.
- Aim for 3 repetitions of this stretch.
Exercise 4: Dead Bug
- Begin lying on your back with both arms extended towards the ceiling.
- Bring your hips, knees, and feet up to 90 degrees (feet off the floor).
- Exhale to bring your ribcage down, flatten your low back to the floor and brace your core
- Start the exercise by extending your left leg and right arm away at the same time – Hold for 1-3 sec at the extended position.
- Keep your abdominal and gluteal muscles tightened and return your left leg and right arm to the starting position.
- Repeat on the other side (right leg and left arm)
- Alternate both sides for 10 repetitions.
Exercise 5: Swimming
Recreational swimming, standing or walking in water above your shoulders is a low impact activity and the buoyancy of the water helps support the body’s weight and decrease the compressive forces on the spine (stretches the spine while you are in the water) which can decrease pain.
If swimming is causing pain stop immediately.
 Gagnet P, Kern K, Andrews K, et al. Spondylolysis and spondylolisthesis: A review of the literature. J Orthop. 2018;15(2): 404-407 doi: 10.1016/j.jor.2018.03.008
 Kalichman L, Kim D, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199–205. doi: 10.1097/BRS.0b013e31818edcfd
 Evans N and McCarthy M. Management of symptomatic degenerative low-grade lumbar spondylolisthesis. EFORT Open Rev. 2018;3(12) 620-631. doi: 10.1302/2058-5241.3.180020
Doctor of Physical Therapy and am currently working full time as a pediatric physical therapist and planning to work with adults on a per diem basis. I have worked in Sports, Inpatient Rehab and Outpatient Ortho settings under the guidance of incredible mentors focusing on low back pain. I believe in wholistic and patient centered care and enjoy working with my patients to develop their course of treatment.