What Is Spondylolisthesis?
Spondylolisthesis occurs when one of the vertebrae in your spine slips out of place—either forward or backward—onto the vertebra below it. It most commonly affects the lower back (lumbar spine), particularly the L4-L5 or L5-S1 levels.
There are different types of spondylolisthesis, including:
- Isthmic (often caused by a stress fracture in childhood or adolescence)
- Degenerative (more common in older adults due to age-related spinal changes)
- Traumatic (from injury)
- Congenital (present at birth)
- Sports activities (Certain sports, such as gymnastics and weightlifting, can put stress on the spine)
What Does Spondylolisthesis Feel Like?
Symptoms vary depending on the degree of slippage, but common complaints we hear in the clinic include:
- Lower back pain, especially during or after physical activity
- Tight hamstrings or stiffness in the legs
- Pain that radiates down the legs (if nerves are compressed)
- Numbness or tingling in the legs or feet
- Muscle weakness, especially in more severe cases
- Difficulty standing or walking for long periods
- Loss of bladder or bowel control (in severe cases)
Many patients describe the pain as a dull ache in the lower back that can become sharp or shooting during specific movements like bending, twisting, or standing up from a seated position.
How We Treat Spondylolisthesis in Physical Therapy
Not everyone with spondylolisthesis requires surgery. In fact, physical therapy is one of the most effective non-surgical treatments—especially for mild to moderate cases.
How we typically approach it at our clinic once the diagnosis has been confirmed is to assess your current level of function, and then create a safe and effective treatment plan that would include:
- Pain Management and Inflammation Control
In the early stages, our focus is on reducing pain and inflammation through:
- Modalities like ice, heat, ultrasound, or electrical stimulation
- Activity modification strategies
- Dry needling as treatment for pain management
- AlterG (Anti-gravity treadmill) for gait training and instability
- Core Stabilization
A strong, stable core helps support the spine and reduce excess stress on the affected vertebrae. We develop a personalized core strengthening program that avoids excessive spinal extension or loading.
Examples include:
- Abdominal bracing
- Pelvic tilts
- Modified planks or bird-dog exercises
- Improving Flexibility
Tight muscles—especially the hamstrings and hip flexors—can contribute to poor posture and increased stress on the lower spine. We use targeted stretching and mobility work to improve range of motion and movement quality.
- Postural Training and Body Mechanics
Poor posture can exacerbate symptoms. We teach patients how to:
- Sit, stand, and lift properly
- Modify daily activities to protect the spine
- Incorporate ergonomic strategies at work and home
- Progressive Strengthening and Return to Activity
As pain improves, we gradually increase the intensity of your exercises and introduce functional movements tailored to your lifestyle—whether that’s playing sports, working a physically demanding job, or just keeping up with your kids.
What About Severe Cases?
In severe cases where conservative treatment isn’t enough—or when nerve compression is significant—a referral to a spine specialist may be necessary. Surgery, such as spinal fusion, may be considered in these situations. However, even post-surgery, physical therapy plays a crucial role in recovery and long-term spinal health.
Don’t Suffer in Silence—We’re Here to Help
Living with spondylolisthesis doesn’t have to mean giving up the activities you love. With the right physical therapy program, many people return to full function and stay active without surgery.
If you’re experiencing back pain, leg symptoms, or simply want a professional assessment, schedule your evaluation today! Our experienced team is ready to design a treatment plan tailored to your body and your goals.
Restore your lifestyle through rehabilitation!
