Spondylolisthesis
There are variuos types of spondylolisthesis amongst which Isthmic and Degenerative type is more common with advancement of age and women are more prone for development of degenerative spondylolisthesis as compared to men.[1] The most common grading system which defines degree of slippage of vertebral body is Meyerding Grading System.[2] There are several causes that can lead you to this condition which commonly includes age related wear and tear, microtrauma during sports, traumatic injuries to spine, congenital abnormalities i.e. misalignment of vertebrae since birth or sometimes it can occur without presence of any significant cause.
It is basically a condition that affects your vertebrae which are the building blocks of your spine. It involves forward (Anterolisthesis) or backward (Retrolisthesis) slippage of one vertebrae in relation to the one below it.
Common symptoms you might experience
- Constant back pain getting worse whilst bending backward and decreases when you sit or bend forward
- Tightness or spasm in Hamstring muscle
- Neurogenic claudication (tingling or cramp like pain in both legs while standing or walking) only if condition is severe
- Weakness
How Physical Therapy can help you
When it comes to effective management of spondylolisthesis, it is our prime duty to conduct thorough assessment of your spine including posture, available pain free range of motion of your back. Moreover, we follow scientific evidence based practice:
Pain reduction is our first goal as pain will interfere in your most movements. The use of Interferential Current (IFC) which helps in reducing muscle spasm and alleviates pain is hence among the first approaches. Hot pack also serves the same purpose by removing waste products at faster rate and providing increased flow of oxygen. During initial periods of pain, Lumbosacral Orthosis helps in preventing backward movement of your spine and thereby assist in reducing pain. However, effectiveness of Lumbosacral Orthosis decreases if it is used for more than 2 weeks.[3] Isometric exercises of Rectus Abdominis, Multifidus and Pelvic Floor Muscles helps in improving their strength which provides greatest stabilization to your spine which should be followed by isotonic exercises in later stages.[4] Other than this, muscular imbalance can be corrected by selective stretching of Iliopsoas, Hamstring and Piriformis muscle.[5] As a result of spondylolisthesis, you might feel increase in arch of your lower back (anterior pelvic tilt) which can be corrected by performing posterior pelvic tilt in lying or quadruped position. In addition to this, there are certain specific series of exercise namely Williams Flexion Exercises which helps in correcting vertebral malalignment.[5]
If you have spondylolisthesis then:
- Avoid sitting in slouched posture
- Keep your back supported with pillow
- Neurogenic claudication (tingling or cramp like pain in both legs while standing or walking) only if condition is severe
- Avoid certain sports which involves repetitive twisting of spine such as tennis, golf
If you are dealing with spondylolisthesis, reach out a Physical Therapist at Advance Physical Therapy as early intervention and personalized treatment protocols can significantly improve your quality of life. Afterall, your health is your greatest asset!
References:
1) Li, N., Scofield, J., Mangham, P., Cooper, J., Sherman, W., & Kaye, A. D. (2022). Spondylolisthesis. Orthopedic Reviews, 14(3)
2) Koslosky, E., & Gendelberg, D. (2020). Classification in brief: the Meyerding classification system of spondylolisthesis. Clinical Orthopaedics and Related Research®, 478(5), 1125-1130.
3) Setiyawan, S., & Nugraha, A. S. (2023). The Impact of Employing a Semi-Rigid Lumbosacral Orthosis (LSO) on Trunk Muscle Strength in Individuals with Low Back Pain (LBP) and Spondylolisthesis. Journal of Prosthetics Orthotics and Science Technology, 2(2), 50-55.
4) Rahman, M. M., Hasan, M. Z., Islam, A., & Islam, M. W. (2023). A Mini Review of Rehabilitation for Spondylolisthesis.
5) Rhajib, M. A. N., Islam, M. W., Hossain, M. A., Haque, M. O., & Fazal, A. I. A. (2022). Evidence based Physiotherapy Intervention of Lumbar Spondylolisthesis: A Narrative Review. Journal of Spine Research and Surgery, 4(2), 72-79.
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