The Slipping Back Problem of Spondylolisthesis

Understanding Spondylolisthesis

Spondylolisthesis is a condition that causes an alteration of the normal alignment of the spine. The term was coined from its Greek root words, spondylo + listhesis which means “vertebra” and “to slip”, respectively. Hence, the particular description of this injury when one of the spine bones slips forward over the one below causing a mechanically motivated inflammation involving the surrounding bone, capsule, ligaments and nerves resulting in pain and limitations.

The lumbar spine accepts a majority of the weight bearing stress.  Because of this important role, it the most susceptible level of the spine for this type of an injury. There are two major causes of this disorder observed in a specific group of people.

For younger adults, slipping of the 5th lumbar vertebra occurs because the vertbraes of the spine tend to sit in a forward direction over the sacrum.  Meanwhile gravity applies a force which increases this forward slippage of the vertebral body.  Another factor is the type of sporting event.  Activities that increase the extension of the lower back can easily result in a stress fracture of the bony ring of the lumbar spine.  When this fracture present with no slippage, it is referred to as spondylolysis.

Signs & Symptoms of Spondylolisthesis

  • Low back pain and tenderness which increases with lumbar extension or twisting.
  • Pain and stiffness which can involve the buttocks area.
  • Tight feeling in the hamstrings region or weakness on the thigh and/or leg.
  • Walking accompanied by  a back and forth shifting shuffle pattern.
  • Slowed lower extremity reflexes.
  • With serious cases, difficulty controlling bowel and bladder functions.
  • Sudden weakness and poor voluntary control of abdomen muscles.

Professional Treatment for Spondylolisthesis

  • Rest on a firm surface in a non-weight bearing position, which completely eliminates the symptoms.  This is usually most effective in a supine (face-up) or side lying positions with pillows placed behind the knees.
  • Implement a progressive flexibility plan focusing on the hamstrings, quads, and hip flexors.
  • A core stability program targeting your functional abdominal strength and endurance along with enhancing trunk and pelvis control.
  • Always avoid all positions and activities that increase lumbar hyperextension, the #1 enemy of spondylolysis and spondylolisthesis of the low back.
  • Wearing a low back brace or corsets may be a smart option for players with a weak core and/or pain with prolonged sitting.
  • Rehabilitation therapy is recommended to minimize activities causing extension pressures at the lumbar vertebrae and to build up your muscles promoting an antilordotic posture.
  • An optional form of treatment for chronic suffers is an epidural steroid injection (ESI).  ESIs is a potent anti-inflammatory injection which helps to reduce pain and swelling. This type of treatment is only considered with advanced cases or when physical therapy is not completely effective.
  • In severe cases where the lumbar slip is causing abnormal walking patterns, loss of control in bowel or bladder function, or simply a worsening condition, surgery may be required. Surgical procedures may include laminectomy, posterior fusion with instrumentation or posterior lumbar interbody fusion.
  • Employing updated physical therapy modalities are also provided to decrease pain and reduce swelling. Treatments of heat, cold, ultrasound, and electrical stimulation may be used to reduce pain, enhance painfree motion and minimize muscle spasm.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What part of my spinal vertebrae is responsible for my pain and limitations?
  2. How important is my core strength to my recovery?
  3. What condition would require wearing a rigid back brace?
  4. Do you think I will eventually need surgery to fix my spondylolisthesis?
  5. When I’m painfree, what preventive steps I should take to avoid a recurrence of this injury?

Elite Sports Medicine Tips from Mike Ryan

  • Go to the core of the problem: Exercises such as planks, pelvic tilt and crunches focus on strengthening core core muscles.
  • Prevention is always the better alternative: A pre-existing bilateral spondylolysis can easily develop into spondylolisthesis.
  • Aim for the right angle: Keeping the spine healthy requires consitent changes in posture.  Movement helps the spine promote circulation and reduce muscle fatigue. Sitting for a prolonged period eventually will make a even a healthy low back unhappy.
  • Get ahead of your game: As you make progress, progressively advance into functional strengthening exercises that get your core, trunk and lower extremity ready to get back in the game!
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