Need Exercises For Spondylolisthesis?
If you have lumbar spondylolisthesis, you may have lower back or leg pain when standing or walking for long periods of time or when lifting heavy things.
Spondylolisthesis, or a slipping of one vertebra on another, can cause some major issues. However, by incorporating the spondylolisthesis exercises, it's often possible to relieve your symptoms without surgery.
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Causes of Spondylolisthesis
Before we get started with exercises, there are actually two different types of spondylolisthesis.
Isthmic Spondylolisthesis (Spondylytic Spondylolisthesis)
If you see the word "spondylolisthesis" on an MRI report, there are some other words that sound kind of similar.
Spondylosis is a word that means an abnormal condition of the spine or vertebrae.
Basically, it's a synonym for arthritis in the spine.
Spondylolysis means a fracture of a part of the vertebrae called the pars interarticularis.
Source: Maryam Kundi. Cureus. 2016 Oct; 8(10): e837. Open Access.
When that pars interarticularis fractures, sometimes it can cause one vertebra to slip on another one.
That slipping of one vertebra on another one due to a fracture is called isthmic spondylolisthesis or spondylolytic spondylolisthesis.
It's a slipping of the vertebrae due to spondylolysis.
Degenerative Spondylolisthesis
The other type of spondylolisthesis, which is actually more common, is degenerative spondylolisthesis.
This happens as you age and you lose water content in your discs from degenerative disc disease.
Normally, your discs are strong stabilizers of the spin.
However, when the discs dry out, it crease some laxity, thus allowing one vertebra to slide forwards on the other one.
How Common Is Spondylolisthesis?
Prevalence of Isthmic Spondylolisthesis
Approximately 11.5% of adults age 40-80 have a spondylosis and 8.2% have isthmic spondylolisthesis according to a 2009 study in Spine.
Isthmic spondylolisthesis often starts from a pars interarticularis fracture from sports.
Spondylolysis is 3 times more common in males than females, and isthmic spondylolisthesis is 2 times more common in males.
This is likely because males are more likely to participate in sports such as football, wrestling, or weightlifting.
However, isthmic spondylolisthesis can also occur in cheerleaders, gymnasts, or people who do a lot of backward-bending activities.
Prevalence of Degenerative Spondylolisthesis
Degenerative spondylolisthesis, develops more in middle age to older age as you lose water content your discs.
Degenerative spondylolisthesis present in approximately 13.6% of adults age 40-80 (Spine 2009)
Degenerative spondylolisthesis is about 3 times more common in women than in men.
Grading of Spondylolisthesis
The severity of spondylolisthesis is graded on a one to five scale.
Grades of Spondylolisthesis
- Grade 1 - less than 25% slippage
- Grade 2 - 26% to 50% slippage
- Grade 3- 51% to 75%
- Grade 4 - 76% to 100% slippage
- Grade 5 - Greater than 100% slippage
Do You Need Surgery For Spondylolisthesis?
In most cases, you don't need surgery for spondylolisthesis.
The presence of spondylolisthesis is not highly correlated with the presence of back pain.
At What Point Is Spondylolisthesis Surgery Needed?
The decision as to whether or not you'll need surgery for spondylolisthesis is usually based more off of your symptoms as well as your response to conservative treatment more so than the severity of the spondylolisthesis.
Source: Farzad Omidi-Kashani. Asian Spine J. 2014 Dec; 8(6): 856–863.
There is an exception that in children or adolescents who are skeletally immature, a slippage of more than 50% is usually an automatic indication for surgery regardless of symptoms.
Can Spondylolisthesis Exercises Really Help?
You might wonder how can exercises help a spondylolisthesis if it's due to degeneration of a disc or a fracture of a vertebra.
The answer is that exercises don't fix spondylolisthesis anatomically.
However, exercises can help resolve the symptoms of spondylolisthesis.
And again, the decision as to whether or not you'll need surgery is based more off of your symptoms and function than it is off of the anatomy.
3 Classes of Spondylolisthesis Exercises
The degree to which the upper vertebrae slips forward on the lower vertebrae is due to the balance of forces pulling the vertebrae forward versus the forces pulling the vertebrae backward.
If you have a forward pelvic tilt and a lot of arch in your lower back, that makes the upper vertebrae slide forward.
Your hip flexors, particularly your psoas pull the vertebrae forwards.
Conversely, your multifidi muscles pull your vertebrae backward.
In the upcoming sections, I'll cover 3 categories of spondylolisthesis exercises:
- Posture exercises
- Hip flexor exercises
- Multifidus exercises
Posture Exercises For Spondylolisthesis
If you stand with a lot of arch in your lower back, no matter how strong your back muscles are, it's very likely that the vertebrae is going to slide forwards.
Therefore, fixing posture is a huge component of resolving symptoms from spondylolisthesis.
That starts by just decreasing the forward tilt of the pelvis.
Think about rolling your pelvis underneath of you so that you flatten your lower back.
Doing this exercise frequently throughout the day helps lessen the forward sliding of the vertebrae due to gravitational compression.
Ideally, you want to make this less of an "exercise" and more of a learned posture that you use whenever you're standing.
Hip Flexor Exercises For Spondylolisthesis
Decreasing the forward pull of your psoas on your lumbar vertebrae can also lessen spondylolisthesis symptoms.
Stretching your psoas is a good idea, but if you're stretching your psoas too much, stretching can actually create a forward pulling of the vertebrae while you're stretching.
You can minimize that by rolling your pelvis underneath of you and trying to flatten your back.
Start in a kneeling position as shown below. Then roll your pelvis underneath of you and push your hips forward until you fell a gentle stretch in the front of the hip and thigh.
Do NOT allow your lower back to arch.
If you can't kneel or can't get down on the floor, you can also do a similar standing version.
Psoas Soft Tissue Release
It may also be helpful to do some soft tissue work to your psoas before stretching.
Again, if your psoas is tight and you try to put it on tension to stretch it, you can pull the vertebrae forwards.
To release the psoas gentle pressure in your abdomen just to the side of your abdominal muscles can help release the psoas.
Additionally, if you move a little deeper towards the midline, you can sometimes actually feel the vertebrae that's slipping forward.
It often feels pretty good to put just a very gentle pressure on the front side of the vertebra.
(Be careful if you do have intestinal problems, or other bowel issues. DON'T do these exercises if you have an abdominal aortic aneurysm.)
Psoas Release Tool
Another tool that you can use is called the psoas release tool.
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You can put this inside your hip bones and then just press down gently as shown below.
Hold this position for 2-3 minutes at a gentle pressure.
I would recommend having your knees bent up as shown above over pillows or a bolster.
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$60.10 ($60.10 / Count) (as of October 9, 2024 07:51 GMT -05:00 - More infoProduct prices and availability are accurate as of the date/time indicated and are subject to change. Any price and availability information displayed on [relevant Amazon Site(s), as applicable] at the time of purchase will apply to the purchase of this product.)This flattens your lower back out against the bed or floor and relaxes the psoas muscle.
Multifidus Exercises For Spondylolisthesis
The final category of spondylolisthesis exercises is to strengthen the multifidi muscles that pull the vertebrae backwards.
I put this category last because your psoas is a much larger muscle group than your multifidus, so it's unlikely that the multifidus can overcome the forward pull of an anterior pelvic tilt with tight hip flexors.
However, they can slightly counteract the forward pull of the psoas.
Bird Dog Exercise For Spondylolisthesis
The bird dog is one of the most commonly performed multifidus strengthening exercises.
To do the bird dog, kneel on all fours. Then raise one leg behind you and the opposite arm in front of you.
A common mistake with the bird dog is going into too much extension.
If you're trying to decrease the extension in your spine, this is not good.
Make sure to keep your spine in a spinal neutral position where your lower back is relatively flat. Then extend your hip backward, but only to the extent that you don't arch your lower back.
That may be a very small amount of hip extension.
Note that this exercise also puts your hip flexors on tension, so it is an active hip flexor stretch as well.
Hold each repetition 10 seconds and repeat 10 times.
Standing Bird Dog Exercise
If you can't get down on the ground or don't want to get down on the ground, you can also do a standing version of the bird dog exercise.
Hold on to a chair as needed. Raise one leg and the opposite arm, again making sure to keep your spine in a neutral position.
Conclusion
Exercises can't anatomically fix spondylolisthesis. However, they can help relieve or even eliminate the symptoms of spondylolisthesis.
Again, keep in mind that not everyone with spondylolisthesis has pain, and only a small percentage of people with spondylolisthesis need surgery.
Furthermore, for adults with with spondylolisthesis, surgery is only recommended if you've tried conservative treatment and it's failed.
Need Non-Surgical Treatment For Spondylolisthesis?
If you're in the St. Louis area and need help to relieve lower back pain from spondylolisthesis without surgery, we'd be happy to help.
Just tap the button below to request an appointment with one of our specialist physical therapists.