Spondylolisthesis

Overview

Spondylolisthesis (pronounced spon-dee-lo-lis-thee-sis) means one vertebra has slipped forward relative to the one beneath it, most commonly at L5/S1 or L4/5. The amount of slip is graded from 1 (mild) to 4 (severe); the great majority of cases we see are grade 1 or 2 and are managed without surgery.

There are two main types. In younger people, usually teenagers and young adults involved in sports with repeated back arching, a stress fracture in a small part of the vertebra (a "pars defect", or spondylolysis) can allow the bone to slip forward. In adults over 50, the slip is "degenerative": wear in the discs and facet joints lets the vertebra drift forward without any fracture, and this can narrow the canal and produce stenosis-like leg symptoms.

Many people with a mild slip have no symptoms at all and only find out from an X-ray taken for another reason. When symptoms do occur, they are typically a lower back ache that is worse with standing, walking and arching, sometimes with hamstring tightness or leg pain. The slip itself rarely progresses in adults, and the aim of treatment is to control symptoms and build the strength to support the segment.

Causes and risk factors

• Repetitive back extension in sport: gymnastics, cricket fast bowling, diving, weightlifting, football
• A pars stress fracture in adolescence (may be unnoticed at the time)
• Age-related degeneration of discs and facet joints, more often in women over 50
• A family history or a congenital difference in the shape of the vertebra
• Weak abdominal and gluteal muscles with a forward-tilted pelvis
• Being overweight, increasing the shear load on the lower lumbar spine

How we may be able to help

Because spondylolisthesis is a structural diagnosis, we take a careful history and examination, looking at your pain pattern, lumbar movement, hamstring length, trunk control and a neurological check of your legs. If you have not had imaging and the pattern suggests a slip — particularly in a young athlete with extension-related pain — we can arrange an online private GP consultation to request an X-ray or MRI.

Treatment is exercise-led. Our physiotherapists build a stabilisation programme focused on the deep abdominal and gluteal muscles, with hamstring and hip flexor mobility and a gradual return to sport that avoids excessive arching. Manual therapy to the stiff segments above the slip and to the hips can reduce compensatory strain. Our chiropractor uses gentle mobilisation rather than manipulation at the slipped level, and treats adjacent regions where appropriate.

Dry needling can ease the chronically tight lower-back and hamstring muscles that often accompany a slip. Interferential therapy may be used as an adjunct for pain. A 3D posture scan is helpful to measure pelvic tilt and lumbar curve, both of which affect how much shear the segment experiences, and to track change as you get stronger.

What you can do at home

• Avoid repeated arching, heavy overhead lifting and deep back-bends until assessed
• Practise pelvic tilts and dead bug exercises daily to build trunk control
• Stretch your hamstrings and hip flexors gently, holding each for 30 seconds
• Walk regularly on flat ground; cycling is often comfortable
• Sleep on your side with a pillow between your knees, or on your back with a pillow under the knees
• If you are a young athlete with new extension-related back pain, pause the sport and get it checked promptly