What is spondylolisthesis?
Spondylolisthesis is a common cause of back and leg pain. The most common question that I get asked immediately after I tell someone that they have a “spondy”, is a variation of….
- “Can it be fixed without surgery?”
- “Will it go back into place if I do a lot of back bends?”
- “Can I reverse my spondylolisthesis with physical therapy?”
Let’s look deeper into questions surrounding the idea of reversing spondylolisthesis. The word spondylolisthesis has two words with Latin roots. “Spondy” is latin for spine, and “listhesis” is latin for slipping. In this condition one vertebral body slips forward with respect to the one immediately underneath it. The two most common locations of a spondylolisthesis are L4-5 and L5-S1.
Here is an X-ray of the spine with a spondylolisthesis at the L4-5 level. In this case, this a grade 1 slip — L4 has slipped about 20% of the length of the L5 vertebral body.
This condition has a couple of different causes. The most common cause of a spondylolisthesis is degenerative disk disease caused by the normal aging process.
The other most common cause is repeated hyperextension during sports as an adolescent when the spine can develop a stress fracture called a “spondylolysis”. This typically causes back pain during adolescence and may later progress to a spondylolisthesis.
Why do some people develop a spondylolisthesis?
The risk factors for developing a spondylolisthesis include:
- female sex
- hyper flexibility
- increased lumbar lordosis
- according to Readysteadygymnastics.co.uk, sports such as football and gymnastics that involve hyperextensions of the spine.
I’ve written a more detailed article about there natural history and treatment of spondylolisthesis here: https://sohrabgolloglymd.com/spondylolisthesis/
Reversing Spondylolisthesis: is it possible?
Since the surgical treatment for fixing a spondylolisthesis typically involves a single level fusion of the spine, most people want to know about their alternatives. Their two most common concerns / desires are as follows:
1. They are reluctant to jump right into a fusion
2. They are very interested in alternatives.
I’m a cross fitter. I love to surf. If I had a spondy, I’d want to wait for as long as I could before I got a fusion. I’d also do all the PT and non-operative treatment that I could. I checked the crossfit boards and found this thread on spondylolisthesis:
“I am an active duty Army officer diagnosed with Spondylolisthesis, L5 shifted approx 30-35% forward (anterior) over S1. I most likely incurred my injury during my early years in the military. To my knowledge, the degree of shift has not changed over the years. I have been crossfitting for 4 years, and my back issues have fluctuated over the years in terms of severity and impact to my workouts. However, it has not impacted my ability to do my job or deploy. At this time, I am mid way through my 8th deployment, and I’m trying to proactively minimze my syptoms as much as possible on a daily basis.
I avoid heavy deadlifts and GHDs, but pretty much do every thing else as Rx’d. My symptoms sometimes include back soreness, which gets too severe to exercise about 1-2 times a year for a few days. I do my best to listen to my body and reduce my activity when this happens.”
The recommendations that follow this post include an excellent discussion about the pros and cons of reverse hyper-extension exercises with the lumbar spine, inversion therapy, and avoiding certain heavy lifts — like deadlift and squats. If you want to read the entire thread, follow this link — http://board.crossfit.com/showthread.php?t=61980
This is a picture of rogue’s reverse hyper extension machine for the lumbar spine:
What should you do next?
Here’s my opinion. FORM is critically important if you have a spondylolisthesis. If you think about it, a spondylolisthesis is probably a normal response to an abnormal movement pattern. Most of these patients trend towards the hyper flexible part of the athletic spectrum. Their joint laxity and movement patterns probably put increased stress on the intervertebral disk during physical exercise. Most likely, this is a shear type of force where the trunk is trying to slide anteriorly with respect to the pelvis. If the core is strong and the trunk is solidly anchored to the pelvis, this shear force should be offset by the stabilizing strength of the glutes and spina erecta musculature.
If you workout with PERFECT FORM, you should theoretically neutralize the forces trying to push your slipping vertebral body anteriorly. If you strengthen the muscles that neutralize these forces, you should be able to work out with risking progression while also stabilizing your core. Do this for long enough and you’ll have a bullet proof core and less pain.
My favorite book on this subject is Kelly Starrett’s Becoming a Supple Leopard, but you can always start with https://www.mobilitywod.com.
Neutral Spine. Neutral Spine. Neutral Spine. That’s the mantra you should be repeating to yourself every time you lace up your shoes if you have a spondylolisthesis.
What about surgery?
Finally, a word about surgical treatment. As the field of microscopic spine surgery has evolved, I have become much more willing to perform an microscopic decompression of the nerve roots affected by the spondylolisthesis, especially if someone has leg pain on only one side.
In my opinion, correct body mechanics has just as much ability to stabilize a spondylolisthesis as a fusion does, and if I needed an operation because I had relentless leg pain due to a spongy, I’d have a microscopic decompression and be absolutely meticulous about my rehab.
If you’ve got questions about what to do about your spondylolisthesis and you’d like us to review your MRI scan, we’d be happy to just visit this page here to get started.