Spondylolisthesis: when one vertebrae slips forward on the vertebrae below it.
There are two types of spondylolisthesis, generally seen in two different groups of people. Isthmic spondylolisthesis occurs mostly in young adults, with symptoms initially appearing between ages ten- and fifteen-years-old. This type is especially prevalent in those who are involved in sports that include a great deal of jarring movements and hyperextension through the lower back, such as gymnastics.
On the other hand, degenerative spondylolisthesis is not usually seen in people younger than forty, becomes more common with greater age, and is three times more common in women than men. Both types are associated with degeneration of the intervertebral disc, arthritis in the joints between the vertebrae, and weakening of the muscles supporting the spine. Exaggerated extension of the lower back will also lead to some muscles in the lower torso and pelvis becoming short and tight, and others long and weak.
Lower back pain is not always a symptom of a spondylolisthesis, though it can certainly be present, especially when bending backwards or with long periods of standing. Symptoms in one or both legs are common, including pain and cramping. Due to possible pressure on the nerves stemming from the slipped vertebrae, weakness, numbness, and tingling in the leg or legs may also be felt. Any concerns should be addressed with a doctor, chiropractor, osteopath, or physical therapist, who can confirm the diagnosis and start you on the appropriate treatment.
So, if you are diagnosed, what then? In addition to rest and any prescribed anti-inflammatory medication, both appropriate exercise and remedial massage therapy can play a significant role in the treatment of spondylolisthesis. Ligament laxity and weakening of the tiny muscles around the vertebra are often found in spondylolisthesis patients, so it’s in your best interest to build stability and strength around the spine. Emphasis should be on torso-strengthening isometric exercises (those that are done in stationary positions, like planks), single-leg exercises that allow you to maintain a neutral spine and pelvis, and any exercises that will avoid hyperextension of the lower back. Reducing tension in the short, tight muscles (hip flexors at the front of the pelvis, and the erector spinae group and quadratus lumborum at the lower back) can help decrease lower back stress associated with hyperextension, and will support any manual treatment provided by a chiropractor, osteopath, or physical therapist.
Remember that your exercise program should always take into account all of your goals and needs, not just addressing one specific diagnosis. As always, both exercise guidance and massage therapy should be provided by qualified professionals working in conjunction with your medical team. For best results, get your doc, physical therapist, and personal trainer or exercise coach talking – plus your chiropractor and massage therapist, if you see these. There are several great therapists in the Alexandria area (and the rest of Northern Virginia), so please ask for a recommendation if needed.