Spondylolisthesis

with Rehab

The slipping of one or multiple vertebrae out of the correct anatomical position is a condition known as spondylothesis. Spondylothesis is most common in adolescents and is caused by a number of different reasons, such as vertebral fracture or something you are born with (congenital). Spondylothesis is diagnosed with the use of x-rays.

SYMPTOMS

  • Dull, achy pain in the lower back.

  • Pain that worsens with extension of the spine.

  • Tightness of the (muscles on the back of the thigh).

  • Lower back stiffness.

  • Signs of nerve damage: pain, numbness, or weakness affecting one or both lower extremities.

  • Muscle wasting (atrophy), uncommon.

  • Loss of stool (bowel) or urine (bladder) function.

CAUSES

The symptoms of spondylothesis are caused by one or more vertebrae that are out of alignment placing pressure on the spinal cord. Common mechanisms of injury include:

  • Congenital defect of the spine.

  • Degenerative process.

  • Stress fracture of the spine.

  • Fracture due to trauma to the spine.

RISK INCREASES WITH:

  • Activities that have a risk of hyper-extending the back.

  • Activities that have a risk of excessively rotating the spine.

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

  • Family history of spondylolysis or spondylolisthesis.

  • Improper sports technique.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique. When possible, have a coach correct improper technique.

PROGNOSIS

If treated properly, the spondylothesis usually resolves.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a chronic problem.

  • Inability to compete in athletics.

  • Prolonged healing time, if improperly treated or re-injured.

  • Failure of the fracture to heal (nonunion)

  • Healing of the fracture in a poor position (malunion).

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. It is important to learn how to use proper body mechanics as to not place undue stress on your spine. If the injury is severe, then your caregiver may recommend a back brace to allow for healing or even surgery. Surgery often involves fusing 2 adjacent vertebrae, so no movement is allowed between them.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Spondylolisthesis

Most people with low back pain will find that their symptoms worsen with either excessive bending forward (flexion) or arching at the low back (extension). The exercises which will help resolve your symptoms will focus on the opposite motion. Your physician, physical therapist or athletic trainer will help you determine which exercises will be most helpful to resolve your low back pain. Do not complete any exercises without first consulting with your clinician. Discontinue any exercises which worsen your symptoms until you speak to your clinician. If you have pain, numbness or tingling which travels down into your buttocks, leg or foot, the goal of the therapy is for these symptoms to move closer to your back and eventually resolve. Occasionally, these leg symptoms will get better, but your low back pain may worsen; this is typically an indication of progress in your rehabilitation. Be certain to be very alert to any changes in your symptoms and the activities in which you participated in the 24 hours prior to the change. Sharing this information with your clinician will allow him/her to most efficiently treat your condition.

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

FLEXION RANGE OF MOTION AND STRETCHING EXERCISES:

STRETCH – Flexion, Single Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest. Hold your leg in place by either grabbing behind your thigh or at your knee.

  • Pull until you feel a gentle stretch in your low back. Hold __________ seconds.

Slowly release your grasp and repeat the exercise with the opposite side.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Double Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest.

  • Tense your stomach muscles to support your back and then lift your other knee to your chest. Hold your legs in place by either grabbing behind your thighs or at your knees.

  • Pull both knees toward your chest until you feel a gentle stretch in your low back. Hold __________ seconds.

  • Tense your stomach muscles and slowly return one leg at a time to the floor.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Spondylolisthesis

These exercises may help you when beginning to rehabilitate your injury. These exercises should be done near your "sweet spot." This is the neutral, low-back arch, somewhere between fully rounded and fully arched, that is your least painful position. When performed in this safe range of motion, these exercises can be used for people who have either a flexion or extension based injury. These exercises may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTHENING – Deep Abdominals, Pelvic Tilt

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Tense your lower abdominal muscles to press your low back into the floor. This motion will rotate your pelvis so that your tail bone is scooping upwards rather than pointing at your feet or into the floor.

  • With a gentle tension and even breathing, hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Abdominals, Crunches

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor. Cross your arms over your chest.

  • Slightly tip your chin down without bending your neck.

  • Tense your abdominals and slowly lift your trunk high enough to just clear your shoulder blades. Lifting higher can put excessive stress on the low back and does not further strengthen your abdominal muscles.

  • Control your return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Quadruped, Opposite UE/LE Lift

  • Assume a hands and knees position on a firm surface. Keep your hands under your shoulders and your knees under your hips. You may place padding under your knees for comfort.

  • Find your neutral spine and gently tense your abdominal muscles so that you can maintain this position. Your shoulders and hips should form a rectangle that is parallel with the floor and is not twisted.

  • Keeping your trunk steady, lift your right hand no higher than your shoulder and then your left leg no higher than your hip. Make sure you are not holding your breath. Hold this position __________ seconds.

  • Continuing to keep your abdominal muscles tense and your back steady, slowly return to your starting position. Repeat with the opposite arm and leg.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Lower Abdominals, Double Knee Lift

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Tense your abdominal muscles to brace your low back and slowly lift both of your knees until they come over your hips. Be certain not to hold your breath.

  • Hold __________ seconds. Using your abdominal muscles, return to the starting position in a slow and controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

POSTURE AND BODY MECHANICS CONSIDERATIONS - Spondylolisthesis

Keeping correct posture when sitting, standing or completing your activities will reduce the stress put on different body tissues, allowing injured tissues a chance to heal and limiting painful experiences. The following are general guidelines for improved posture. Your physician or physical therapist will provide you with any instructions specific to your needs. While reading these guidelines, remember:

  • The exercises prescribed by your provider will help you have the flexibility and strength to maintain correct postures.

  • The correct posture provides the optimal environment for your joints to work. All of your joints have less wear and tear when properly supported by a spine with good posture. This means you will experience a healthier, less painful body.

  • Correct posture must be practiced with all of your activities, especially prolonged sitting and standing. Correct posture is as important when doing repetitive low-stress activities (typing) as it is when doing a single heavy-load activity (lifting).

PROPER SITTING POSTURE

In order to minimize stress and discomfort on your spine, you must sit with correct posture. Sitting with good posture should be effortless for a healthy body. Returning to good posture is a gradual process. Many people can work toward this most comfortably by using various supports until they have the flexibility and strength to maintain this posture on their own.

When sitting with proper posture, your ears will fall over your shoulders and your shoulders will fall over your hips. You should use the back of the chair to support your upper back. Your low back will be in a neutral position, just slightly arched. You may place a small pillow or folded towel at the base of your low back for

support.

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles fatigue and lead to excessive strain on joints and other tissues. Keep these recommendations in mind:

CHAIR:

  • A chair should be able to slide under your desk when your back makes contact with the back of the chair. This allows you to work closely.

  • The chair's height should allow your eyes to be level with the upper part of your monitor and your hands to be slightly lower than your elbows.

BODY POSITION

  • Your feet should make contact with the floor. If this is not possible, use a foot rest.

  • Keep your ears over your shoulders. This will reduce stress on your neck and low back.

INCORRECT SITTING POSTURES

If you are feeling tired and unable to assume a healthy sitting posture, do not slouch or slump. This puts excessive strain on your back tissues, causing more damage and pain. Healthier options include:

  • Using more support, like a lumbar pillow.

  • Switching tasks to something that requires you to be upright or walking.

  • Taking a brief walk.

  • Lying down to rest in a neutral-spine position.

CORRECT LIFTING TECHNIQUES

DO:

  • Assume a wide stance. This will provide you more stability and the opportunity to get as close as possible to the object which you are lifting.

  • Tense your abdominals to brace your spine; then bend at the knees and hips. Keeping your back locked in a neutral-spine position, lift using your leg muscles. Lift with your legs, keeping your back straight.

  • Test the weight of unknown objects before attempting to lift them.

  • Try to keep your elbows locked down at your sides in order get the best strength from your shoulders when carrying an object.

  • Always ask for help when lifting heavy or awkward objects.

INCORRECT LIFTING TECHNIQUES

DO NOT:

  • Lock your knees when lifting, even if it is a small object.

  • Bend and twist. Pivot at your feet or move your feet when needing to change directions.

  • Assume that you cannot safely pick up a paperclip without proper posture.