Spondylolisthesis

Spondylolisthesis is the condition in which one vertebral body, the bones of your spine, is slipped forward over another. Spondylolisthesis is a spinal condition that causes lower back pain. Most of the time, nonsurgical treatment can relieve your symptoms.

Slipped disc vs slipped vertebrae

Spondylolisthesis is not the same as a slipped disc. A slipped disc is when a disc (the tissue between the bones in your spine) moves out of place.

The disc lies between the vertebrae throughout the spine, and it can slip/herniate/bulge out from between those vertebrae and compress nerve roots. A slipped vertebrae is referred to as spondylolisthesis and is when one vertebrae slips forward/backward and out of place in relation to the vertebrae above or below.

Types of spondylolisthesis

1. Congenital/Dysplastic- Occurs when a baby’s spine does not form the way it should before birth. The slip in this type of spondylolisthesis is a defect in the facet joints, which connect spinal vertebrae. This occurs in the lower joints at L5 (inferior Joint), the upper joints at S1 (superior joints), or at both joints and cause a gradual slip of the L5 vertebrae over time.
2.  Isthmic spondylolisthesis happens because of spondylolysis. The crack or fracture weakens the bone. In isthmic spondylolisthesis there is a defect, typically a fracture, of the pars interarticularis, the bone that connects the upper and lower facet joints. This fracture prevents the affected vertebra from staying in line with the other vertebrae, allowing it to slide forward. The L5-S1 level is most frequently affected by isthmic spondylolisthesis.
3. Degenerative spondylolisthesis, the most common type, happens due to aging. Once the joints in the spine begin to wear, they have difficulty keeping the spine in line and a vertebra slips forward. This occurs most frequently in the lumbar spine, but can happen in the cervical spine as well. As the disks thin, they are more likely to slip out of place.

Less common types of spondylolisthesis include:

1. Traumatic spondylolisthesis happens when an injury causes vertebrae to slip.
2. Pathological spondylolisthesis occurs when a disease such as osteoporosis or tumor causes the condition.
3. Post-surgical spondylolisthesis is slippage as a result of spinal surgery.

Risky population for spondylolisthesis

1. Athletics: young athletes who participate in sports that stretch the lumbar spine are more likely to develop spondylolisthesis
2. Genetics: some people with isthmic spondylolisthesis are born with thinner sections of the vertebra called the pars interarticularis, which connects the facet joints linking the vertebrae directly above, and below to form a working unit that permits movement of the spine. These thinner areas of vertebrae are more likely to fracture and slip.
3. Age: with aging, degenerative spine conditions can develop, which is when wear and tear on the spine weakens the vertebrae. Older adults with degenerative spinal conditions may be at higher risk for spondylolisthesis. It becomes more common after age 50.

 Symptoms of spondylolisthesis

Lower back pain is typically the main symptoms of spondylolisthesis. The pain may extend to the buttocks and down the thighs. You may also experience:

• Muscle spasms in the hamstring (muscles in the back of the thighs).
• Back stiffness.
• Difficulty walking or standing for long periods.
• Pain when bending over.
• Numbness, weakness or tingling in the foot.

Physiotherapy management of spondylolisthesis

A physiotherapy program is one of the more effective ways to treat spondylolisthesis for it helps strengthen the muscles that support your spine, and it trains you how to keep your spine safe and prevent further and future injury.

A physiotherapist will incorporate both passive and active treatment:

Passive treatments will help your body relax and give it an apportunity to heal, especially if you have pars interarticularis fracture. This treatment will include:

• Deep tissue massage: this method targets spasms and chronic muscle tension that perhaps builds up as your body readjusts to the slipped vertebra. Physiotherapist’s uses direct pressure and friction to release the tension in your low backs soft tissues (muscles, ligaments and tendons)
• Tens (transcutaneous electrical nerve stimulation): A TENS machine stimulates your muscles through variable intensities of electrical current. Tens helps reduce muscle spasms, and it may increase your body’s production of endorphins, your natural painkillers.
• Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.
• Hot and cold therapies: Your physical therapist will alternate between hot and cold therapies

Active Treatments: These therapeutic exercises strengthen your body and help prevent a recurrence of possible pain from spondylolisthesis.

In the active part of physiotherapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with spondylolisthesis.

A physiotherapist may also suggest a personalized exercise program for you. This can help reduce the likelihood of your back pain recurring and can improve your overall health. For spondylolisthesis, the physiotherapist will likely recommend abdominal strengthening and hamstring work because both of those muscle groups are crucial to low back support.