Spondylolisthesis: Signs You Have It and How to Treat It

Spondylolisthesis (pronounced spaan-duh-low-luhs-thee-suhs) is a mouthful that sounds pretty serious, but this somewhat common cause of low back pain isn’t as complicated as it seems. It essentially means instability in the spine, and anyone from a young athlete to an older adult with osteoarthritis has the potential to develop it. 

Fortunately, most of the time, symptoms associated with spondylolisthesis aren't hard to treat, as conservative methods including physical therapy usually help a lot, says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. 

Read on to learn about what causes spondylolisthesis and how to get relief with help from our Hinge Health physical therapists.

What Is Spondylolisthesis?

Spondylolisthesis results when one of the vertebrae in the spine (“spondy” refers to spine) shifts its position (“listhesis” means slippage). Spondylolisthesis can affect any vertebrae along the spine, but it's most common in the lumbar spine (low back). 

You may have heard of other similar conditions, like spondylosis (osteoarthritis of the spine) or spondyloarthritis (inflammatory arthritis of the spine). In the case of spondylolisthesis, instability is the main problem.

“Spondylolisthesis can simply be part of natural changes in the spine, but it also can be the result of a change or fracture in the pars interarticularis, which is a small piece of bone that links each vertebra to the vertebra beneath it,” Dr. Kimbrough explains. “If it gets fractured or otherwise disrupted, the vertebra can slip forward and out of alignment.” 

This displacement isn’t always painful. If a vertebra has shifted only slightly, you might not even know it. If the affected vertebra irritates nearby nerves, however, it can lead to back pain that may also radiate down the legs. 

Spondylolisthesis: A Hinge Health Perspective

Learning about conditions that cause pain can be scary, and the prospect of hearing that any of your vertebrae have moved position can be understandably alarming. But we know from Hinge Health members and research studies that anatomical labels can backfire when it comes to your treatment and recovery. When people hear they may have a condition like spondylolisthesis, it can cause feelings of panic, like you have something "wrong" that needs to be fixed. This way of thinking about pain is largely outdated.

For most common musculoskeletal conditions, regardless of what may or may not be contributing to pain, the solution is often the same. Movement — through physical and exercise therapy — can build strength, flexibility, and resilience to pain in and around the spine. 

Dr. Kimbrough notes that the only way to definitively diagnose this problem is to have an imaging test, like an X-ray, but this kind of workup is not always essential. Physical therapists can usually help based on symptoms as well as information about what preceded the discomfort. Research has shown that the overwhelming majority of patients with mild spondylolisthesis — about 84% — improve with conservative care like physical therapy.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Symptoms of Spondylolisthesis

Spondylolisthesis symptoms can vary depending on the severity and location of the affected vertebra. For some people, the condition doesn’t cause any pain. If you do experience symptoms, they’ll often include: 

• Low back pain that’s worse when standing or walking for long periods of time (versus sitting)

• Stiffness in the low back

• Tight hamstrings (muscles behind your thighs); you may also notice spasms

• Pain, numbness, or tingling that goes from your lower back down one leg (if the shift impacts a nerve and causes sciatica)

Causes of Spondylolisthesis

Spondylolisthesis is rarely the result of just one cause and is often due to a combination of factors, including:

• Sports-related injuries. “Some cases of spondylolisthesis stem from back injuries related to sports, particularly those that involve a lot of hyperextension of the spine,” says Dr. Kimbrough. Gymnastics and weight lifting are common culprits. So is football and wrestling (falling on your stomach can also cause vertebrae to slip forward).

• Trauma, like a car accident or a fall. Injury to the spine, such as fractures or stress fractures, can cause instability and contribute to spondylolisthesis.

• Genetics. Some people may be born with slight variations in the structure of their spine, such as defective facet joints or elongated pars interarticularis (part of the vertebra). This can make some more likely to develop spondylolisthesis in the future. 

• Age-related changes. Osteoarthritis and other age-related changes to the spine may lead to spondylolisthesis.

No matter why spondylolisthesis develops, there’s a lot you can do to manage the symptoms.

Treatment Options for Spondylolisthesis Symptoms

Spondylolisthesis ranges from low grade (mild) to severe (high grade), depending on how far the alignment of a vertebra has shifted. Most mild to moderate cases respond to conservative treatment, says Dr. Kimbrough. Treatment options include:

• Activity modification. It’s generally wise to keep moving as much as possible, says Dr. Kimbrough, but you may have to temporarily pull back on pain-provoking activities. Limit back-bending motions (especially extension), high-impact activities, and heavy lifting until the pain subsides.

• Ice or heat. Both hot and cold therapy can help you manage lower back pain resulting from spondylolisthesis. Applying ice can help reduce swelling and inflammation, while a hot compress can help relax tense muscles near the affected vertebrae. Whichever feels best and most soothing to you is fine, says Dr. Kimbrough.

• Over-the-counter pain medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for pain related to spondylolisthesis. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Bracing. “I don’t often recommend bracing for this problem, but some patients might benefit from temporarily wearing a brace that goes around their waist at the lower part of the spine,” says Dr. Kimbrough. “It might give you a little support and decrease symptoms.” This may also help you feel strong and stable enough to move with confidence. But remember to exercise without the brace as well to help build strength along your back and spine.

• Physical therapy. Physical therapy for spondylolisthesis aims to stretch and strengthen surrounding muscles, including those in the hamstrings, hip flexors, and core muscles that wrap around your front and back. Most patients with mild to moderate slippage of vertebrae will benefit from a physical therapy program, says Dr. Kimbrough.

• Surgery. If conservative treatments including physical therapy don’t help, or if your vertebrae have shifted significantly (high-grade spondylolisthesis), then surgery may be recommended. Surgery for spondylolisthesis typically entails spinal fusion, during which two vertebrae are joined together to increase stability.