What is Spondylolithesis?
Spondylolithesis results when a vertebral dysfunction occurs, usually at the articulating processes or joints between two vertebral levels, and one vertebrae slips forward over the vertebra beneath it. This most often occurs in the lumbar spine resulting in a narrowing of the vertebral foramen through which the spinal cord passes.1 You may find it helpful to view the anatomy of the spine and this condition at Integrative Learning Center of Mid-America’s Online Library as you read this article.
Symptoms of spondylolithesis include pain in the low back or lower extremities, weakness in leg muscles, tight hamstrings and, when severe, loss of bowel or bladder control.1, 2 Pain may increase with prolonged standing or backward bending (extension) and is usually relieved by sitting or lying down. Excessive lumbar lordosis or incurving of the low back and a stomach that protrudes are signature signs of this condition.1
Congenital or developmental spondylolithesis is present at birth or develops during childhood but may not be problematic until adulthood is reached.2, 3 However, spondylolithesis occurs more often in adults than children.4
Acquired spondylolisthesis may be caused by excessive wear and tear on the lumbar vertebrae and is found more often in men than women due to strenuous sports especially those involving excessive and repetitive hyperextension.3 Degenerative spondylolisthesis (a subset of acquired) usually occurs over age 50 as degenerative changes weaken the spinal infrastructure and slippage results.3 “Isthmic” spondylolisthesis occurs when the bone above the joint fractures causing the vertebra to slip forward.5 One or both sides may slip forward at a vertebral level. Retrolithesis is rare and indicates the vertebra has slipped backward. Other risk factors and causes include:
- Athletics including diving, gymnastics, weight lifting, football, wrestling etc.6
- Trauma, injury, or motor vehicle accident history2, 4
- Lifting heavy objects (especially repetitive lifting)3
- Genetics2, 4
- Infection and disease2
- Posture and body mechanics3, 4
Spondylolithesis ranges from a mild to a severe condition and is graded from 1 to 5. Grade 1 is the least severe dysfunction with 25% slippage from neutral, Grade 2 indicates 50% slippage, up to Grade 5 where 100% slippage is found (Spondyloptosis).1 Spondylolithesis occurs in 6% of the ambulatory population.6 Symptom manifestation does not always correlate with the severity of the slippage and may be present yet asymptomatic.6
Conservative medical treatment options include bed rest (2-3 days), physical therapy,2 medications to control pain, spasm, or inflammation, a back brace, and activity restrictions.1 Heavy lifting and strenuous sports may need to be avoided.1 Extension of the lumbar region may increase the dysfunction and therefore put pressure on the spinal cord or nerve roots, while flexion activities may relieve the symptoms.2
Precautions & Contraindications
The primary precaution and contraindication with spondylolithesis is avoiding movements that accentuate low back extension. The exception to this is with a Retrolithesis, where flexion activities should be avoided (see flexion precautions for herniated disc). Using good body mechanics (neutral lumbar curve) with sitting, standing and especially with lifting is important. Sleeping position is also important.
Avoid stomach lying or prone position. Use of a pillow under knees in supine or between knees when side-lying can be helpful. Make sure the mattress is firm enough so posture is not distorted during sleep. To understand how somatic education can be of value to individuals with this condition, see the addendum to this article.
Addendum: Benefits of Somatic Education with Spondylolithesis
Bones for Life®
Special emphasis on the Bones for Life® (BFL) exercises (called processes) that teach alignment of the neck and the low back can be very helpful to students who have Spondylolithesis. BFL offers excellent cues on neutralizing excessive incurving of the spine in all anti-gravity movements such as walking and standing up from a chair. The processes are rich with information regarding the relationship between foot, knee and low back and the influence on posture. A neutral spine is gradually trained, not locally via abdominal contraction but rather throughout the system in dynamic relationship with gravity. This neutral spine provides the safe starting point for function. Furthermore, the many processes emphasizing “axis” offer a unique opportunity to sense force passing through a neutral low back. This cultivates improved load handling in the spine in the upright. The positive impact inherent in the activity of walking improves even further when special attention is given to the postural alignment through a BFL program.
Proportional Flexibility is a key insurance policy that is built into the BFL program especially for limiting injury and managing symptomology in students with disorders such as spondylolithesis. By recruiting and engaging seldom used regions of the spine and ribs, the overworked areas can take a much needed break and begin to function in concert with the underused regions. The result is improved muscle balance and tone throughout the entire trunk, increased efficiency of movement, and decreased effort required to perform regular activities of daily living.
The Feldenkrais Method®
Awareness Through Movement® (group classes) lessons have many benefits for those individuals suffering from a myriad of spinal disorders, including spondylolithesis. This unique method of movement addresses the soma or “living body” of an individual by accessing areas of the brain and body often under a person’s radar or awareness. By bringing awareness to habitual movement patterns students will usually be able to experience an expansion of choices regarding their alignment.
Specifically with spondylolithesis, where limiting excessive extension of the low back is a part of symptom management, these choices become critically important. Further injury and dysfunction can be avoided if a person becomes aware of the specific movements and activities that contribute to the problem and makes modifications accordingly. Improved awareness and increased choices are just two of the benefits that somatic education and the Feldenkrais Method® have to offer. If needed one-on-one Functional Integration® sessions can further contribute by increasing awareness and improving reorganization to optimize function for a person with spondylolithesis.
Denise Deig is the author of Positional Release: from a dynamics systems perspective. A Physical Therapist, Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer. She has a private practice in Fishers, Indiana. You can find out more about her and her practice at www.denisedeig.com. Deig can be reached by email at firstname.lastname@example.org. She offers certification and continuing education programs through www.intgrativelearningcenter.org.
- SpineUniverse.com. Spondylolisthesis-The Basics. Online access 10/8/2007 9:44 a.m. http://www.spineuniverse.com/displayarticle.php/article4000.html
- WebMD.com. Back Pain Health Center. Pain Management: Spondylolithesis. Online access 10/8/2007 9:39 a.m. http://www.webmd.com/back-pain/pain-management-spondylolithesis
- SpineUniverse.com What Causes Spondylolisthesis? Online access 10/8/2007 9:46 a.m. http://www.spineuniverse.com/displayarticle.php/article4002.html
- PhysicaltherapyCalifornia.com. Spondylolithesis. http://physicaltherapy.ca/ortho/Spondylolisthesis.1.html
- 2003 Swarm Interactive. About Spondylolisthesis. rel=”nofollow”http://www.swarminteractive.com
- Medifocus:Spondylolisthesis Guidebook. Spondylolithesis. Online access 10/8/2007 9:41 a.m. http://www.spondylolisthesis-guidebook.com/guide_detail.asp?gid=R