Spondylolisthesis Pain and Chiropractic Treatment

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Spondylolisthesis has been widely studied, but management can be challenging. The condition can affect most any age groups from teens to active seniors. There are a wide range of treatments for Spondylolisthesis such as bracing, exercise, chiropractic adjustment and spinal fusion. The care for people suffering from spondylolisthesis pain should be focused on long term results rather than temporary symptom relief.

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What, Where, Why?

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The term spondylolisthesis is defined as the anterior displacement of the vertebral body in relation to the vertebral segment below. There are different ways this condition can be acquired. The first is from a fracture (spondylolysis) of the pars interarticularis, which can affect any age group. The most prevalent site for Spondylolisthesis is the lumbar region, particularly L4 (degenerative) and L5 (isthmic) spondylolisthesis seen before age 50 is most likely due to a pars fracture during childhood or adolescence (due to trauma or overuse injury) and after age 50 degeneration of the vertebra and intervertebral discs.

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Categorical Classification

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The clinical classification of Spondylolisthesis has four presentations which are recent, pre- existing stable, pre-existing unstable and degenerative. Using these classifications, the therapeutic assessment and clinical decisions are focused for effective treatment.

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Response to Chiropractic Treatment

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Adolescents and young adults in the recent classification have an active fracture of the pars and should avoid any lumbar hyperextension. A lumbosacral brace may aid in a successful treatment outcome. The most prevalent classification seen in chiropractic offices is pre-existing stable.

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Chiropractic Patients have an excellent prognosis with Spondylolisthesis when treated early. Adults with Spondylolisthesis more often need the segments above and below adjusted as well as the sacroiliac joints. Flexion-distraction has been found to increase treatment outcomes when the patient is not in the unstable classification which provides limited benefit.

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Improving Stability and Control

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The most important treatment for improving stability and control to the Spondylolisthesis is by strengthening the deep support muscles of the lumbar spine. These muscles include the multifidus, internal oblique and transverse abdominus muscles. Spinal stabilization exercises are the key to improving the spondylolisthesis and some specific exercises include the posterior pelvic tilt, lower abdominal hollowing and abdominal bracing. All exercises are non-weight in the beginning while lying face up or face down and will then progress to hands and knees if pain does not worsen. Finally the exercises will evolve into seated and standing positions. These are known as isometric exercises which will follow a ten week program that is designed to be incorporated into daily activities and has been found to reduce back pain and improve stability significantly.

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Maintenance and Support

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Patients with spondylolisthesis are taught a general fitness exercise program for lumbar support to ne performed once per week. Heavy plastic tubing can also aid in isotonic resistance exercises and can be performed at home. Finally, the last recommendation for a patient with spondylolisthesis is to acquire custom orthotics “spinal stabilizers” in order to aid arch support and maintain pelvic alignment. Foot over-pronation is a major cause of chronic back, knee and pelvic pain.