Spondylolisthesis

Spondylolisthesis and spondylolysis are terms that strike fear into the hearts of many, even if it’s only how to pronounce the words or to spell them. However, the conditions are common and manageable if the person seeks treatment and complies with their exercise program. My own mother at the age of 77 started complaining of intense pain in her back, only to find out that a stress fracture she was unaware of for many years (spondylolysis) had become spondylolisthesis, so all of a sudden she was in severe pain.

 In this article we will be covering:

//   What are spondylolisthesis and spondylolysis;
//   Some of the common causes and situations;
//   What are the common treatments for these conditions;
//   What are the common contraindications;
//   Some considerations for exercise;
//   Some simple ways to modify Pilates exercises for people with this condition.

Note that this article is part of the work we cover in more detail in the the Anatomy Dimensions Spine and Torso workshops.

What is spondylolisthesis?

The term spondylolisthesis describes a condition in which a vertebra in the spine slips on the vertebra below. The vertebra most commonly slips anteriorly (anterolisthesis), but may also slip posteriorly (retrolisthesis). The slippage is associated with a bilateral deficit in the pars interarticularis (see the picture below) and is most common between L5 and S1, however also commonly occurs between L4 and L5. A pars fracture can occur without any slippage of the vertebrae and this is then known as spondylolysis. A spondylolysis is quite common occurrence in children as young as 7 years, often due to repetitive sports loading, e.g. gymnastics.

Remember that spondylolisthesis can occur in children and teenagers who can have difficulty explaining why they are in pain, or more commonly having people properly listen to them. As one parent recently explained:

“No one would listen to my ten year old daughter when she said she was in pain and was told to just ‘toughen up’.  When she was finally treated and diagnosed she was in a lot of pain and her condition had been aggravated by exercises such as swimming (note: due to extension of the legs and lower back). Teachers at school would only stop pushing her in sports once X rays had been taken”

This mother’s advice was listen to kids when they are in pain and get it investigated as soon as possible.

There are a number of different reasons why a spondylolisthesis can occur:

//  in children it is often due to a birth defect in that area of the spine;
//  due to a lesion in the pars interarticularis, such as an acute traumatic fracture, or repetitive micro-fractures resulting in elongation of the pars;
//  degenerative spondylolisthesis due to degeneration of structures such as the facet joints or discs;
//  due to an acute trauma leading to fracture in parts of the spine other than the pars interarticularis;
//  post-surgery where too much of the posterior spinal structures have been removed;
//  due to some diseases/pathologies such as spina bifida, Scheuermann’s disease, spinal stenosis, etc;
//  certain sporting activities such as gymnastics, weight lifting, football and fast bowling in cricket can put a great deal of stress on the bones in the lower back. They also require that the athletes constantly overstretch (hyperextend) the spine. This can lead to a stress fracture of the pars interarticularis on one or both sides of the vertebra.

The existence of a spondylolisthesis does not always result in pain, particularly if it is only a low-grade slippage.

Spondylolisthesis is graded as follows:

Grade 1 – the top vertebra has slipped up to 25% over the body of the vertebra below.
Grade 2 – the top vertebra has slipped between 25-50%.
Grade 3 – the top vertebra has slipped between 50-75%
Grade 4 – the top vertebra has slipped over 75%.

What are the symptoms of spondylolisthesis?

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Other examples and modifications can be found throughout the Body Organics Repertoire Manuals which detail the teaching points, contraindications and modifications for conditions such as spondylolisthesis.   This topic is explored in more depth as part of our Foundational Workshops series Anatomy Dimensions spine and torso courses, This course is available online and when possible we offer these courses in person.  All  course participants receive high quality colour manuals, detailed instruction and valuable information about pathologies and how to adjust, modify and teach for pathologies.   Our courses are designed to help practitioners who don’t always have healthy clients .

For those of you who like a lovely class series, try our Pilates Anytime class wishing you well.

Enjoy the Spine and Torso Course

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