What is the role of physical therapy in the treatment of lumbar spondylolysis and spondylolisthesis?

Updated: Jul 08, 2020
  • Author: Beth B Froese, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Most patients with low-grade isthmic spondylolisthesis and degenerative spondylolisthesis can be treated conservatively. If an isthmic lesion is acute, the patient should be restricted from provocative activities or sports until they are asymptomatic. Physical therapy is an integral part of the patient's rehabilitation process. The most accepted protocol includes activity and exercise that reduces extension stress.

The goals of exercise are to improve abdominal strength and increase flexibility. Since tight hamstrings are almost always part of the clinical picture, appropriate hamstring stretching is important. Instruction in pelvic tilt exercises may help to reduce any postural component causing increased lumbar lordosis. Myofascial release may play a role in reducing pain from the surrounding soft tissues.

If conservative treatment is indicated for congenital spondylolisthesis, the above principles apply. Adequate work up must be completed for pathologic causes of spondylolisthesis prior to treating with conservative means. Traumatic spondylolisthesis most often requires surgical stabilization.


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