Spondylolysis and Spondylolisthesis

Spondylolysis is when there is a stress fracture of one or more spinal vertebrae. Spondylolisthesis is when a spinal vertebrae moves out of its normal position, usually near the bottom of the spine.

Typically, spondylolysis happens first, then spondylolisthesis occurs afterwards. Sometimes, a congenital abnormality can lead to spondylolisthesis without spondylolysis.

Causes

There are several reasons why spondylolysis and spondylolisthesis may occur. Some common ones include:

• When too much stress is placed on the lower back, such as in sports like gymnastics or weight lifting
• Hyperextending or arching the spine
• Congenital abnormality

‍Symptoms

Common symptoms related to spondylolysis and spondylolisthesis are:

• Lower back pain
• Stiffness in lower back and legs
• Pain radiating into one or both legs
• Back spasms
• Tight hamstring muscles
• Difficulty walking and changes in posture

Diagnosis

To determine if your child has spondylolysis or spondylolisthesis, our specialists will perform a physical exam that may include flexibility tests, stress tests, muscle tests, and gait analysis. These additional tests will help our specialized team better understand your child’s condition, assess range of motion, and identify abnormalities that might occur in bone alignment or muscle function.

After a physical exam, our specialists may also order imaging tests such as an X-ray, MRI, or computed tomography.

Treatment

Possible non-surgical treatments your doctor may offer or recommend to treat your child’s spondylolysis or spondylolisthesis include:‍

• Physical therapy and home exercise program (HEP)
• Resting and activity modification
• Bracing
• Over the counter nonsteroidal anti-inflammatory drug (NSAIDs)
• Nutritional workup including vitamin D and C

If our doctors and surgeons believe surgery is the best option for your child, we may recommend fracture repair or fusion.

At-Home Care

Common at-home treatment options for spondylolysis or spondylolisthesis include:

• Icing the Area: Put ice packs wrapped in a towel or thin cloth on your child’s back for 20–30 minutes every 3-4 hours for the first 2-3 days. If pain does not go away, contact your healthcare provider.
• Taking Non-Prescription Medication: Take a non-steroidal, anti-inflammatory drug (NSAID), such as ibuprofen as recommended by your healthcare provider.
• Exercising: Your doctor may recommend doing exercises at home. These are designed to stretch the back, maintain range of motion in the spine and strengthen your child’s back and spine.

Prevention

Perform lower extremity and core stretching and strengthening exercises regularly.

Don’t overtrain, especially in sports that require using and arching the back, like gymnastics or track and field.

Use proper technique in high-risk sports such as football, gymnastics, or dance

Recovery

Below are common exercises a doctor may recommend to help your child recover after spondylolysis or spondylolisthesis. Always check with your doctor to find out which exercises are right for your child.

Stretching

Hamstring Stretch

• Lie on back and bring the affected leg towards the chest.
• Grab the back of the thigh and try to extend the leg.
• Your child may also try this with a towel around the foot if it is more comfortable.
• Hold for 30-60 seconds. Repeat 3 times.

Single Knee to Chest Stretch

• Lie on back with one knee bent.
• Hold thigh behind the knee and bring one knee up to chest.
• Hold 30 seconds. Relax.
• Repeat 3 times on each side.

Core Exercises

Abdominal Crunch

• Lie on back with both knees bent and feet planted on the floor.
• Tuck buttocks under like in the pelvis tilt exercise.
• Gently place both hands behind head for support and tuck upper body in.
• Do not pull head with hands.
• The movement should come from squeezing abdominal muscles.

Pelvic Tilt

• Lie on back with both knees bent and feet planted on the floor.
• Tuck buttocks under and move front of hips slightly up
• Think of pulling belly button in towards the back.
• Hold for 10 seconds. Repeat 10 times.

Abdominal Crunch

• Lie on back with both knees bent and feet planted on the floor.
• Tuck buttocks under like in the pelvis tilt exercise.
• Gently place both hands behind head for support and tuck upper body in.
• Do not pull head with hands.
• The movement should come from squeezing abdominal muscles.

Cat Cow

• Start on hands and knees, and use slow, gentle movements.
• While breathing in, slowly round back like a scared cat and hold for 1-2 seconds.
• While breathing out, arch back to cow position.
• Repeat 10 times.

Forearm Plank

• Lie down facing the floor on forearms.
• Raise up until resting on knees and elbows.
• Maintain body straight from head to knees.
• Hold for 10 seconds.
• Try again, lifting knees up off the floor.
• Work up to 30-60 seconds, if possible.

Plank (Upper Pushup)

• Lie down facing the floor with hands planted on either side next to chest.
• Raise up until resting on knees and hands.
• Maintain body straight from head to knees.
• Hold for 10 seconds.
• Try again, lifting knees up off the floor.
• Work up to 30-60 seconds, if possible.

Side Plank

• Start in hands and knees position.
• Slowly lift one arm off the ground and roll slightly so weight is on one arm and the same knee and side of the opposite foot.
• Keep body in a straight line.
• Hold for 10 seconds.
• Work up to 30 seconds to 1 minute, but make sure to keep body straight like a board.
• For a greater challenge, straighten the lower leg out, so weight is on hand and feet only.

Opposite Arm and Leg

• Lie down facing the floor.
• Lift up the opposite arm and leg 2 inches above the floor.
• Hold for 10 seconds. Repeat 10 times on each side. Do three sets.
• Use a rolled-up towel under forehead for comfort.

Advanced Opposite Arm and Leg

• Start in hands and knees position.
• Lift one arm in front and the opposite leg behind.
• Hold for 10 seconds.
• Repeat 10 times on each side. Do 3 sets.

E-Y-I

• Lay on stomach.
• Gently lift the upper chest off ground slightly.
• Move arms into an “E” position.
• Move arms into a “Y.”
• Move arms into an “I” position.
• Repeat 10 times. Do 3 sets.

Dead Bugs

• Lie on back and place both hands under buttocks.
• Bring both legs up to point to the ceiling with knees slightly bent.
• Gently lower one leg towards the ground then slowly back up.
• Try to keep lower back on the floor and repeat with opposite leg.
• Complete 3 sets of 10.

Hollow Hold

• Lie on back and place both hands under buttocks.
• Lift shoulders and feet up.
• Keep lower back on the floor or bed. Hold for 10 seconds. Do 3 sets.
• Only complete If you can keep low back on the ground.

Heel Raises

• Sit on the floor with the injured leg straight and the other leg bent, foot at on the floor.
• Pull the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on the top of your thigh.
• Raise your leg six to eight inches off the floor and hold for 5 seconds.
• Slowly lower it back to the floor.
• Complete 3 sets of 10.