Isthmic Spondylolisthesis.

Isthmic spondylolisthesis is quite a common problem in clients that I treat.

Spondylolisthesis is where one vertebra slips forwards on another - often in the lumbar region.

In the spine each vertebra is stacked one on top of the other like a flexible pillar.

When one vertebra moves forwards out of that alignment it is referred to as spondylolisthesis - "spondylo" meaning spine and "listhesis" meaning slippage. Lumbar refers to the lower part of your spine.

There are various severities of slippage found in clients with spondylolisthesis. I, amongst many other healthcare professionals, grade them on a grade 1 - grade 5 scale:

Grade 1 - is where there is a small slippage forwards of a bony vertebrae, usually about 25%.

Grade 2 -a 50% slippage

Grade 3 - a 75% slippage

Grade 4 - 100% slippage

Grade 5 - vertebra has fallen off the edge!!

The most common grade that I encounter on a weekly basis is a grade 1 or 2.

Lumbar spondylolisthesis

There are 2 kinds of spondylolisthesis:

Congenital - where you are born with a degree of slippage of a vertebra. This usually occurs in the lower back and often is not discovered until you are in your teens or twenties. It may never display symptoms.

Acquired -is where you develop a slippage either traumatically from falling, or from repetitive strenuous exercise resulting in a slippage.

Symptoms of spondylolisthesis:
Your symptoms can vary greatly, from no pain at all to severe pain and sciatica-type nerve symptoms down your legs. It depends on the severity and extent of your slippage, as well as the posture you have adopted with the activities you are involved in.

Quite often clients have come to me with spondylolisthesis and their symptoms have not been coming from the slippage at all. Their symptoms have been coming from joints and muscles above and below the slipped vertebra. Often their symptoms have disappeared completely with treatment, although their slippage is still there!!

Spondylolisthesis Treatment:
The treatment of spondylolisthesis will depend on the severity of the slippage, the symptoms you are experiencing and the nature and level of activity in your daily life. Spondylolisthesis surgery can be necessary where slippage is large and symptoms severe. However, quite often conservative manual treatments specific to your condition will resolve your symptoms fully. My treatment usually involves mobilising the stiffened segments above and below your vertebral slippage, followed by an intense stability exercise programme. The most important aspect of conservative treatment is that the therapist treating you has a good understanding of your condition, as exercises must be very specific in direction and range. A good chartered physiotherapist should help you. I use an adapted Pilates programme - "adapted" being the key word.

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