Friday, September 7, 2018

PT Pathologies: Degenerative Spondylolisthesis

Degenerative spondylolisthesis occurs when vertebra slip forward from the the vertebra below it.  This type of lumbar disorder is caused when joints become weak and it allows for the vertebra to begin slipping forward on the one below the forward segment.  Arthritis is the most common cause of the disease and intervertebral disks lose stability over time.  These damaging changes in the joints typically result in stenosis of the spinal cord and then the slippage.

The most common location is the L4-L5 level of the spine where the L5 nerve root is compressed. This disease is most common in individuals over the age of 50, especially African Americans and women.  A common symptom is back pain which increases with exercise, lifting, prolonged standing, getting out of the bed or car, walking up stairs or steep inclines, and extension of the body.  Neurological damage is unlikely but pain may be radiating down the legs.

The individual should see the help of a physical therapist to reduce the level of lordosis occuring.  Flexion exercises would help the patient strengthen the abdominals as well as reduce the lumbar lordosis. There is strong evidence for exercise therapy, which consists of strengthening exercises of the deep abdominal musculature.. In addition, isometric and isotonic exercises may be beneficial for strengthening of the main muscle groups of the trunk, which stabilize the spine. These techniques may also play a role in pain reduction.. In order to improve the patient’s mobility, physical therapy includes stretching exercises of the hamstrings, hip flexors and lumbar paraspinal muscles

There is evidence that suggests that specific stabilization exercises and core stability exercises can be useful in reducing pain and disability in chronic low back pain in patient with spondylolisthesis.
  • Movements in closed-chain-kinetics
  • Renewing of the motion-pattern
  • Antilordotic movement patterns of the spine
  • Elastic band exercises in the lying position
  • Gait training
  • Brace-gymnastics
  • Stretching exercises
  • Sensomotoric training on unstable devices
  • Functional electric stimulation
  • Walking in all variations
  • Underwater therapy
  • Balance training
  • Coordinative skills
In Summary:
  • Caused by the weakening of joints that allows the forward slippage of one vertebral segment on the one below due to degenerative changes
  • Most common site of degenerative spondylolisthesis is the L4-L5 level
  • Williams flexion exercises may be indicated to strengthen the abdominals and reduce lumbar lordosis.

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