This condition usually affects the lumbosacral joint, which is the fifth lumbar vertebra above the sacrum (the large triangular bone at the end of the spine). On rare occasions it can affect other areas of the spine. Children, young adults, and older adults can be affected. The severity of spondylolisthesis is classified as Grade 1, 2, 3, or 4. Basically, what happens is that the 5th lumbar vertebra slips forward on the sacrum. Depending on how much the forward slide is determines the degree.

The causes can be sudden severe trauma, a fracture in a part of the bone, or degeneration of the spinal joint or disc. A trauma, such as a sudden, severe stretching of the lower spine that can occur in weightlifting, gymnastics, basketball, soccer, or any sport that puts increased stress on the lower back. A spondylolisthesis due to trauma is usually found in the younger adult because he is more likely to engage in more sports activities, where there is bodily contact of a violent nature. Degenerative spondylolisthesis will occur in older adults, especially if they are engaged in jobs that require heavy lifting and bending, and also participate in strenuous sports. Anything that exposes them to sudden, acute stress on the lower back can cause spondylolisthesis to develop. Pathological conditions of the disc, such as disc degeneration, wear and tear, can cause hypermobility of the fifth lumbar vertebra causing it to slip forward on the sacrum.

With all of the above causes of spondylolisthesis, abdominal and back muscle laxity due to a sedentary lifestyle may be the most important causative factor. Loss of necessary muscular support predisposes the individual to spinal trauma.

As the population aged 50 and over increases, more cases of spondylolisthesis due to degenerative changes will be seen. An increase of about 10% to 25% is not only likely, but also certain. This increase is due to older people working longer before retirement and the increase in sports activities, such as running, bowling, golf, tennis, etc. Other causes may be attributed to a congenital defect involving the joint of the 5th lumbar vertebra and/or the sacrum. Being 20 or more pounds overweight will add insult to injury, and not having the necessary muscular support puts the individual at risk.

Spondylolisthesis can be an extremely painful condition that causes a variety of symptoms and long-term disability. Symptoms can be severe and cause low back pain, with pain that can also radiate to the groin, buttocks, and lower extremities. In men, pain in the snout will most likely affect the testicle. There may also be neurological symptoms, such as numbness and tingling in the leg. These symptoms are due to a decrease in the size of the foramen (opening) through which the spinal nerve exits the spine. This narrowing of the opening causes the nerve to be pinched, which irritates the nerve and creates radiating pain syndrome. The side on which the nerve is pinched will determine the side of pain. In men testicular pain will be reflected in the testicle on the side of the pinched nerve, and can be a sharp pain or neuralgia.

If these symptoms occur after a traumatic event, the individual should see their chiropractor or physician to diagnose and evaluate the condition. Once the diagnosis and evaluation have been made, they will determine the course of treatment. Depending on the severity of the condition, especially if there is a fracture, the treatment of choice would be immobilization of the lumbosacral area with an orthopedic lumbar belt. Absolute rest is also indicated. The belt should be worn for at least 3 months, but during this time, physical therapy and conservative chiropractic care can help relieve pain and muscle spasms. During very intense painful episodes, the person may want to sleep with the belt on, but it must be removed for a few hours during the day when the person is at rest. On rare occasions, when the vertebra has been severely fractured, surgical intervention may be necessary.

In the older patient, where the onset of symptoms has been gradual over a period of years, they should also be diagnosed and evaluated and appropriate treatment initiated. Receiving treatment does not prevent the person with spondylolisthesis from helping themselves. Instituting a home self-care program can prevent further deterioration of her condition. If they are grade 1, they can prevent a progression to grade 2, and so on. Preventing this progression will also prevent more severe symptoms from occurring, sparing the individual some very painful episodes.

The program at home should consist of hot showers, morning and night, letting the shower hit your back for 5 to 10 minutes at a time. The use of an analgesic gel applied 3 to 4 times a day in the lumbosacral area will calm and relieve some of the pain. A massage of the lumbar muscles and the gluteal areas will help reduce muscle spasms. During this self-care period, they should also wear the orthopedic lumbosacral belt during the day and, if necessary, during sleeping hours. If you are not at work, or when you are resting, take your belt off for several hours during the day as mentioned above.

If the individual must return to work, extreme care should be taken not to aggravate the condition through overwork. This means they must take every precaution not to bend over too far or lift anything heavier than 5 pounds. Anyone who is overweight should try to lose excess weight. An obese person with a large abdomen puts more stress on the lumbosacral area by helping gravity pull on the already stressed spine. They must make a concerted effort to lose weight, because of their condition and their overall health.

After a treatment regimen is started as described above, the individual should respond in approximately 2 to 3 months. If the response is not favourable, they should be reassessed. However, by following their doctor’s advice and the concentrated effort they use at home, they will in all likelihood prevent this and result in a full recovery. Now, during all of this self-care, the individual should begin an exercise program as soon as he can begin to move freely without pain. The exercise program will strengthen your abdominal and back muscles. It is these muscles that play such an important role in supporting the spine. The ideal program for strengthening and as a preventive, is the “Doctor’s Major Exercise” program. It’s a no-impact, full-body workout done at home that takes only 15-20 minutes. Starting your program is just the first step. Dedicating yourself to sticking with the program on a daily basis is your second step, and that will determine your results and how you feel and enjoy life.