What is Spondylolisthesis?
Your vertebrae normally line up creating gentle natural curves in your spine. There are three joints between each vertebra: the intervertebral disc and two facet joints. Together with the ligaments, these joints provide the primary passive stability of your spine. When this stability is compromised, by a fracture or degenerative changes, the vertebra can slip and this is called spondylolisthesis. If the vertebra slips forward it is called anterolisthesis or, less commonly, if it slips backward it is retrolisthesis. Up to 20% of people between the ages of 40-80 have been shown to have spondylolisthesis (1). In younger populations the rate is approximately 5-8% (2,3).
Causes of Lumbar Spondylolisthesis
Spondylolisthesis can occur as a result of a trauma or a congenital (birth) defect. It often occurs as a result of a stress fracture in adolescents, especially those involved in athletics that involve backward bending, such as gymnasts, dancers and football linemen. These repetitive or sustained movements stress the back of the vertebra and can eventually cause a stress fracture without requiring a major trauma. In addition, it can also occurs as a result of degenerative changes in the spine, which allow the vertebra to slip due to a decrease in the passive stability of the spine.
Symptoms of Lumbar Spondylolisthesis
Lumbar spondylolisthesis can cause pain in the back, buttocks or down the legs. It can also cause stiffness and can put pressure on the nerves, causing tingling, numbness or muscle weakness down the legs.
Diagnosis of Lumbar Spondylolisthesis
This diagnosis is made through medical imaging it is apparent on x-rays, MRIs and CT scans. While these methods of imaging are very accurate at determining if spondylolisthesis is present, they do not determine if it is responsible for your current pain. Studies have shown little correlation between spondylolisthesis and low back pain in adults (1,3,4). It is thought that this is often an unrelated finding. A thorough physical evaluation is thus very important to determine if the spondylolisthesis is the source of your pain.
Treatment for Lumbar Spondylolisthesis in Montreal
It is well recognized, in medecine, that before considering invasive treatment options, conservative options should be exhausted. If you have had unsuccessful passive treatments where the therapist performs the corrective treatment and you are not actively involved, Montreal’s Active Solution Physiotherapy may be your solution.
Trained physiotherapists at Montreal’s Active Solution Physiotherapy perform a thorough history and physical examination using the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). By analysing the effects of different movements and positions on your symptoms, the type of problem and the different contributing factors become evident. Once these different factors have been identified, an individualised treatment program is initiated to address them. The McKenzie Method/MDT classification process is an important step in identifying other source of your pain such as problems with the intervetebral discs (5), facet (zygapophyseal) joints (6), and the sacroiliac joints (7), etc. This is an excellent approach to determine if your pain is a result of spondylolisthesis or something else.
The McKenzie Method/MDT involves using the least force required to successfully treat your low back pain, thus decreasing the chances of irritating you in the process. It also has the goal of empowering you to take control of pain in as few visits as possible. Most of our patients feel better after their first session and we're usually able to determine whether our approach is right for you within three sessions. The vast majority of our patients have less than six sessions.
Trained physiotherapists at Montreal’s Active Solution Physiotherapy perform a thorough history and physical examination using the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). By analysing the effects of different movements and positions on your symptoms, the type of problem and the different contributing factors become evident. Once these different factors have been identified, an individualised treatment program is initiated to address them. The McKenzie Method/MDT classification process is an important step in identifying other source of your pain such as problems with the intervetebral discs (5), facet (zygapophyseal) joints (6), and the sacroiliac joints (7), etc. This is an excellent approach to determine if your pain is a result of spondylolisthesis or something else.
The McKenzie Method/MDT involves using the least force required to successfully treat your low back pain, thus decreasing the chances of irritating you in the process. It also has the goal of empowering you to take control of pain in as few visits as possible. Most of our patients feel better after their first session and we're usually able to determine whether our approach is right for you within three sessions. The vast majority of our patients have less than six sessions.
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references
1 - Kalichman, L., Kim, D. H., Li, L., Guermazi, A., Berkin, V., & Hunter, D. J. (2009). Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine, 34(2), 199.
2 - Leboeuf, C., Kimber, D., & White, K. (1989). Prevalence of spondylolisthesis, transitional anomalies and low intercrestal line in a chiropractic patient population. Journal of manipulative and physiological therapeutics, 12(3), 200-204.
3 - Jacobsen, S., Sonne-Holm, S., Rovsing, H., Monrad, H., & Gebuhr, P. (2007). Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine, 32(1), 120-125.
4 - van Tulder, M. W., Assendelft, W. J., Koes, B. W., & Bouter, L. M. (1997). Spinal radiographic findings and nonspecific low back pain: a systematic review of observational studies. Spine, 22(4), 427-434.
5 - Laslett, M., Aprill, C. N., McDonald, B., & Öberg, B. (2006). Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography. European spine journal, 15(10), 1473-1484.
6 - Laslett, M., McDonald, B., Aprill, C. N., Tropp, H., & Őberg, B. (2006). Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules. The Spine Journal, 6(4), 370-379.
7 - Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.
2 - Leboeuf, C., Kimber, D., & White, K. (1989). Prevalence of spondylolisthesis, transitional anomalies and low intercrestal line in a chiropractic patient population. Journal of manipulative and physiological therapeutics, 12(3), 200-204.
3 - Jacobsen, S., Sonne-Holm, S., Rovsing, H., Monrad, H., & Gebuhr, P. (2007). Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine, 32(1), 120-125.
4 - van Tulder, M. W., Assendelft, W. J., Koes, B. W., & Bouter, L. M. (1997). Spinal radiographic findings and nonspecific low back pain: a systematic review of observational studies. Spine, 22(4), 427-434.
5 - Laslett, M., Aprill, C. N., McDonald, B., & Öberg, B. (2006). Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography. European spine journal, 15(10), 1473-1484.
6 - Laslett, M., McDonald, B., Aprill, C. N., Tropp, H., & Őberg, B. (2006). Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules. The Spine Journal, 6(4), 370-379.
7 - Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), 207-218.
