What exercises are recommended for spondylolisthesis?

Recommended Exercises for Spondylolisthesis

Physical therapy with supervised exercises is strongly recommended as the cornerstone of non-pharmacological treatment for spondylolisthesis, as they are more effective than home exercises alone. 1

Types of Recommended Exercises

Core Stabilization Exercises

• Specific training of deep abdominal muscles (transversus abdominis) with co-activation of lumbar multifidus
• These exercises help provide dynamic stability to the lumbar spine 2
• Focus on maintaining neutral spine position during exercises

Flexion-Based Exercises

• Recent evidence shows flexion exercises offer similar benefits to stabilization exercises for pain control and disability improvement 3
• Can be incorporated into your routine as they are not inferior to stabilization exercises

Supervised vs. Home Exercise Program

Supervised Exercise (Preferred)

• Strongly recommended over home exercises alone 1
• Should include:
  • Professional instruction on proper form
  • Progressive resistance training
  • Individualized modifications based on symptoms

Home Exercise Program

• Should be performed daily after initial professional instruction 3
• Conditionally recommended as part of ongoing management 1
• Should include exercises specifically taught by your physical therapist

Exercise Guidelines

DO:

• Start with gentle exercises and gradually increase intensity
• Focus on proper form rather than repetitions
• Maintain neutral spine position during exercises
• Perform exercises consistently (daily recommended)

DON'T:

• Avoid high-impact activities that may worsen symptoms
• Avoid exercises that cause pain
• Strongly avoid spinal manipulation if you have spinal fusion or advanced spinal osteoporosis 1

Land vs. Water-Based Exercise

• Land-based physical therapy interventions are conditionally recommended over aquatic therapy 1
• However, water-based exercises may be beneficial for initial pain management due to reduced gravitational forces

Sample Exercise Program

1. Core Activation:

   • Transverse abdominis engagement (drawing navel to spine)
   • Hold 5-10 seconds, 10 repetitions

2. Pelvic Tilts:

   • Lying on back with knees bent
   • Gently flatten lower back against floor and release
   • 10-15 repetitions

3. Glute Bridges:

   • Lying on back with knees bent
   • Lift hips toward ceiling while engaging core
   • 10-12 repetitions

4. Bird Dog:

   • On hands and knees
   • Extend opposite arm and leg while maintaining stable core
   • 8-10 repetitions each side

5. Wall Slides:

   • Back against wall, slowly slide down to partial squat
   • Maintain neutral spine position
   • 8-10 repetitions

Monitoring Progress

• Regular assessment of pain and function is conditionally recommended 1
• Modify exercises based on symptom response
• Consider working with a physical therapist for periodic reassessment and program modifications

Remember that the primary goal of exercise for spondylolisthesis is to improve long-term health-related quality of life through control of symptoms, prevention of progressive structural damage, and preservation of function 1.