From the Guidelines
Physiotherapy in Spondylolisthesis
Physiotherapy is not absolutely contraindicated in spondylolisthesis, but it should be approached with caution and individualized to the patient's specific condition and symptoms [ 1 ].
- In general, physiotherapy interventions such as gentle exercises, stretching, and strengthening programs can be beneficial in managing symptoms and improving functional ability.
- However, high-impact activities and excessive lumbar flexion or extension should be avoided to prevent exacerbating the condition [ 1 ].
- Patients with spondylolisthesis may also require concurrent management with medications for pain relief, and physical therapy should be tailored to avoid exacerbating the condition.
- It is strongly recommended that physical therapy and exercise be managed by experts in physical medicine and rehabilitation, and that active physical therapy and supervised exercise be preferred over passive physical therapy and unsupervised exercise [ 1 ].
- Additionally, in patients with spinal fusion or advanced spinal osteoporosis, avoiding treatments that involve spinal manipulation is strongly recommended due to the risk of serious adverse events [ 1 ].
From the Research
Physiotherapy in Spondylolisthesis
- Physiotherapy is not contraindicated in spondylolisthesis, as it is considered a part of nonoperative treatment for most cases of spondylolysis and low-grade spondylolisthesis 2.
- Conservative physiotherapy management has been described in case series, including postural reeducation, stretching, and strengthening exercises, which improved outcomes for patients with low back pain and lumbar isthmic spondylolisthesis 3.
- Physical therapy is included as a conservative management strategy for patients with symptomatic lumbar spondylolisthesis, along with non-narcotic and narcotic pain medications, epidural steroid injections, and transforaminal injections 4.
- A trial of conservative therapy, including physical therapy, may be considered for patients with low-grade spondylolisthesis presenting with radiculopathy and/or pseudoclaudication 5.
- Documented conservative treatment for spondylolisthesis includes instruction in exercise and body mechanics, which can be part of a physiotherapy program 6.
Conditions for Physiotherapy
- Physiotherapy may be more effective for patients with low-grade spondylolisthesis, as high-grade spondylolisthesis may require operative management 2.
- Patients with dysplastic spondylolisthesis are at higher risk for progression and should be monitored closely, which may affect the physiotherapy approach 2.
- The type of spondylolisthesis, such as isthmic or degenerative, may influence the physiotherapy treatment approach 3, 6.