Spondylolisthesis: Know the Causes, Symptoms, Treatment, Returning to Sports
Spondylolisthesis is a condition of the back in which the lower vertebra of the spine moves out of alignment onto the vertebra below it. This occurs commonly in children between 9 to 14 years old. It is an injury of the back. Sports people or athletes commonly suffer from this condition as they suffer from a lot of strain on their backs e.g. wrestling, weight lifting, throwing events and gymnastics. Individuals who are over 25 years of age are at minimal risk for developing this. Spondylolisthesis commonly occurs between the fifth bone in the lumbar vertebra and the first bone in the sacral area.
Depending on the degree of displacement of the vertebra, spondylolisthesis can be graded (with the help of x-ray).
- Grade 1 - 25% forward movement.
- Grade 2 - greater than 25% forward movement.
- Grade 3 - greater than 50% forward movement.
- Grade 4 - greater than 75% forward movement.
Causes of Spondylolisthesis
- It can be a congenital defect in the spine.
- Sudden injury or severe trauma may also cause this.
- Degenerative disease such as arthritis is the most common cause for spondylolisthesis in adults.
- Bone diseases.
- Traumatic and stress fractures.
- Strenuous sport activities like gymnastics and weight lifting, which causes a lot of stress on the bones in the lower back.
Symptoms of Spondylolisthesis
- Patient may not feel any symptoms in Grade 1 spondylolisthesis.
- For other grades of spondylolisthesis, the patient suffers from low back pain.
- The pain can also radiate into the legs.
- Worsening pain upon activities especially backwards bending of the spine (extension).
- Tightness in muscles.
- Pain and tenderness in the region of slipped disc.
- A dip can be felt in the spine at the site where the vertebrae has slipped forward.
- Leg weakness and numbness may indicate nerve damage.
- An x-ray helps in confirming the diagnosis.
Treatment for Spondylolisthesis
- Rest from aggravating activities.
- Exercises which stress the back should be avoided; otherwise the sportsperson can continue training.
- If there are tight hamstring muscles, they may turn the pelvis backwards in association to the forward slipping vertebra, so they should be stretched.
- Athlete should do abdominal and core strengthening exercises.
- A back brace or a back support helps in preventing the lower spine from excessively bending forward.
- A sports injury specialist should be consulted.
- Strengthening exercises should be done.
- Physiotherapy helps.
- Anti-inflammatory medicines help in pain relief.
- The athlete should try to slowly mobilize the stiff joints in the spine around the forward slipping joint. Manipulation should be avoided at the joint itself.
- If this treatment fails, then surgery is required. Usually spondylolisthesis does not get worse, but if it does, then surgery is done which comprises of fusing the bones together in order to prevent more forward slipping of the vertebra.
Returning to Sports
- Patients suffering from Grade 1 and 2 spondylolisthesis can return to sports training if they have good core strength and are symptom free.
- Patients suffering from Grade 3 and 4 spondylolisthesis should avoid contact sports.