Lumbar Spondylolisthesis: Symptoms, Treatment, and Exercises

Q: Lumbar Spondylolisthesis: Symptoms, Treatment, and Exercises

Hello JC： Based on the description of your X-ray, it is suspected that you have spondylolisthesis at the fourth and fifth lumbar vertebrae. <br>It is recommended that you consult a professional physical therapist to guide you in appropriate exercises. <br><br>1. <br>Pulling up on

Lumbosacral spondylolisthesis of the fourth and fifth lumbar vertebrae?

Hello, Doctor! For the past two to three months, I have been experiencing some discomfort in the lower part of my back, particularly when I bend over for a prolonged period.
Sometimes, I feel a bit of pain in the lower left side of my back, but I can't pinpoint the exact location.
Overall, it just feels off, but there is no numbness or pain in my legs or feet; it's just discomfort in the area around my lower back.
A few days ago, I visited an orthopedic doctor and had an X-ray of my lower back.
The doctor mentioned that I have a slight vertebral displacement.
The X-ray from the front shows a slight leftward deviation of my spine, while the side view indicates that my fourth vertebra is slightly anterior and my fifth vertebra is slightly posterior.
He said my condition is not severe and suggested that if convenient, I could wear a brace for correction, perform pull-ups, or engage in swimming and other exercises to improve my condition.
He recommended another X-ray in three months to check if my spine has straightened.

I have a few questions:
1.
What is the purpose of doing pull-ups? Is it similar to the principle of spinal traction? However, my hands hurt a lot when doing pull-ups, and I can only hold on for 2-3 seconds at a time.

2.
If I choose not to do pull-ups and instead go to a hospital for rehabilitation, what type of rehabilitation should I pursue?
3.
How does swimming help in straightening the spine? Should I swim freestyle or does it not matter?
4.
Are there other exercises that could be beneficial? Are there any exercises or movements I should avoid? Thank you!

JC, 50~59 year old female. Ask Date: 2006/05/29

Dr. Xu Zhenrong reply Rehabilitation

Hello JC: Based on the description of your X-ray, it is suspected that you have spondylolisthesis at the fourth and fifth lumbar vertebrae.
It is recommended that you consult a professional physical therapist to guide you in appropriate exercises.

1.
Pulling up on a bar functions similarly to lumbar traction; however, it tends to distribute most of the force to the hands and shoulders, which may not provide sufficient traction for the lumbar region.
Additionally, prolonged hanging can be uncomfortable for the hands, so lumbar traction is generally more appropriate for patients.
2.
Rehabilitation for lumbar spondylolisthesis can be categorized into acute and chronic phases.
In the acute phase, the focus is on pain reduction, which can be achieved through local heat application and electrical therapy to alleviate discomfort.
In the chronic phase, patients can engage in moderate lumbar traction and be taught appropriate exercises to strengthen the lumbar muscles, stabilizing the area and preventing further slippage.
3.
Swimming is fundamentally an aerobic exercise that can enhance the endurance of spinal muscles, but it does not assist in straightening the spine.
The specific swimming style is not a concern.
4.
You can perform exercises to strengthen your abdominal muscles.
For example, you can bend your knees and perform sit-ups, reaching your hands to touch your knees and holding for about 3-5 seconds.
This action can be repeated several times to increase abdominal strength.
The above responses are based on the questions you raised, but it is still advisable to seek a comprehensive evaluation and treatment from a professional physician and physical therapist in the rehabilitation department.
The medical team at Taipei City Hospital's Rehabilitation Department is eager to provide you with professional consultation and services.
Taipei City Hospital's Rehabilitation Department cares about you.

Reply Date: 2006/05/29

More Info

Understanding lumbar spondylolisthesis is crucial for managing symptoms and determining appropriate treatment options. Lumbar spondylolisthesis occurs when one of the vertebrae in the lower back slips out of place, which can lead to pain and discomfort. Your symptoms, including discomfort in the lower back and occasional pain when bending, suggest that you may be experiencing this condition.

Symptoms
Common symptoms of lumbar spondylolisthesis include:
- Lower back pain, especially when bending or lifting.

- Muscle tightness or spasms in the lower back.

- Pain that may radiate to the buttocks or thighs.

- In some cases, numbness or weakness in the legs, although you mentioned not experiencing these symptoms.

Treatment Options
1. Physical Therapy: Engaging in physical therapy is often the first line of treatment. A physical therapist can design a program tailored to your specific needs, focusing on strengthening the core and back muscles, improving flexibility, and enhancing overall stability. Exercises may include:
- Core Strengthening: Exercises like planks and bridges can help stabilize the spine.

- Stretching: Gentle stretches can improve flexibility and reduce tension in the back muscles.

- Low-Impact Aerobic Exercises: Activities like walking or cycling can improve cardiovascular fitness without putting excessive strain on the back.

2. Chiropractic Care: Some patients find relief through chiropractic adjustments, which can help realign the spine and alleviate pain.

3. Medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain and inflammation.

4. Bracing: As your doctor suggested, wearing a brace can provide support and limit movement, allowing the spine to heal.

5. Surgery: In severe cases where conservative treatments fail, surgical options may be considered to stabilize the spine.

Exercises
1. Pull-Ups on a Bar: The action of hanging from a pull-up bar can help decompress the spine, similar to traction. However, if you find it painful, it’s essential to listen to your body. You might want to start with assisted pull-ups or use resistance bands to reduce the load on your arms and back.

2. Swimming: Swimming is an excellent low-impact exercise that can help strengthen the back muscles without putting undue stress on the spine. Freestyle swimming is beneficial, but any stroke that feels comfortable for you is acceptable. The buoyancy of water reduces the weight on your spine, allowing for a greater range of motion and flexibility.

3. Other Beneficial Exercises:
- Walking: A simple yet effective way to maintain mobility and cardiovascular health.

- Yoga: Gentle yoga can improve flexibility and strength. Poses that focus on spinal alignment and core strength are particularly beneficial.

- Pilates: Similar to yoga, Pilates emphasizes core strength and stability, which can support the spine.

Exercises to Avoid
- High-Impact Activities: Running or jumping can exacerbate your symptoms and should be avoided.

- Heavy Lifting: Lifting heavy weights can place additional strain on your back.

- Twisting Movements: Activities that involve twisting the spine can lead to increased discomfort.

Conclusion
It's essential to follow your orthopedic doctor's advice and monitor your symptoms closely. If you experience increased pain or new symptoms, consult your healthcare provider. Regular follow-ups, including X-rays, can help track your progress and adjust your treatment plan as necessary. Always prioritize exercises that feel comfortable and avoid those that cause pain. With a consistent approach to rehabilitation and exercise, many individuals with lumbar spondylolisthesis can achieve significant improvement in their symptoms and overall quality of life.

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