An 18-year-old high school football player is referred to an outpatient physical therapy clinic after an evaluation for persistent central low back pain. The orthopaedist established a diagnosis of type IIB, grade II spondylolisthesis at L5/S1. He reports no history of specific trauma. His pain is aggravated by prolonged standing or walking, lifting weights (especially overhead), and bending backward or twisting. Sitting or lying down with his hips and knees bent relieves the pain. His medical history is otherwise unremarkable. The patient's goal is to return to football as soon as possible.
What are the examination priorities?
What examination signs may be associated with this diagnosis?
Based on the patient's diagnosis, what do you anticipate may be the contributing factors to his condition?
What are the most appropriate physical therapy interventions?
What are possible complications that may limit the effectiveness of physical therapy?
Identify the psychological or psychosocial factors apparent in this case.
CORE STABILITY: Ability of muscles within the "core" region (abdomen, lumbar spine, pelvis, and hips) to protect (i.e., stabilize) the lumbar spine from potentially injurious forces and to create and/or transfer forces between anatomic segments during functional movements
DYSPLASTIC SPONDYLOLISTHESIS: Translational displacement of one vertebral segment on another caused by congenital deficiency of the posterior elements of the spine
SPONDYLOLISTHESIS: Translational displacement or nonanatomic alignment of one vertebral segment on another
SPONDYLOLYSIS: Defect or abnormality of the pars interarticularis of the vertebral arch
Describe spondylolisthesis and identify potential risk factors associated with this diagnosis.
Prescribe joint range of motion and/or muscular flexibility exercises for a patient with spondylolisthesis.
Prescribe motor control exercises for a young athlete with spondylolisthesis.
PT considerations during management of the individual with a diagnosis of spondylolisthesis:
- General physical therapy plan of care/goals: Decrease pain; increase pain-free range of motion and muscular flexibility; increase spine and lower quadrant strength, endurance and motor control; maintain or improve aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease pain and improve joint motion; muscular flexibility exercises; resistance exercises to increase muscular strength and endurance of the core and lower extremities; aerobic exercise program
- Precautions during physical therapy: Address precautions or contraindications for exercise, based on the patient's pre-existing condition(s); identify and avoid postures and loading conditions that are likely to exacerbate the condition
- Complications interfering with physical therapy: Potential for further anterior translation of the L5 vertebra with neurologic impairment of the lower extremities
Spondylolisthesis is defined as translational displacement or nonanatomic alignment of one vertebral segment on another.1 It is most common in the lumbar spine ...