Spondylolysis/Spondylolisthesis Symptoms & Treatment Options
Spondylolysis is a stress fracture in a vertebra, often in the lower spine, while spondylolisthesis occurs when a vertebra slips forward over the one below it. Both conditions can cause lower back pain which is often felt on one side of the back, stiffness, and muscle tightness. Treatment includes rest, physical therapy, bracing, and, in severe cases, surgery.
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Find Relief TodayOverview
Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are two distinct but closely related conditions that affect the vertebrae, the bones forming the spine. Spondylolysis involves a stress fracture in the thin connecting parts of the vertebrae, which help link the bones together and maintain spinal stability.
Spondylolisthesis occurs when one vertebra weakens to the point that it slips forward or out of its normal position in the spine, potentially causing nerve compression. Both conditions are common sources of lower back pain and are particularly prevalent among young athletes participating in sports that place repetitive stress on the lower back, such as gymnastics, football, and weightlifting. Symptoms can include stiffness, muscle tightness, and discomfort during activity or prolonged standing.
What causes Spondylolysis/Spondylolisthesis?
Spondylolysis and spondylolisthesis are typically caused by playing sports that involve repetitive hyperextension of the lower back, such as football or soccer.. Acute trauma to the lower back can also cause these injuries.
- How the Injury Occurs: The injury occurs when repetitive stress, sudden force, or overextension weakens the vertebrae, causing fractures or slippage.
- Common Everyday Causes: Poor posture, prolonged bending, improper lifting, and repetitive back extension in daily activities can contribute to spinal stress and increase the risk of spondylolysis or spondylolisthesis.
Spondylolysis and spondylolisthesis are most common in these sports:
- Soccer: Repeated twisting and kicking motions strain the lower back.
- Diving: Backbends and flips place extreme stress on vertebrae.
- Gymnastics: Frequent hyperextension and impact increase fracture risk.
- Football: Tackling and sudden movements load the spine heavily.
- Weightlifting: Lifting heavy weights with poor form can overload vertebrae.
Symptoms
The most common symptom of spondylolysis and spondylolisthesis is lower back pain, which often occurs on one side of the lower back, though some people may have no noticeable symptoms. In young athletes, symptoms often begin around ages 15–16. Other common signs include:
- One-sided lower back pain: Pain is often felt more on one side of the spine and may feel like a muscle strain.
- Dull or aching back pain: The pain typically worsens with activity, especially during sports or prolonged movement.
- Pain that spreads to the buttocks or thighs: Discomfort may radiate due to muscle tightness or nerve irritation.
- Pain that increases with activity: Bending, twisting, or extending the spine can make symptoms worse.
- Tingling, numbness, or weakness: In more severe cases, pressure on spinal nerves may cause symptoms in the legs.
When to see a doctor
Children or adolescents should see a doctor if they experience persistent lower back pain, tingling, numbness, or pain after an acute back injury. The doctor will review physical activities and perform a physical exam to check for tenderness, range of motion, and posture or gait issues. X-rays or other imaging may be used to confirm vertebral fractures and assess the degree of slippage, often classified as “low grade” or “high grade.”
Non-operative treatment
Non-operative lumbar spondylosis treatment is usually effective for spondylolysis and low-grade spondylolisthesis. Common conservative approaches include:
- Rest from sports that place stress on the back: Reduces strain on the vertebrae and surrounding muscles.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, for pain relief: Helps manage discomfort and inflammation.
- Wearing a back brace: Limits movement to support the healing of the lower back bones and muscles.
- Physical therapy: Focuses on stretching, strengthening, and improving the flexibility of the back and core muscles.
Try these exercises to help address your condition:
Below is a PDF of the Exercise Program
Surgical Treatment
Surgery may be recommended for high-grade spondylolisthesis or when non-operative treatments fail. Your doctor will guide you on whether surgery is necessary and discuss the best approach for recovery.
Recovery
Most athletes recover fully from spondylolysis and spondylolisthesis. They can return to sports once pain has resolved and the full range of motion is restored. A gradual return to activity, combined with strengthening exercises and follow-up appointments, ensures a safe and complete recovery.
Dr. Jay Kimmel is a board-certified orthopedic surgeon specializing in sports medicine, arthroscopic surgery, and shoulder and knee disorders. He completed his orthopedic training at New York-Presbyterian/Columbia University Medical Center and a Sports Medicine Fellowship at Temple University.
Dr. Kimmel previously served as the Director of the Connecticut Sports Medicine Institute at Saint Francis Hospital and has held faculty appointments as Clinical Assistant Professor in the Departments of Orthopedics and Family Medicine at the University of Connecticut. He has extensive experience caring for athletes as a team physician for high school and collegiate programs and continues to teach in the athletic training departments at Westfield State University and Springfield College.
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/MonthFrequently Asked Questions
Who is most at risk for developing these spinal conditions?
Young athletes, especially those involved in sports that put repeated stress on the lower back—like gymnastics, football, or weightlifting—are more prone to developing these conditions.
What are the common symptoms of spondylolysis and spondylolisthesis?
The most common symptom is lower back pain, usually more on one side, which may worsen with activity, especially with bending backwards. In some cases, there may also be stiffness, muscle tightness, or difficulty standing or walking properly.
How are these conditions diagnosed?
Doctors typically begin with a physical exam and a review of physical activity history. Imaging tests like X-rays, CT scans, or MRIs are often used to confirm a fracture and determine the degree of vertebral slippage.
When should someone see a doctor for back pain related to these conditions?
Medical attention should be sought if a child or adolescent experiences lower back pain, either after an injury or if the pain persists for a while, especially if it is localized to one area of the back and is worsened by bending backwards.