Have you been diagnosed with spondylolisthesis?

Spondylolisthesis is a lower back condition that often begins in adolescence. It begins with a stress fracture of one of the vertebrae in the lower back.

One of my cases involved a 16-year-old boy who played baseball. Every time he swung the bat and missed (which, of course, happens a lot) his lower back would end up in an extremely twisted position. Over the months, his bones could not support him and a stress fracture occurred.

Spondylolisthesis is also relatively more common in young dancers and gymnasts who repeatedly lean back.

Sometimes the spondylolisthesis fracture will cause pain, but often the discomfort will go away fairly quickly without treatment. If so, you may not even know that you have spondylolisthesis.

Unfortunately, the stress fracture allows instability of the spinal alignment. Over the years, with further deterioration of the discs and other supporting ligaments, the vertebra can slide forward relative to the bone below. Then symptoms of pain, restricted movement and pinched nerves can occur.

One of the standard ways to diagnose spondylolisthesis is with conventional lower back X-rays. In addition to the lateral and frontal views, a diagonal (oblique) X-ray view can focus on the exact location of the vertebral arch fracture.

MRIs can also be used in diagnosis.

If your forward sliding continues to get worse, or if you begin to experience pinching of the nerves as a result of spondylolisthesis, you may even need surgery to stabilize your lower back.

But it does not have to be like that. Many adults with spondylolisthesis do not have any symptoms and their condition is only diagnosed by chance.

What is the secret to avoiding problems related to spondylolisthesis?

Proper exercise and postural awareness are essential.

The problem is that the wrong exercises, or even the correct exercise done in the wrong way, can make your problem worse.

Abdominal support of the spine to maintain neutral spinal alignment is of utmost importance. The simplest exercise to strengthen your abdominal support is the plank pose. Begin by holding the pose for 30 seconds, making sure your back is straight.

If your abs are out of shape and holding for 30 seconds is a challenge, start with 10 seconds repeated three times. Ultimately, you will develop the strength to hold the pose for 30 seconds.

Once you can maintain straight alignment in plank pose for 30-90 seconds, you can move on to a more difficult variation, such as placing your feet on a low bench so that your torso is tilted downward.

Avoid squats, push-ups, or sit-ups; in fact, they can put more stress on your discs and make their condition worse.

You want to maintain a full range of spinal motion. You can do this with variations of the cat or dog pose. But avoid leaning forward in a long or extreme way, such as leaning forward to touch your toes. And too many downward facing dogs in yoga class could backfire.

Similarly, extreme or prolonged backbending could also create problems. Even the simple cobra stance could provide an opportunity for forward spinal glide. Instead, perform a lean-back pose while lying on your back. That way, gravity will tend to pull the offending bone back, rather than allowing it to slide further forward.

If you have tight hip flexors, they may tend to drag your lower back forward, making spondylolisthesis worse. It is important to stretch the hip flexors, but you should perform the stretch avoiding backward arching (extension) of the lower back. That’s hard to describe briefly, but I have specific images of a safe way to stretch the hip flexors available in my Downloadable Spondylolisthesis Clinician’s Guide.

Many people with spondylolisthesis lead fully active lives without pain or other limitations. By following a few simple precautions, you can join them.