Definition
Spondylolysis and Spondylolysthesis are closely related so will be categorized together.
Spondylolysis is a stress fracture of the vertebra that usually results from excessive loads. It affects a part of the spine called the pars interarticularis which is the area between the superior and inferior facets joints of the spine. This can be there from birth.
When the stress fracture fully breaks then there will be a forward or anterior slippage of the superior spine. This is known as Spondylolysthesis.
A spondylolysthesis usually occurs at L5-S1.
Causes
· Congenital (from birth)
· Sports such as gymnastics, rowing, diving, swimming (especially butterfly), tennis, wrestling, weight lifting and rugby.
· Car accidents
· Running on hard surfaces.
Who gets it?
Women are more likely to get than men. This may also be related to the higher rate for women with osteoporosis and spinal fractures. Adolescents dong gymnastics or sports that require heavy load on the lumbar spine are more susceptible to it.
Subjective
History (Hx)
Generally the pain in both of these conditions is experienced the same. It can produce a dull ache in the lower lumbar, sacral region and can also extend into the buttocks and into the lower extremities.
· What does the pain feel like? Dull ache?
· Flexion and extension aggravate before pain came on?
· Any trauma to lower back, falls, sporting accidents?
· How long has the pain been there?
· Running, especially on hard surfaces?
· Have you had any tests, XRAY’s, MRI’s.
Objective
Observation
An excessive lumbar lordosis can be the only observable sign of these conditions. An XRAY or MRI is the only conclusive test.
Palpation
Pressure near or around the spine causes pain. Note this can aggravate and cause more of a forward slippage so be careful if it is known that there is a Spondylolysis or Spondylolysthesis.
ROM and Resistance tests
AROM – hyperextension of the spine will aggravate and cause pain. Flexion will alleviate pain. Lateral flexion and rotation will also cause pain. There may be tightness in hamstrings as these will tighten proprioceptively to limit hyperextension of the spine.
PROM – same as AROM
MRT – There may be weakness in extensor muscles of the back due to reflex muscular inhibition.
Special Tests
One Leg Lumbar Extension: Tests for Spondylolysis or Spondylolysthesis. Client balances on one leg and then attempts to bend backwards. If pain is felt in the lumbar region then this could be the issue. Lumbar extension aggravates these conditions.
Assessment
If the subjective and objective findings matched these conditions then it would be likely that Spondylolysis or Spondylolysthesis may be suspected. Further investigations using imaging would confirm this.
Treatment Plan
Remedial massage treatment will focus on releasing musculature that may have tightened up due to inactivity such as erector spinae, glutes, piriformis etc. The hip flexors should be worked on so as to decrease anterior pelvic tilt.
Referral to a GP or sports doctor for diagnosis or if already diagnosed a referral to a Physio for strengthening exercises. Exercises would include core muscles to build stability for the spine such as Transversus Abdominis.
Note: always use a pillow under the abdomen to prevent excessive extension on the spine while the client lies prone. When client is supine use a pillow under their knees.
Differential Diagnosis
Fracture of the spine, disc injury, muscle spasm, facet joint irritation, spinal tumour, myofascial trigger points,