Lumbar spondylolisthesis is when one vertebra slips forward on the one below it, usually at L4-L5 or L5-S1. It can be present without symptoms for years, but it can also drive low back pain, referred leg pain, and reduced tolerance to standing and walking.
Types
Isthmic — from a small stress fracture in the pars interarticularis (part of the vertebra). Common in adolescent athletes involved in repetitive extension (gymnasts, dancers, cricket bowlers, football linemen).
Degenerative — from age-related disc and facet joint changes. Common in adults over 50, especially women.
Traumatic — from a specific injury (uncommon).
Congenital — anatomical variation from birth.
Grading
Slips are graded I-V based on percentage displacement. Most people we see have Grade I (<25%) or Grade II (25-50%). Grades III-V are rarer and often need surgical opinion.
Typical symptoms
- Low back pain, worse with extension (arching backward)
- Pain referring into the buttocks or thighs
- Sometimes leg symptoms if the slip narrows the spinal canal or nerve openings
- Reduced tolerance to standing or walking, better with sitting or leaning forward
Conservative treatment (works for most)
Core stability — deep core activation (transverse abdominis, multifidus, pelvic floor) reduces load transfer through the slip.
Hip mobility and strength — tight hip flexors and weak glutes worsen the extension load through the lumbar spine.
Movement pattern retraining — hip-hinge mechanics, avoiding excessive extension, and posture awareness.
Manual therapy — soft tissue work, gentle mobilization, and traction can reduce guarding and improve mobility. We modify chiropractic technique to respect the segment.
Activity modification — reduce repetitive extension (backbends, overhead pressing, running downhill) during flares.
When surgery gets discussed
Progressive slippage, significant leg symptoms from nerve compression, or persistent disabling pain despite comprehensive conservative care. Most patients don't reach this threshold.
If you've been diagnosed with a spondylolisthesis, come in for an assessment. With targeted rehab, most people live active lives with excellent function.