®Pelvic tilt
Lie on your back with your knees bent and feet on the floor. Gently tighten your stomach muscles to press your lower back towards the floor, hold for 5 seconds and relax. Keep the movement small and pain-free.
10 reps, 1–2 times a dayL5–S1The level where slips are most common: between the lowest lumbar vertebra and the sacrum
4 gradesBy the amount of slip: grade I is 0–25%, grade IV is 75–100%
6 timesHow much more common age-related (degenerative) slips are in women than in men
247 patientsA Swedish trial testing whether adding screws to surgery helps; no difference at 2 years
What causes it?
- Age-related (degenerative)The most common type. It results from wear in the discs and joints between the vertebrae and is usually seen in people over 50–60 and in women.
- IsthmicA stress fracture develops in the thin bony bridge at the back of the vertebra (the pars interarticularis), and the vertebra slips. It is seen mostly in young people and athletes, linked to repeated strain.
- OthersA difference in how the vertebra formed before birth, an accident or fall, diseases that weaken bone and, rarely, after spinal surgery.
Symptoms
- Often no symptoms at all
- Lower back pain and stiffness
- Pain spreading to the buttock or thigh
- Pain spreading down the leg (sciatica)
- Difficulty standing or walking for long
- Numbness, tingling or weakness in the feet
Diagnosis and grades
The diagnosis is made by examination and X-ray; the grade of the slip is measured on a side-view film. Films taken while bending forwards and backwards show whether the slip increases with movement. If a trapped nerve is suspected, an MRI or CT scan may be requested.
- Grade IThe vertebra has slipped by up to 25% of the length of the vertebra below. The most common grade, and usually does not need surgery.
- Grade IIA slip of 25–50%.
- Grade IIIA slip of 50–75%.
- Grade IVA slip of 75–100%. Surgery is much more likely at grades III and IV.
Spondylolisthesis is generally a stable condition that does not progress over time. A slip seen on X-ray does not mean it is the only cause of the pain; it is assessed together with the symptoms.
Non-surgical treatment
- Adjusting activityTaking a break for a while from sports and intense activities that make the pain worse.
- Physiotherapy and exerciseExercises that strengthen the trunk and abdominal muscles and stabilise the lower back are the foundation of treatment.
- PainkillersDon’t take over-the-counter painkillers for more than 10 days in a row without talking to a doctor.
- InjectionsFor pain spreading down the leg, a steroid injection is one of the options.
- BraceUsually if there is a crack (fracture) in the vertebra.
When is surgery considered?
- A grade III or IV (advanced) slip
- Severe symptoms that markedly limit standing and walking
- Symptoms that persist despite non-surgical treatment
- Worsening weakness or problems with bladder or bowel control
In a Swedish trial of 247 patients having surgery for spinal stenosis (some of whom had a mild slip), adding screw fixation to surgery that relieves the nerves gave no better results at 2 years; the hospital stay lengthened from 4.1 to 7.4 days and costs rose. See also the spinal stenosis guide.
Exercises at home
Six exercises that support the lower back
The aim is to strengthen the trunk and abdominal muscles and keep the lower back stable. Do the movements slowly and within a pain-free range. If movements that push the lower back backwards make your pain worse, avoid them for a while. If your symptoms are new, or you have numbness or weakness in your leg, talk to a doctor or physiotherapist first.
Knee-to-chest stretch
Lie on your back. Use both hands to draw one knee slowly towards your chest until you feel a gentle stretch in your lower back; hold for 20 seconds. Then do the other leg, and then both knees together.
20 seconds each, 3 repetitionsBridge
Lie on your back with your knees bent. Gently tighten your stomach and lift your hips until your shoulders, hips and knees form a straight line; don’t push your back too high. Hold for 3–5 seconds and lower slowly.
10 reps, 2 setsBird dog
Get on your hands and knees with your back straight. Stretch one arm forwards and the opposite leg backwards; hold for 5 seconds without arching your lower back or twisting your hips. Swap sides.
8 repetitions on each sideSide plank on the knees
Lie on your side with your knees bent and your elbow under your shoulder. Lift your hips to make a straight line from your head to your knees and hold for 10 seconds. Hold for longer as it gets easier.
5 repetitions on each sideWalking
Walk at a comfortable pace on level ground. If leg pain starts on a long walk, take short breaks. Build up the time gradually.
10–30 minutes a dayFrequently asked questions
Does spondylolisthesis go away?
The slipped vertebra usually does not move back into place; but for most people the slip does not progress over time, and symptoms ease with non-surgical treatment. Mild slips may cause no symptoms; many people find out about it on an X-ray taken for another reason.
Will exercise make the slip worse?
Exercises that strengthen the trunk and abdominal muscles are a core part of treatment. Stop any movement that clearly makes your pain worse for a while, and plan your programme with a physiotherapist.
Should I wear a brace?
A brace is usually recommended when there is a crack (fracture) in the vertebra. If your doctor hasn’t recommended one, you don’t need it; strengthening the trunk muscles with exercise is the foundation of treatment.
Do I need screws (fusion) if I have surgery?
In a Swedish trial of patients with spinal stenosis causing leg pain on walking, some of whom also had a mild slip, adding screw fixation (fusion) to surgery that relieves the nerves gave no better results at 2 years, while the hospital stay and costs increased. Which operation is right is decided with your surgeon, based on the grade of the slip and how stable it is.
When to seek help right away
Go to an emergency department straight away if you have:
- Loss of bladder or bowel control, or being unable to pass urine
- Numbness in the groin or around the back passage
- Rapidly worsening weakness or loss of feeling in the legs
- Severe lower back pain starting after a fall or accident
Sources
- Cleveland Clinic. Spondylolisthesis. Medically reviewed 15 August 2024.
- Moley PJ. Spondylolisthesis. MSD Manual Professional Version. Reviewed November 2024.
- Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413–1423. Summary: The Bottom Line, The Swedish Spinal Stenosis Study.