Example of Spondylolisthesis:
Backward Slip of Lumbar Vertebra 3 on Vertebra 4

Q: Five weeks ago, my husband was diagnosed with Spondylolisthesis. He is currently undergoing physical therapy twice a week, with little to no improvement. He sees his orthopedist again next week for next steps. The orthopedist told us on our first visit that he may need surgery at some point in the future to correct this. 

In addition to being a Hatha yoga instructor, I am also a nurse. I love combining my medical knowledge with my yoga practice and instruction. I have been reading everything I can find on Spondylolisthesis (ouch!!!) and would like to hear your take on the role yoga can safely play with this injury. 

A: Let’s start out by defining what spondylisthesis is. It is a condition of the spine in which one of the bones of your spine (collectively called the vertebrae) slips out of place relative to the bone (vertebra) right below it. If the degree of slip is large enough, it can result in pain from the bones pressing on the nerves in that area. I am going to assume that our reader’s husband is having back pain and perhaps other symptoms associated with this condition as well. (Common symptoms include pain in the lower back or buttock, pain that radiates down one leg, and numbness in one leg. A less common symptom is weakness in a leg.) I also assume that the evaluation by his health care team uncovered spondylolisthesis as the underlying cause or contributing factor for his pain. 

Our colleague Beth has this condition, and in her post My Magic Four for Back and Spine), she mentioned that her situation probably arose from trauma. However, here are several other causes of this condition. Some people are born with a congenital form of the condition, some develop it due to overuse of the joints leading to a stress fracture, and others develop it with advancing age due to the presence of arthritis or infections of the spine. 

The slippage usually occurs in the lower lumber area of the spine (in the lower back.) One other aspect of this condition to consider is the direction of the bone slippage that occurs: inn most people is an anterior or forward slip of the top bone on the one just below it, which is called anteriolisthesis. A smaller minority of people will have a backward slippage of the top bone on the one just below it, which called retrolisthesis. The direction of slippage can influence what is safe to do and which exercises are best. I will address that later on. And although the condition is obviously symptomatic in some people (like our reader’s husband), it is sometimes discovered incidentally in people with no history of back pain or other suspicious symptoms. This latter group might benefit from following the recommendations below to prevent the condition from becoming symptomatic. 

Recommended Practices for Spondylolisthesis 

The following section includes cautions for working with spondylisthesis, goals to keep in mind, and seven poses or practices to support you in your efforts. 

Cautions 

For those with forward slippage, deeper back bending actions are potentially dangerous, whereas for those with backward slippage, forward bending of the spine is potentially dangerous. However, movement in any direction that worsens pain and other symptoms should be modified, whether that is forward bending, back bending, or twisting of the joints of the spine, especially the lower spine. Now, I don’t think this implies that you cannot do any of those actions, but it would be wise to limit those movements to a more limited range (not moving to the full position you are able to take) and assess how that movement impacts your symptoms. 

Goals to Work Towards 

Most people who receive a diagnosis of spondylolisthesis will initially be referred to a physical therapist to work on the condition. By noting what physical therapists focus on, you can get some great ideas on how to use our yoga practice to reduce pain in this area and providing more muscular support for the lower spine. Physical therapy goals usually include: 

  1. Reduce pain, initially with short periods of rest 
  2. Lengthen your spine (called axial extension), with the hope that the slippage will come back into better alignment. 
  3. Build core strength to improve spinal stability (ineffective muscle stability of the spine is one of the only self-correctable causes of degenerative Spondylolisthesis-the type most often associated with aging) 
  4. Improve flexibility, especially in the hamstrings, which are often very tight in this condition.

Using Yoga for Spondylolisthesis 

All of the above goals can be achieved using yoga as an adjunct to physical therapy exercises or, as Beth found, on their own. Here are my suggestions: 

1. Easy Inverted Pose (Beth’s variations). 

Beth found four particular poses, done from what we call Easy Inverted Pose, a variation of Legs Up the Wall pose, helpful in resolving and controlling her pain. Beth’s first pose allows for deep rest of the body, addressing the first goal listed above. The second pose addresses core strengthening. The third pose addresses flexibility around the hips and lower back, but not specifically the hamstrings, which we will address in the next recommendation. The final pose, with small twisting action, also supports core strengthening. See My Magic Four for Back and Spine for her pose recommendations.

2. Reclined Leg Stretch, versions 1 and 3. 

This pose improves hamstring flexibility. See Featured Pose: Reclined Leg Stretch for instructions. 

3. Hunting Dog Pose, any version. 

To build core strength, practice this pose with attention to keeping your lower back arch neutral. See Featured Pose: Hunting Dog Pose for instructions. 

If getting up and down from the floor is a challenge for you, the chair version of Hunting Dog pose could be a good alternative, and also will stretch the hamstring of your bottom leg. See Friday Q&A: Standing Hunting Dog Pose for instructions. 

4. Mountain Pose, version 1 or 2. 

This pose helps to length of your spine when you actively engage the muscles of your spine to move the crown of your head away from your tailbone. See Featured Pose: Mountain Pose for instructions.

5. Arms Overhead Pose, any version. 

To lengthen your spine and strengthen your core, keep the lower back arch in its neutral Mountain pose shape. See Featured Pose: Arms Overhead Pose for information. 

6. Low Back Care Practice. 

To address low back pain in general I recommend my low back care sequence. However, do omit Locust pose, as that could be too much back bending action for many of you. See Featured Sequence: Low Back Care for information. 

7. Stress Management and Equanimity Practices. 

Stress management and equanimity practices can have dramatic impact on helping you deal and support your healing. You can choose whichever stress management and equanimity practices work best for you. The following two posts include recommendations: 

For stress management, see Stress Management for When You’re Stressed

For equanimity, see: 7 Ways to Cultivate Equanimity with Yoga

—Baxter

 

Follow Baxter Bell, MD on YouTube, Facebook, and Instagram. For info on Baxter see baxterbell.com.  

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