Chiropractic Care for Spondylolisthesis

Patients with spondylolisthesis, and disturbed pelvic and spinal mechanics because of this condition, will find chiropractic to be a very good approach to relieving their back pain.

Understanding Spondylolisthesis
Spondylolisthesis is a forward (anterior) shifting of a spinal vertebra in relationship to the vertebra below it. Chiropractors routinely diagnose spondylolisthesis in their patients, and chiropractors are trained to measure and evaluate the extent and significance of this condition.

It is important to emphasize that spondylolisthesis is not usually associated with acute problems. Most frequently displacement is noted as an incidental finding on low back x-rays in an adult with no direct clinical significance. Most of these patients have a forward slipping that is not extreme (minimal displacement). Spondylolisthesis in these cases is not considered a direct cause of low back pain.

Some patients have low back pain that is associated with an increased lordosis (sway back), and stress to the facet joints that may be influenced by their spondylolisthesis. Low back pain and leg pain can result from facet joint injuries. These patients are good candidates for conservative chiropractic care.

Spondylolisthesis may be the result of fractures, both stress fractures and acute injuries, and there is evidence that heredity can also play a determining role in displacement.

Spondylolisthesis usually occurs in childhood and young adulthood, usually at L5, the last lumbar vertebra. Gymnasts and dancers may be susceptible to stress fractures that lead to spondylolisthesis.

Children with back pain are examined for possible mechanical problems associated with spondylolisthesis. Chronic back pain associated with strain to the facet joints can occur in children with spondylolisthesis.

Two groups of patients may have spondylolisthesis that requires a referral to a spine surgeon for evaluation: children with evidence of recent fracture, and associated pain of less than 6 months, and adults with persistent pain, progressive slipping of the vertebra, and neurological deficits (nerve problems, such as numbness or tingling).

Chiropractors grade the extent of vertebral displacement on x-rays and with other imaging techniques.

The Treatment Goals in Spondylolisthesis
Chiropractors do not attempt to reduce the slippage of spondylolisthesis. Instead the chiropractor addresses the spinal joints above and below the spondylotic defect in order to improve motion in the region. Optimizing good spinal mechanics and improving posture and alignment are important goals of your chiropractor in treating spondylolisthesis.

Therapeutic exercises are especially important. Specific exercises are prescribed by the chiropractor to encourage pelvic muscular stability. Corrective spinal care and exercises are intended to minimize the hyperlordosis and to address inflammation and pain caused by spondylolisthesis.

Chiropractic Care and Spondylolisthesis
Chiropractors are doctors who specialize in the care of non-surgical conditions of the low back with gentle, time-saving approaches that address the mechanical and neurological causes of spondylolisthesis.

Chiropractors are rigorously trained to diagnosis the different types of low back injuries and conditions, such as spondylolisthesis. Your chiropractor will take an extensive history and provide a comprehensive examination, including x-ray studies, to determine the degree of your displacement and the possible effects, if any, on the facet joints and mechanics of the low back.

Chiropractors are specialists in spinal manipulation—an active, hands-on care that returns motion to the spine. The restricted motion and disturbed mechanics that are sometimes secondary to disturbed mechanics secondary to spondylolisthesis are especially helped by spinal manipulation in patients who are considered good candidates for this approach.

How a Chiropractor Diagnoses Spondylolisthesis
Even if you go to the chiropractor complaining of chronic low back pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It's important to examine the entire spine because even though it's just your low back that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation, diagnostic techniques unique to chiropractic. Motion and static palpation is an examination by means of touch. The chiropractor will feel for tenderness, tightness, and how well each spinal joint moves.

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

You'll also go through your past medical history with the chiropractor. Your chiropractor will have x-rays of your spine taken to evaluate possible degenerative changes, or an MRI if it is indicated.

After the examination, the chiropractor will be better able to create an effective treatment plan for your back pain.

Possible Chiropractic Treatment Approaches for Spondylolisthesis
The exact treatment plan depends on your diagnosis. Your chiropractor may use a type of spinal manipulation, or spinal adjustment, to improve joint motion and soft tissue health. Some spinal manipulation techniques are:

• Specific spinal manipulation: The chiropractor identifies the joints that are restricted or show abnormal motion, also called subluxations, and returns motion to the joint with a gentle thrusting technique. This gentle thrusting rapidly stretches soft tissue and stimulates the nervous system to return normal motion to the spine.
  
• Flexion-distraction technique: This is a gentle, non-thrusting type of manipulation. Flexion-distraction technique is especially indicated for degenerative disc conditions and facet strain associated with disturbed mechanics that may be related to spondylolisthesis. This treatment is hands-on, utilizing a specialized table to assist the chiropractor, but uses a slow pumping action on the disc instead of direct force.
  
• Instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

The chiropractor may also use manual therapy to treat injured soft tissues such as ligaments and muscles. Some examples are:

• Trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. He or she puts direct pressure (using the fingers) on these points to relieve the tension.
  
• Manual joint stretching and resistance techniques: Muscle energy therapy, an osteopathic technique, is an example of a resistance manual joint therapy.
  
• Instrument-assisted soft tissue therapy: The chiropractor may use Graston technique, an instrument-assisted therapy to treat the injured soft tissue. Your chiropractor will perform gentle repeated strokes of the instrument over the area of muscle injury.

In addition to spinal manipulation and manual techniques, the chiropractor may use various therapy modalities to help reduce inflammation caused by conditions associated with spondylolisthesis. Some examples are:

• Interferential electrical stimulation: This uses a low frequency electrical current to stimulate your muscles in order to reduce inflammation.
  
• Ultrasound: By increasing blood circulation, ultrasound helps reduce muscle spasms, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and heating.

To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.

Chiropractors are "whole person" doctors who view back pain as unique to each patient. Therefore, they don't focus on just your back pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to low back pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Keeping the back healthy is vital to the chiropractic approach to care.

How Chiropractic Helps Patients with Spondylolisthesis
A chiropractor will help you return to your normal activities quickly so that you can enjoy your daily life without pain. While your chiropractor cannot reduce the slippage of spondylolisthesis, he or she will work to address the underlying mechanical (how the spine moves) or neurological (nerve-related) causes of your low back condition.