Physical Therapy After Spondylolisthesis Lumbar Surgery

After undergoing surgery for lumbar spondylolisthesis surgery, the body needs time to heal and recover. An important aspect of this recovery process is physical therapy.  

Physical therapy can greatly improve your recovery process from lumbar spondylolisthesis surgery. By reducing inflammation, tension, stiffness, and pain, this therapeutic practice will help you heal from spondylolisthesis. 

This article will dive into the topic of lumbar spondylolisthesis, its signs and symptoms, and what to expect from surgery. We’ll also discuss the TOPS system, a compelling alternative to spinal fusion in lumbar spondylolisthesis surgery. 

What is Lumbar Spondylolisthesis?

Spondylolisthesis affects approximately 4% to 6% of adults. This spinal disorder impacts the vertebrae, which are the bones of the spine. Lumbar spondylolisthesis affects the lower (lumbar) spine and is one of the most common forms of the condition. 

With lumbar spondylolisthesis, one of the spine’s vertebra slips out of its regular position. The bone then settles on the vertebra directly below it. Although some patients experience no symptoms from this condition, it typically causes:

  • Lower back pain
  • Tenderness in the lower back
  • Lost range of motion in the back and legs 
  • Tightness in the buttock and thigh muscles
  • Pain in the thighs

Causes of Lumbar Spondylolisthesis

Most often, lumbar spondylolisthesis is caused by overstretching the spine. Genetics, age, and certain lifestyle factors can increase your risk of developing the condition.


Older adults are at a higher risk of developing spondylolisthesis due to age-related spine degeneration. However, adolescents can also get this condition as a result of rapid growth. 


Athletes are at a higher risk of straining the lower back. In particular, regularly participating in gymnastics, weight lifting, football, and running can heighten your risk for lumbar spondylolisthesis. 

Non-Surgical Treatment For Spondylolisthesis

Patients with spondylolisthesis are usually started out on a non-surgical treatment plan. There are a variety of non-surgical treatment methods that can provide relief from symptoms of this spinal condition, including:

  • Taking a break from intensive physical activity

Especially for athletes and people with physically demanding jobs, rest can ease pain and inflammation from spondylolisthesis. 

  • Physical therapy

Physical therapy for spondylolisthesis can reduce stress on the spine and ease the pain with targeted exercises and pain management methods. 

  • Medications

Over-the-counter medications can reduce pain and inflammation from spondylolisthesis. Your doctor may also prescribe medications to help manage your symptoms. 

Patients who don’t respond to non-surgical treatment options may need to consider surgery. Surgery for lumbar spondylolisthesis can relieve persistent pain and re-establish the function of the spine.  

An Overview of Surgery for Lumbar Spondylolisthesis

Surgery for lumbar spondylolisthesis is focused on relieving pain and stabilizing the spine so that the vertebrae are less likely to slip out of place. To achieve this goal, doctors generally perform decompression surgery with spinal fusion. 

Spinal Decompression Surgery

In decompression surgery, your surgeon will create extra room in the spinal canal. This can relieve stress on nerves that are irritated from spondylolisthesis.

Spinal Fusion

Spinal fusion is a surgical procedure that involves fusing two spinal bones together. Over time, the vertebrae gradually connect to form one bone. 

Although spinal fusion can prevent the instability associated with lumbar spondylolisthesis and help you heal, it compromises the patient’s range of motion in the back. After spinal fusion, patients may no longer be able to bend down to pick up objects and perform other motions as they could before the procedure. 

Spinal fusion also has a lengthy recovery period. Patients may need to remain in the hospital for a few days after the surgery, and it can take months to complete the recovery process. 

Spinal Fusion Alternatives

The TOPS System is a spinal implant that can take the place of spinal fusion for patients with lumbar spondylolisthesis. This device stabilizes the spine but moves with the body, ensuring that patients retain spinal flexibility after the procedure. Additionally, the TOPS spinal implant can dramatically reduce patients’ recovery times when compared to spinal fusion. 

What Does Physical Therapy After Spondylolisthesis Surgery Involve?

After lumbar spondylolisthesis surgery, doctors typically recommend that patients undergo physical therapy. Physical therapy can improve your recovery from the procedure by helping to restore spinal flexibility, strengthen muscles that bolster the spine, and promote spinal alignment for lasting pain relief. 

Typically, patients are recommended to start physical therapy a month to a month and a half after spondylolisthesis surgery. Keep in mind that everyone progresses at different rates after this procedure. Your physical therapist will tailor your routine to your body’s unique needs.

Additionally, it’s important for your physical therapist to continually monitor your progress before introducing new exercises or activities to ensure that your body heals properly. A re-injury is a serious setback for the healing process. 

The key components of physical therapy after lumbar spondylolisthesis surgery include:

Pain-Relieving Treatments

Especially in the early stages of recovery for spinal surgery, pain-relieving treatments are a major part of physical therapy. These treatments may include massage, ultrasound, heat and cold therapy, and transcutaneous electrical nerve stimulation (TENS). Pain-relieving methods can alleviate pain, tension, inflammation, and muscle spasms.  

Targeted Exercises and Training

After spondylolisthesis surgery, one of the key goals is to stabilize and strengthen the spine’s supporting muscles to ward off re-injury. Your physical therapist will work with you one-on-one to teach and assist with a variety of strengthening exercises. 

Your post-operative training with a PT may involve:

  • Weight training
  • Balance exercises
  • Re-learning body mechanics (pulling and pushing, carrying, etc.)
  • Abdominal exercises
  • Cardiovascular/endurance conditioning
  • Stretching

Exercises such as intensive weight lifting and endurance exercises are generally avoided for several months after surgery. 

Your physical therapist will gradually introduce more strenuous and challenging exercises over time. It typically takes around three to five months after surgery for spondylolisthesis for patients to advance their training to include resistance training, weight machine exercises, and intensive cardiovascular training.   

After recovering from spinal surgery, patients will need to be particularly cautious for overhead lifting. Overhead lifting can compress the spine and poses a major risk of injury in spondylolisthesis patients. 

Exercise Regimen

In addition to providing exercises and passive treatments, your physical therapist can recommend an exercise routine to guide you throughout the recovery process. Exercise is an essential part of healing after a spinal procedure.

Aquatic Therapy

Your physical therapist may recommend that you try aquatic therapy as you recover from spinal surgery. Performing various exercises in the pool reduces the impact on your spine. This can help you recover from the procedure while preventing injuries. 

Making a Full Recovery With Physical Therapy 

Approximately five months to a year after spinal surgery, the goal of physical therapy is to restore your body to a pre-spondylolisthesis state. During this late period in the recovery process, patients generally follow a home conditioning program as recommended by their physical therapist. 

If spinal fusion was performed during spondylolisthesis surgery, patients may experience pain or mobility issues above and below the fused vertebrae. For these patients, ongoing physical therapy and spinal care may be required to prevent complications. 

The Premia Spine TOPS System is an alternative to spinal fusion that can shorten your recovery period after spondylolisthesis surgery. To learn more, contact Premia Spine today.