Spondylolisthesis Grades and Physical Therapy

What Is Spondylolisthesis? 

Spondylolisthesis is a disorder in which one vertebral body slips from the adjacent vertebral body. As an effect, there might appear radicular or mechanical symptoms. An affected person can feel pain and discomfort. The cause can be acquired, idiopathic, or congenital. Depending on the degree of slippage, a doctor can grade your spondylolisthesis. To do this, medical experts use the Meyerding Classification.

Spondylolisthesis Grades

The Meyerding Classification divides levels of spondylolisthesis into five grades. The location of the posteroinferior corner of the vertebra above influences the grade.

  • Grade One: 0-25%
  • Grade Two: 26-50% 
  • Grade Three: 51-75% 
  • Grade Four: 76-100%
  • Grade Five, when spondylosis can be identified: >100%


Spondylolisthesis can cause various symptoms that can help to diagnose this disorder. Some of them include: 

  • Intermittent pain localized in the lower back area. People who suffer from cervical spondylolisthesis can feel pain in the neck.
  • The pain can increase when an affected segment is flexed or extended. Mechanic pain caused by motion can appear. 
  • The pain can increase while touching the affected area. 
  • The pain can radiate to other parts of the body, for example, the legs, because the nerve roots can be under pressure.
  • The pain can be eased while lying down, as in this position the pressure on the bony elements is reduced.
  • Pain in the lower back. 
  • Muscle weakness and atrophy. 
  • Tense hamstrings. Spasm in legs. 
  • Difficulty in walking, problems with coordination and balance. 
  • Rare appearances of loss of bowel and bladder control.

Spondylolisthesis Physical Therapy 

Physical therapy is one of the most effective and non-invasive methods that can help you with your issue. Particular exercises performed under the eye of a professional can help you to strengthen the muscles that support the spine. You can also learn how to take care of your spine and prevent injuries in the future.

Types of Physical Therapy

There are two types of treatment of spondylolisthesis: passive and active. 

Passive treatments allow patients to relax and release the muscles in the body. As the name suggests, you don’t have to actively participate in the process. It is a perfect solution for people who suffer from tremendous pain and have advanced problems. The passive treatment can prepare you and your body for further steps in the process of recovery. 

The goal of passive treatments is to get you into the active one. Active treatments are exercises that can strengthen your body and help to prevent recurring pain from spondylolisthesis. 

Examples of Passive Treatments 

Hot and Cold Therapies

This therapy uses hot and cold in intervals or uses just one of the two treatments. By using heat, you get more blood to the targeted area. Increased blood flow means that more oxygen and nutrient go to the heated area. Blood can also help with removing byproducts that were created by muscles spasm.

Cryotherapy, cold therapy, can slow circulation. Thanks to that, inflammation, muscle spasms, and pain can be reduced. Common ways to use cold therapies are by using a cold pack on the affected area, cold spray, or massages with the use of ice. After performing cryotherapy, your physician might want you to stretch the affected area. 

Deep Tissue Massage

When your body readjusts to the slipped vertebra, your muscles can build up a lot of tension. A deep tissue massage allows to reach those muscles and release them. Your therapist can use direct pressure on the affected area to release the tension in soft tissues.

Transcutaneous Electrical Nerve Stimulation (TENS)

During this therapy, you are going to be connected to a machine that stimulates your muscles using electricity. The whole process is totally safe. TENS reduces muscle spasms and tension. Because of that, it can also trigger your organism to produce endorphins. This hormone can, in a natural way, reduce your pain. 

TENS machines used in physical therapists’ offices are quite large, but if you would like to continue treatment at home, you can find smaller machines.


An ultrasound is a great way to reduce muscle cramping and spasms. It can also eliminate swelling and stiffness of the affected area, releasing pain. Ultrasound waves travel deep into your muscles and generate heat. As an effect, your blood starts circulating faster and the process of healing starts. 

Active Treatments 

Once your pain eases a bit, your physical therapist can show you exercises that can improve your strength, flexibility, range of motion, and stability. Your therapist is going to interview you to know more about your health and history. They are also going to consider your physical abilities before programming exercises for you. 

During therapy, your physician might teach you how to keep a correct posture and incorporate it into your daily life. Through the practice, you not only get better but also learn good habits that can help you to prevent injuries in the future. 

Your therapist can recommend a set of exercises to you that you should follow even after therapy. This way, the risk of getting recurring back pain is lower. Moreover, you improve your overall health. If you suffer from spondylolisthesis, you can expect exercises that strengthen your abdominal and hamstring. Those two muscle groups are very important for low back support and can prevent lumbar spondylolisthesis from developing. 

Isotonic and isometric activities can strengthen the main muscles of the chest. The stronger is the trunk, the better is the spine’s stability. Those types of exercises are also for reducing pain. Another great way to get rid of pain is performing endurance training of muscles.

Core exercises are useful in easing pain. They can reduce chronic pain in patients with spondylolisthesis. A stable core also means more support for the spine. 

Stretching and strengthening exercises can help to decrease the force which the lumbar spine has to carry. Activities that involve hamstrings, lumbar paraspinal muscles, and hip flexors are crucial to improving the patient’s mobility. 

Some of the other most common active exercises recommended for spondylolisthesis are:

  • balance training: sensomotoric exercises on unstable ground, coordinative skills, walking,
  • hydrotherapy, 
  • Gailt training,
  • anitlordotic movement patterns of the spine, 
  • Elastic band exercises

Remember that some exercises can be great for some people, but not necessarily good for you. Before performing any of the mentioned activities, consult your doctor or physical therapist to verify if you can benefit from them and if they are safe for you. 

Depending on the grade of your spondylolisthesis, you might need to adjust the level of exercise. The best way is to seek the help of a professional. After a few sessions, you might be able to perform all the exercises on your own, without the risk of hurting yourself.


In case the physical therapy is not effective, you might need spondylolisthesis surgery

There is no one type of surgical treatment that suits all patients. Some of the most common treatments include decompression, fusion with instrumentation or without it, and interbody fusion. In some cases, these treatments can be combined.

Some surgeons recommend reducing spondylolisthesis. This way, the foraminal narrowing can be decreased. Moreover, spinopelvic sagittal alignment can improve. All of this creates a lower risk of further spinal changes. The higher the grade of spondylolisthesis, the bigger is the risk of the operation.