What Makes Spondylolisthesis Worse?

If you have symptomatic spondylolisthesis, you know that it can cause significant back pain. At times, this pain may be manageable and not interfere with your normal activities. However, when spondylolisthesis flare-ups occur, it may be more difficult to carry out your routine. 

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Why is Spondylolisthesis So Painful?

Spondylolisthesis becomes painful if the displaced vertebra compresses spinal nerves. When spinal structures press on nearby nerves, it can lead to lower back pain, as well as weakness, numbness, and tingling in the extremities. 

However, pain with spondylolisthesis isn’t necessarily a constant problem. In many cases, patients experience pain flare-ups, which are limited periods of more severe pain. These flare-ups are often triggered by specific factors. 

What Causes Spondylolisthesis Flare-Ups?

Spondylolisthesis flare-ups are generally caused by exercise or fast, sudden motions. These factors place added stress on the spine, which may worsen nerve compression from spondylolisthesis. 

Certain forms of exercise are more likely to cause spondylolisthesis flare-ups than others. These include:

  • Exercises that require bending and/or twisting the lumbar spine

Any form of exercise that involves twisting or bending the lumbar spine should be averted with spondylolisthesis. Examples include trampolining, sledding, golfing, gymnastics, and diving. These activities can exacerbate spondylolisthesis symptoms. 

  • High-impact exercise

Physicians also advise against high-impact exercises for spondylolisthesis patients. Running, jumping, tennis, skiing, football, basketball, and weightlifting are all examples of high-impact activities that may cause spondylolisthesis flare-ups. These activities place a high amount of stress on the joints throughout your body, as well as the spinal structures. 

  • Exercises that involve bending forward with straight knees

With spondylolisthesis, bending the spine forward with your knees straight can trigger a flare-up. To safely bend forward, you’ll need to bend your knees and engage your abdominal muscles to limit the stress on the spine. Additionally, you’ll need to avoid bending forward while twisting the spine. 

  • Any other activity that causes pain and/or neurological symptoms

No two cases of spondylolisthesis are exactly alike. So, certain movements and activities may be painful for you, in particular. Take note of any motions that worsen your symptoms so that you can avoid them in the future.   

How Fast Does Spondylolisthesis Progress?

The speed at which spondylolisthesis progresses can vary from patient to patient. 

In one study, 145 patients with degenerative spondylolisthesis managed without surgery were evaluated over several years. Progression was found in 34% of patients, with the average slip progression occurring over a 10- to 18-year period. 

In another study, 31.8% of the study participants experienced slip progression after a minimum of five years of non-operative management. The study concluded that most low-grade cases of spondylolisthesis don’t progress over five years with non-surgical management.  

The progression of spondylolisthesis can change depending on various factors, such as the patient’s activity level, diet, whether or not they smoke, etc. 

How Do You Stop Spondylolisthesis From Progressing?

One strategy to prevent spondylolisthesis progression is to optimize specific lifestyle factors that influence the health of your spine, including: 

  • Exercise

In certain cases, your physician may advise that you rest for a limited period to ease a spondylolisthesis flare-up. However, low-impact exercise that doesn’t involve twisting or bending the spine is beneficial for most patients with spondylolisthesis. 

Exercise promotes blood flow, improves flexibility, and strengthens the abdominal and back muscles, which support the spine. Additionally, exercising stimulates the release of endorphins, which are “feel-good” hormones that offer natural pain-relieving and mood-boosting properties. Combined, these benefits of exercise can prevent spondylolisthesis progression. 

  • Nutrition

Eating a healthy, nutrient-dense diet with plenty of fruits and vegetables will give your body the fuel required to recover from spondylolisthesis. Additionally, drink plenty of water and limit your intake of alcohol, which can inhibit your body’s natural healing process. 

  • Smoking

Smoking is a detriment to the health of your entire body, including your spine. Nicotine is a vasoconstrictor, meaning that it limits blood flow throughout your body. Given that patients with spinal conditions (and virtually any injury) need the oxygen and nutrients that blood carries to the damaged tissues, smoking can severely slow down your spondylolisthesis recovery. 

Additionally, managing spondylolisthesis will help prevent the condition from progressing. Physical therapy, bracing, and pain medications are all commonly used to treat spondylolisthesis and stop it from getting worse. 

What Helps Ease Spondylolisthesis Pain?

As mentioned above, lifestyle adjustments, bracing, pain medications, and physical therapy can all help ease spondylolisthesis pain. For some patients, epidural steroid injections are also helpful, although you shouldn’t undergo more than three to four shots per year. 

Physical therapy for spondylolisthesis generally involves both passive and active treatments. Passive treatments are intended to relax the body and may involve massage, electrical stimulation, hot/cold therapy, and/or ultrasound therapy.

Active treatments involve exercises to stabilize the spine by strengthening various muscle groups and improving the range of motion. Additionally, your physical therapist may work with you to improve your posture and develop healthier habits to support your spondylolisthesis recovery.   

How Do You Stabilize Spondylolisthesis?

For most spondylolisthesis patients, bracing, physical therapy, and lifestyle modifications are sufficient to stabilize the spine. However, when these methods fail to provide improvement, surgery may be considered. 

Surgery for spondylolisthesis typically involves spinal decompression and spinal fusion. Spinal decompression alleviates nerve compression by removing certain spinal structures, such as the lamina. Spinal fusion addressed spinal instability by fusing two or more affected vertebrae with bone graft material. 

Unfortunately, while spinal fusion stabilizes the spine in spondylolisthesis patients, it also eliminates their mobility at the fused segment. This can restrict their activities while creating the risk of degeneration in adjacent segments. 

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Non-fusion implants like the TOPS System from Premia Spine offer an alternative to fusion for spondylolisthesis patients. This mechanical device works by creating a controlled range of motion at the affected spinal segment. It offers shorter recovery periods and superior outcomes when compared to spinal fusion. 

Patients struggling with symptoms of spondylolisthesis should speak to their physicians about all available treatment options. With the latest medical technology, you may have more options than you realize!