Chiropractic treatment for spondylolysis and spondylolisthesis provides the patient with a conservative option for treatment of their back pain. The methods of treatment can vary, but the clinician must first determine if the spondylolisthesis is stable or unstable. This ultimately determines the course of initial treatment. The doctor will obtain a history and perform an examination to help determine the stability of the spondylolisthesis. This process is explained in the companion article “What is Spondylolisthesis?”.
Chiropractic Care of Spondylolisthesis
There are various conservative techniques used by chiropractors for lower back pain. Some are more effective than others regarding favorable results and duration of care. This article discusses two of the most effective and efficient chiropractic techniques for the care and treatment of a stable spondylolisthesis.
How is a Stable Spondylolisthesis Treated?
Chiropractic Carereduces biomechanical dysfunction to the sacroiliac and the lumbar vertebra above the spondylolisthesis. It helps to maintain motion and flexibility to the spinal joints for proper spinal mechanics. Two effective techniques include flexion-distraction (F/D) or Cox© Technique and traditional diversified chiropractic technique.
The initial goal of treatment is to control the pain and begin the rehabilitation process. Supportive conservative treatment may include the following:
- Rest – Participation in sports, work or activities that aggravate or caused the condition should be stopped. Resting the injured area gives it a chance to reduce swelling and prevents continual irritation and pain. Depending on the severity of the injury it may take anywhere from a few days to 12 weeks before a return to work or sport is advisable.
- Cryotherapy – The use of ice helps to reduce pain and swelling. Ice should be applied on a regular basis during the acute phase and then taper off as needed when the acute pain is reduced.
- Bracing – Use of an anti-lordotic (sway back) brace may be helpful in some cases. This should be gradually discontinued as the pain lessens and exercise becomes easier to do without discomfort. It is important for exercises to begin as soon as possible. Prescribing muscle strengthening exercises needs to be a primary focus of the doctor and patient. Wearing a brace for too long promotes muscle weakness and dependence.
- Physical Therapy Modalities – The use of ultrasound or electrical muscle stimulation during the acute phase helps to reduce swelling and muscle spasm.
- Exercises – Start with lower back stretching exercises. Avoid extension or arching of the lower back. This activity increases the stress on joints of the vertebral segment at the area of spondylolisthesis. As the pain starts to subside, begin a course of exercise to strengthen the lower back. Attention to the upper leg muscles on both the front and back of the legs is helpful in reducing lower back stress. A good exercise program will incorporate the upper legs.
Start your rehabilitation with mild Swiss ball or physioball exercises. Please wait until you have achieved nearly a 50% reduction in pain with the stable spondylolisthesis. Exercises are to your tolerance.~ Dr. Ryan J. Brandt
- Medication – Prescribed anti-inflammatory medication must be obtained from your family doctor. Follow the recommendations and precautions of the manufacturer when taking over-the-counter pain and anti-inflammatory medication.
- Activity Modification – A gradual return to work beginning with a few hours and working up to a full work shift is an easy method of “work hardening.” The same is true with sport activities. Gradually return to the sport starting with conditioning and building strength and endurance. The trainers and coaching staff need to understand the injury and course of recovery. The saying, “if it hurts don’t do that,” is germane to work and sport activity.
What if the pain and limitations persist after all conservative management options have been tried? Then a consultation for an epidural injection or surgical intervention should be considered as the next option. An unstable spondylolisthesis requires a surgical consultation. It cannot be successfully managed with only conservative management. Post surgical symptoms may respond to conservative treatments if the pain is from the sacroiliac or spinal segments above/below the site of spinal fusion.
For the patient that responds to conservative management, a thorough understanding of the condition as well as what activities to try to avoid is necessary. Ongoing exercises, weight control and possible job modifications may be necessary. A significant number of people with stable spondylolisthesis may go through life having no greater episodes of lower back problems than the general population. Following the instructions given and working with doctors who understand spondylolisthesis will help to minimize further problems.
The doctors at Coon Rapids Chiropractic Office have experience working with patients suffering from the symptoms of spondylolisthesis.