SPONDYLOLYSIS EXERCISES, CAUSES, SYMPTOMS AND TREATMENT

SPONDYLOLYSIS

• In spondylolysis, there is a defect in the pars interarticularis but without the forward slipping or displacement. The reason could be a fracture, stress fracture, or non-union.

• There exists a cartilage plate which helps in bone growth when we are young, such cartilage plates are also present in the spine (in the lamina of the vertebrae between the joints) and as we grow up the bones become solid and these cartilage plates close.

• During our childhood, physical activities like gymnastics which involves bending backward, cause too much strain on this cartilage plate so this plate does not close. This is a Spondylolysis.

• Now because of lack of contact between the vertebrae in spondylolysis, a further strain may move the detached part forward, and that instability is a spondylolisthesis.

• Oblique view of the spine is recommended to rule out spondylolysis.

Spondylolysis: crack at pars with no displacement

CAUSES OF SPONDYLOLYSIS

• Repetitive trauma can be due to sports activity that requires frequent or persistent hyperextension (backward bending) of the lower back, gymnastics, diving, wrestling, weight lifting, etc.

• Genetics is a developmental defect of the pars interarticularis and spondylolisthesis. 15–70% of first-degree relatives affected with the disorder.

• Spondylolysis is 2–3 times common in boys but slip or displacement is 2–3 times most common in females and 5% of the general population

• Most susceptible to occur during the growth spurt

• Stress or fatigue fracture of the pars interarticularis

• “Nutcracker” mechanism is direct compression of that particular region under stress.

• "Tension mechanism" that is the traction of pars interarticularis in various sports and athletic activities.

SYMPTOMS OF SPONDYLOLYSIS

• Mild low back pain

• Radiating pain and numbness (only when there a is nerve compression)

• Exacerbation of the symptoms by back Extension (backward bending) activities.

TREATMENT FOR SPONDYLOLYSIS

• Some people with spondylolysis are asymptomatic and hence required no treatment.

• If the person has moderate symptoms then conservative treatment is adequate but if the symptoms are severe and hamper the daily activities of the person than surgery would be required.

• Bracing to support the spine: Anti lordotic total contact, a thoraco-lumbosacral molded brace can be recommended.

• Braces has to be continuously worn for a period of 2 years to avoid slippage progression

• Anti-inflammatory medications to decrease pain

• Activity modification

• Postural correction

• Physiotherapy

• Surgery is rarely done if bracing is unable to control pain or nerve compression or there is a progressive slippage, lumbar spine surgery (bony fusion) can be done

PHYSIOTHERAPY

Heat therapy

SWD

Ultrasound

Lowe back exercises.

EXERCISES FOR SPONDYLOLYSIS

LEVEL 1

SUPINE PELVIC TILT EXERCISE

HAMSTRING STRETCH 1 EXERCISE

CALF STRETCH EXERCISE

ISOMETRIC ADDUCTOR SQUEEZE EXERCISE

SINGLE-LEG ELONGATION EXERCISE

BACK FLEXION EXERCISES

LEVEL 2 ( start after pain reduces)

KNEELING PELVIC TILT EXERCISE

SEATED PELVIC TILT EXERCISE

PRONE KNEE BEND EXERCISE

ISOMETRIC HIP FLEXION EXERCISE

BACK FLEXION EXERCISES (INCREASE NUMBER OF REPETITION)

PRECAUTIONARY GUIDANCE:

GETTING IN AND OUT OF BED

TURNING IN BED

MODIFIED SLEEPING HABITS

AVOID BACKWARD BENDING ACTIVITIES AND BACK EXTENSION EXERCISES TILL THE PAIN RESOLVES

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