Does this sound like you?
Common signs
- A low back ache that is worse when standing or arching backward and easier when sitting or bending forward
- Hamstrings that feel unusually tight
- Pain, tingling or heaviness into the buttocks or legs when walking
- Back pain in a teenager that gets worse with sport, such as gymnastics, badminton, fast bowling or weightlifting
- A feeling that the lower back gives way or catches
- Stiffness after standing for a long time
This list describes the condition in general. It is not a diagnosis. Only an in-person assessment can tell you what is causing your symptoms.
What contributes to it
Why it happens
- Wear in the disc and joints (degenerative spondylolisthesis)
- As a disc loses height and the facet joints behind it wear, the segment can loosen enough for one vertebra to drift forward a little. This is the most common kind in adults, more common in women, and usually at the second lowest level of the lower back.
- A stress crack from repeated arching (isthmic spondylolisthesis)
- Sports that bend the lower back backward again and again load a thin bridge of bone at the back of the vertebra. Over time it can crack, which is spondylolysis, and if the crack separates the vertebra can slip forward. It usually affects the lowest level of the lower back.
- Growth spurts in teenagers
- A slip linked to a stress crack is most likely to progress during a period of rapid growth, which is why back pain in an active teenager is taken seriously rather than put down to growing pains.
- Injury or the shape of the spine from birth
- Less often, a slip follows a significant injury, or the vertebrae have been shaped in a way that allows it since birth. These are uncommon, and they are part of what imaging is used to rule in or out.
How we help
Our approach
Finding out whether the slip is the source, and whether it is stable
Your first visit follows the Gonstead six-step assessment: history, visualisation, instrumentation with the nervoscope, palpation, and X-ray analysis where indicated, with a neurological examination of the legs added on this presentation. Where further imaging is needed, or a scan you already have needs to be read alongside the examination, we arrange or review it. A high grade slip, signs that the segment is unstable, or nerve signs that are getting worse mean a referral to an orthopaedic or spine specialist.
What an adjustment does and does not do with spondylolisthesis
The assessment decides whether any adjustment is appropriate. The slipped level itself is not forced back into place, and an adjustment does not reposition a vertebra that has moved forward. Where the assessment supports it, neighbouring levels that have become restricted may be adjusted by hand, and some presentations are not adjusted at all.
Trunk strength and how you load the slipped level
Our physiotherapy side leads the longer part of the work: deep trunk and hip strength, hamstring flexibility, and changing habits that keep the lower back arched for long periods, such as standing with the hips pushed forward. For athletes, the return to sport is graded rather than all at once.
A teenager with a suspected stress crack
If spondylolysis is suspected in a young athlete, imaging and a medical opinion come first, along with a break from the sport that provokes it. A brace is sometimes used early on to let a recent crack settle. We coordinate with the doctor and help with the return to sport afterwards, rather than adjusting through a fresh stress fracture.
When to seek urgent care
See a doctor first if you have any of these
These need a medical assessment before you begin chiropractic care. If any apply to you, contact a doctor or go to the nearest emergency department.
- Loss of bladder or bowel control, or numbness around the groin, buttocks and inner thighs
- Weakness in a leg that is getting worse, or a foot that drags when you walk
- Leg symptoms in both legs that are getting worse
- A teenager with back pain from sport that has lasted more than two to three weeks, or that wakes them at night
- A child or teenager whose walk or posture has changed, with very tight hamstrings
- Back pain after a significant fall, road accident or direct blow
- Fever, unexplained weight loss, or a history of cancer alongside new back pain
Frequently asked questions
What patients ask us
Can a chiropractor fix spondylolisthesis?
No, and we would rather be plain about that. An adjustment does not move a slipped vertebra back into place, and nobody should promise you that it does. What care aims at is the pain, the stiffness around the slipped level and the strength of the muscles that support it. Many people with a low grade slip manage well this way, and the assessment tells us whether you are likely to be one of them.
Is it safe to have a chiropractic adjustment with spondylolisthesis?
It depends on the grade of the slip and whether the segment is stable, which is why the assessment comes before anything else. The slipped level itself is not forced back into place. Neighbouring levels that have become restricted may be adjusted where the assessment supports it, some presentations are not adjusted at all, and high grade or unstable slips are referred to a specialist. Tell us about any leg weakness, numbness or bladder changes when you book.
What do the grades of spondylolisthesis mean?
The grade describes how far the vertebra has slipped forward, as a share of the width of the bone below. Grade 1 is under 25%, grade 2 is 25 to 50%, and grades 3 and 4 are over 50%. Low grade slips, grades 1 and 2, are by far the most common and are usually managed without surgery. High grade slips are more likely to press on nerves and to need a surgical opinion.
Will my spondylolisthesis get worse over time?
Most slips change little. In a long term study of degenerative spondylolisthesis, about a third of slips progressed, and whether a slip progressed had no clear link to how much it hurt. The body also tends to stiffen a loose segment with age, which can steady it. New or worsening leg symptoms are the thing to watch, more than the measurement on a report.
Is a slipped vertebra the same as a slipped disc?
No. In spondylolisthesis a whole vertebra has shifted forward. A slipped disc is the soft disc between two vertebrae bulging or herniating, while the bones stay where they are. They feel different too: a disc problem tends to hurt with sitting and bending forward, while a slipped vertebra tends to hurt with standing and arching back. Our page on a slipped disc covers the disc side in full.
My teenager has back pain from sport. Could it be spondylolysis?
It could be. Spondylolysis is one of the more common causes of persistent low back pain in active teenagers, especially in sports that arch the back repeatedly. Pain that lasts more than a couple of weeks, gets worse with arching, or comes with tight hamstrings is worth having imaged by a doctor first. Once a stress fracture has been ruled out or has settled, we can help with strength and the return to sport.
What exercises are safe with spondylolisthesis?
Exercises that build the deep trunk and hip muscles without arching the lower back are the usual starting point, along with gentle hamstring stretches. Repeated back bends and heavy overhead lifting tend to load the slipped level, so leave those out until you have been assessed. Our post on lower back pain exercises has a strength stage that suits many people with a stable slip, but skip any exercise in it that arches your back.
Can spondylolisthesis cause spinal stenosis?
Yes. When a vertebra shifts forward, it narrows the canal at that level, and the two often turn up together in people over 50. The leg pattern then matches spinal stenosis, with heavy or tingling legs on walking that ease with sitting or leaning forward.