Isthmic spondylolisthesis: physical therapist
viewpoint
This patient's subjective history and physical
exam both point to the fact that placing his
lower lumbar spine in a relatively forward flexed
position tends to relieve symptoms. Although
we know he has a disc bulge present at L4-L5
on MRI, we have found symptoms to be more consistent
with his spondylolisthesis at L5-S1 and will
treat accordingly.
One of the most important factors in this patient's
response to physical therapy is having a good
sense of body awareness. The patient is instructed
that we are not trying to correct his spondylolisthesis,
but he can be taught to continue performing all
of his activities with greatly diminished if
not completely resolved pain. The patient feels
best in forward flexion. However, standing and
walking in a forward flexed position is not practical,
nor is it safe. Therefore, he is taught to perform
a posterior pelvic tilt, flexing the lower lumbar
spine from below and allowing him to maintain
an erect posture.
Physical therapy treatment program
To achieve this position, a home program of stretching the trunk extensors
and strengthening the trunk flexors (especially lower abdominals) will help.
However, this exercise program alone will likely not improve his situation.
This patient is then taught to recognize and maintain the pelvic tilt to
his optimal position, which must be determined by the patient according to
his symptoms. For this he must have a good sense of body awareness, which
the therapist can help him develop through exercise. The most difficult task
the patient has is to maintain this position with activity, especially those
activities done in standing or walking. This is also his most beneficial
task. For this, abdominal strength is important, though control is imperative.
By:
Ron S. Miller, PT
October 10, 2000 |
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