This protocol addresses low-grade isthmic spondylolisthesis — Meyerding Grade I or Grade II — in patients who have completed an initial course of conservative management without achieving the key goals of low back pain relief or prevention of further vertebral slippage.
Initial management — which included activity restriction and modification to avoid lumbar hyperextension, spinal bracing, analgesic and anti-inflammatory medications, and muscle relaxants — was directed at achieving low back pain relief and preventing further vertebral slippage. When these goals are not reached, the next structured intervention is indicated.
Isthmic spondylolisthesis is primarily associated with a defect or fracture in the pars interarticularis, often caused by repetitive mechanical stress, and frequently progresses from a pre-existing spondylolysis.
Conservative treatment is typically recommended for patients with low-grade spondylolisthesis (grades I and II), especially those who are asymptomatic or have mild to moderate symptoms without significant neurological deficits.
For patients with isthmic spondylolisthesis, conservative treatment for three to six months has demonstrated good outcomes, managing most unilateral pars lesions and approximately 50% of bilateral lesions.
If symptoms persist beyond 1 to 2 weeks, physical therapy is typically introduced as the next step.
For patients with isthmic spondylolisthesis, who are often young and physically active, including athletes, the primary goal of physical therapy is to restore their previous physical condition and enable a safe return to activity.
Rehabilitation programs may focus on core stability, strength recovery, resistance training, postural correction, and flexibility exercises.
The primary objectives of physical therapy are to reduce pain, improve ROM, and enhance strength and spinal stability.
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