Rehabilitation of Spondylolysis (what to expect)

Julie Sherry, PT, MSUW Health Spine Clinicjsherry2@uwhealth.org

PT Interventions

•

Core Stabilization•

Glute

Strengthening

•

Joint Mobilization•

Flexibility

•

Body Mechanics•

Return to Sport Progression

Treatment: Core Stabilization

•

activation of deep abdominal muscles

–

transverse abdominus

& internal oblique–

“draw-in”

•

with co-activation of lumbar multifidi

–

“swell back muscles”

Why Abdominal Stabilization?-Delay in transverse abdominal contraction

in patients with LBP*

-Lumbar multifidus

atrophy correlated to the same side and vertebral level of symptomatic LBP**

*Hodges and Richardson. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus

abdominis. Spine 1(22): 2640-50. 1996.

** Hides etal. Evidence of lumbar multifidus

muscle wasting ipsilateral to symptoms in patients with acute/subacute

low back pain. Spine

19(2):165-72. 1994.

Phases of Core Stabilization

Phase 1:

Core Initiation: supine, 4-point drawing-in

Phase 2:

Static Stabilization: 4-point, ½ kneel, standing drawing-in with arm/leg motion

Phase 3:

Dynamic Stabilization:

allow trunk motion to occur with dynamic control

Phase 4:

Reactive Core Control: dynamic control during specific drills & various environmental challenges

Core Initiation

Transverse Abdominus: “drawing-in”

Lumbar Multifidus: “swell back muscles”

NWB Static Stabilization

Standing Static Stabilization

Swiss Ball Dynamic Stabilization

rotation from above rotation from below

Medicine Ball Dynamic

Stabilization

Treatment: Strengthening

•

Core “Strengthening”: External oblique•

Gluteus Maximus: pelvic stability in sagittal

plane•

Gluteus Medius: pelvic stability in fromtal

plane•

Oblique Abdominals

•

Erector Spinae

Glute

& External Oblique Strength

Squat with hip hinge Backward lunge with twist

Glute Strength

Sidestep with band at knees → ankles→ forefoot

in squat position (weight on heels) in bow position (weight on heels)

Treatment: Joint Mobilization

if necessary: “steal” joint ROM from elsewhere….

•

Mobilization of Hips•

Manipulation of Thoracic spine

Hip

Thoracic Spine

Treatment: Flexibility

•

Hip Flexors: Psoas and Quads

•

Latissimus

Dorsi (overhead athlete)

•

Hamstrings: tight from growth spurt or muscle spasming

Treatment: Flexibility

Treatment: Body Mechanics•

Body Mechanics–

Sleep: avoid sleeping prone (suggest body pillow to break the habit)

–

School: unload backpack to10% BW (suggest double copy of textbooks for home and school, rolling bag); use both straps

–

Footwear: avoid flip flops, tie shoes, consider arch supports to improve LE alignment

Treatment: Return to Sport Progression

•

NWB to WB postures

•

Static to Dynamic Stabilization

•

Sport-Specific planes of movement, speeds, loads, dosing impact

ReferencesHodges and Richardson. Inefficient muscular stabilization of the

lumbar spine associated with low back pain. A motor control evaluation of transversus

abdominis. Spine. 1996:1(22): 2640-50.

Hides etal. Evidence of lumbar multifidus

muscle wasting ipsilateral to symptoms in patients with acute/subacute

low back pain. Spine. 1994:19(2):165-72.

O'Sullivan PB, Phyty

GD, Twomey

LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic

diagnosis of spondylolysis

or spondylolisthesis.Spine. 1997: Dec 15;22(24):2959-67.

Klein G, Mehlman

CT, and M McCarty. Nonoperative

treatment of spondylolysis

and grade 1 spondylolisthesis

in children and young adults. A meta-analaysis. J Pediatr

orthop. 2009: 29: 146-156.