Spondylolisthesis can feel overwhelming, especially when you’re managing persistent back pain, nerve symptoms, or limited mobility. Many people worry that surgery is their only solution, but at Physiologic, our approach prioritises non-surgical management.

In this blog, I’ll explain what spondylolisthesis is, what causes it, how to identify it, and how we have been able to manage >95% of our clients with Spondylolisthesis conservatively (non surgically).

What Is Spondylolisthesis?

Spondylolisthesis occurs when one vertebra in your spine slips forward over the one beneath it. This condition most commonly affects the lower back (lumbar spine) and can vary significantly in severity. For some, it causes mild discomfort; for others, it may lead to more debilitating symptoms that produces nerve pain that travels down the leg!

Common Signs and Symptoms of Spondylolisthesis

The symptoms of spondylolisthesis can vary depending on severity but may include:

• Localised lower back pain, especially with prolonged standing or walking.

• Stiffness and reduced flexibility in the spine, usually in all directions!

• Referred pain into the buttocks, thighs, or legs (nerve pain, or ‘sciatica’).

• Step deformity, a visible or palpable misalignment in the spine detected clinically or via imaging (video below)

• Tight hamstrings or a sensation of pulling in the back of the legs.

• Neurological symptoms, like tingling, numbness, or weakness in the legs, caused by nerve compression.

If you recognize these symptoms, it’s important to consult a professional for accurate diagnosis and management.

What Causes Spondylolisthesis?

There are several reasons why spondylolisthesis may develop:

• Degenerative changes in the spine due to aging.

• Stress fractures, especially in athletes who engage in repetitive movements like gymnastics or weightlifting.

• Progression from a pars fracture/severe spondylosis

• Congenital abnormalities, where the spine didn’t form correctly at birth.

• Trauma, such as a sudden injury or impact.

Knowing the cause helps tailor treatment to your specific needs.

Why Choose Non-Surgical Management for Spondylolisthesis?

For many people with spondylolisthesis, surgery can and should be avoided. Non-surgical management is often highly effective in reducing pain, improving mobility, and preventing the condition from worsening.

At Physiologic, we prioritise strategies that aim to stabilise your spine, alleviate discomfort, and restore your quality of life without invasive procedures.

This approach not only reduces the risks associated with surgery but also leads to faster recovery and sustainable improvements. With the right care, most clients can achieve significant relief and avoid the need for an operation.

"Evidence suggests that non-surgical management, including comprehensive physical therapy and pain relief strategies, can effectively alleviate symptoms of spondylolisthesis and may reduce the need for surgery, particularly in cases of degenerative spondylolisthesis (Demir-Deviren et al, J Neurosurg Spine, 2019, PMID: 30664502)."

At Physiologic, we would normally trial an intensive 3-6 month period of conservative rehabilitation, before considering anything interventional that the Spinal Surgeon may recommend. This gives us ample time and opportunity to work on restoring your function and alleviating pain, and gives an overwhelming majority of our clients excellent results.

My Non-Surgical Approach to Spondylolisthesis

Comprehensive Assessment

Every treatment journey begins with a detailed assessment. We conduct a physical examination to identify movement restrictions, weakness, and pain triggers, while also reviewing imaging results to confirm the diagnosis. This ensures that we’re addressing the exact source of your symptoms and not just managing them superficially.

Our assessment procedures also take into account contributing factors, such as hip, lower limb and thoracic spine function as it has a direct effect on your lumbar spine.

This allows us to create a comprehensive rehabilitation plan that targets your issue at the source AND it’s contributing factors.

Pain Relief

The first goal of treatment is to reduce pain and improve comfort. I use spinal manual therapy to ease stiffness and improve mobility. Dry needling can help release muscle tension, while soft tissue therapy addresses inflammation and promotes healing. Together, these techniques provide a solid foundation for recovery.

Active Rehabilitation

Active rehabilitation focuses on restoring your movement and building confidence. We create a customised exercise program tailored to your unique needs. This program is designed to gradually improve your strength and flexibility without overloading the spine. Progression is carefully monitored to ensure that exercises remain effective and safe.

Strengthening and Conditioning

Building strength is essential for stabilising the spine and reducing pressure on the vertebrae. I focus on strengthening the muscles of the core, back, and lower body to improve spinal stability. This approach not only addresses current symptoms but also helps prevent flare-ups and further issues.

Long-Term Solutions

Our philosophy at Physiologic is to guide you towards a pain free, stronger you that you once dreamt of. We work with you to build your body up for life’s important moments, and so you can quit saying ‘sorry I can’t, I’ve got a bad back’.

Complex conditions like Spondylolisthesis are best managed with a team, and that’s why we work closely with Spinal Orthopaedic Surgeons and other health and fitness professionals who are here to help you achieve your goals.

Conclusion: Your Path to Relief

Spondylolisthesis doesn’t have to hold you back. With the right care, you can reduce pain, regain function, and avoid surgery like many of our clients at Physiologic.

At Physiologic, I combine expert assessment, targeted therapies, and tailored rehabilitation to deliver effective, long-lasting solutions so you can skip the guesswork and get start on your path to recovery.

Take the first step toward a pain-free life today. Visit www.physiologichk.com to book a consultation or learn more about how I can help you.

ABOUT THE AUTHOR

Ryan Tan, the Clinical Director and Spinal Physiotherapist at Physiologic Hong Kong, brings over a decade of expertise in sports and spinal physiotherapy. He holds a Certificate of Spinal Manual Therapy (COSMT), an intensive qualification dedicated to advanced spinal care, as well as being trained in Osteopathic Spinal Manipulations (OMT).

Ryan’s extensive background includes working in renowned Complex Pain Clinics in London, where he specialised in managing complex spinal conditions, working closely with Pain Consultants & Spinal Neurosurgeons.

Here in Hong Kong, he collaborates with leading Orthopaedic Spinal Specialists to deliver comprehensive and effective treatments for individuals suffering from persistent Spinal (Neck and Back) Injuries. If you have a complex spinal injury that remains unresolved, contact us for a thorough and obligation-free assessment!