As physiotherapists, we often meet patients confused by the terms spondylolysis, spondylolisthesis, and spondylosis. While these conditions all affect the spine, they differ in causes, symptoms, and treatment approaches. This blog breaks each one down – with a clear focus on how we assess and rehabilitate them through early, mid, and end stages.
Spondylolysis – Stress Fracture in the Pars Interarticularis
What is it?
Spondylolysis is a small fracture or defect in the bony bridge at the back of the vertebra (pars interarticularis). It often appears in sporty adolescents and young adults who do a lot of spinal extension and rotation (1).
Physiotherapy Assessment:
Subjective History:
● Gradual onset low back pain, often one-sided.
● Pain worsens with activities involving lumbar extension (e.g. sprinting, kicking, arching backwards).
● May describe recent growth spurt or sudden increase in training load.
● No neurological symptoms in most cases.
Objective Examination:
● Observation: Increased lumbar lordosis or asymmetry in spinal alignment.
● Palpation: Localised tenderness over the lower lumbar spine (often L5).
● Stork Test (Single Leg Hyperextension): Standing on one leg and extending the lumbar spine – reproduction of pain indicates possible pars involvement (2).
● Active Lumbar Extension Test: Painful and limited.
● Flexion usually pain-free.
● Neurological testing: Normal sensation, reflexes, and power.
Spondylolisthesis – Forward Slippage of a Vertebra
What is it?
Spondylolisthesis is when one vertebra slips forward over the one below. It can be caused by a pars fracture (as in spondylolysis) or degeneration (3). It may range from mild to severe depending on how much slippage has occurred.
Physiotherapy Assessment:
Subjective History:
● Dull ache in the lower back, worse with standing or walking for long periods.
● Hamstring tightness and reduced flexibility.
● Reports of spinal “instability” or “locking.”
● In more severe cases: pain radiating into the buttocks or legs, tingling, or weakness.
Objective Examination:
● Observation: Flattened lumbar spine or palpable step deformity at the affected level (commonly L4-L5 or L5-S1).
● Palpation: Gapping or slippage between spinous processes.
● Prone Instability Test: Relief of pain when core is activated may indicate instability (4).
● Range of Motion: Extension often limited and painful; flexion may also be guarded.
● Neurological Testing: Depending on grade, may show altered reflexes, weakness (especially L5/S1), or sensory changes.
● Functional Testing: Poor lumbopelvic control during single leg tasks or bridging.
Spondylosis – Degenerative Spine Changes
What is it?
Spondylosis refers to age-related degeneration in the spine – disc narrowing, facet joint stiffness, and bony spurs. It’s incredibly common in over-40s, and doesn’t always correlate with pain levels (5).
Physiotherapy Assessment:
Subjective History:
● General back or neck stiffness, particularly in the morning or after rest.
● Dull, aching discomfort, aggravated by prolonged sitting or standing.
● Occasional episodes of pain referral into the limbs or buttocks.
● Often associated with a sedentary lifestyle or repetitive spinal loading.
Objective Examination:
● Observation: Forward head posture, thoracic kyphosis, or reduced lumbar lordosis.
● Palpation: Localised tenderness over facet joints; stiffness in thoracic or lumbar segments.
● Range of Motion: Reduced spinal mobility, particularly in extension and rotation.
● Joint Springing (PA mobilisation): Hypomobility and discomfort over stiff segments.
● Neurodynamic Tests: Positive slump or straight leg raise if nerve root involvement present.
● Functional Testing: Difficulty with sit-to-stand, forward bending, or overhead activities depending on spinal region affected (6).
Rehabilitation Phases for Each Condition
Spondylolysis
Early Phase:
● Relative rest from sport and spinal extension.
● Pain management (ice, soft tissue release, possible bracing).
● Isometric core activation in neutral spine (e.g. dead bugs, TA contractions).
● Hip mobility and postural education (7).
Mid Phase:
● Core stability progression (bird-dogs, side planks, glute bridges).
● Control through range (pelvic tilts, gentle lumbar flexion/extension in neutral).
● Begin low-impact aerobic activity (bike, walking).
End Stage:
● Gradual return to sport-specific drills (e.g. agility, change of direction).
● Controlled lumbar extension and rotation exercises.
● Monitor strength symmetry with VALD force plates or similar testing tools.
● Functional movement re-education (jumping, landing, sprint mechanics).
Spondylolisthesis
Early Phase:
● Reduce mechanical stress: avoid extension, long sitting, or lifting.
● Isometric abdominal and gluteal activation.
● Pain education and reassurance.
● Hip flexor and lumbar mobility within pain-free range.
Mid Phase:
● Core strengthening in neutral spine (TA, multifidus, glutes).
● Closed chain strengthening (wall sits, bridges, resistance band work) (8).
● Re-educate movement patterns (e.g. hip hinging, squatting, stepping).
● Introduce light aerobic activity with spinal control.
End Stage:
● Plyometric prep if returning to sport.
● Dynamic core and glute work under load (lunges, resisted running drills).
● Functional strength training with posture correction.
● Regular re-testing and graded exposure to sport/work demands.
● Ongoing monitoring if slip is moderate/severe.
Spondylosis
Early Phase:
● Manual therapy and joint mobilisations to reduce stiffness.
● Soft tissue release of paraspinals, glutes, neck or thoracic muscles.
● Gentle mobility exercises (cat-cow, lumbar rolls, thoracic rotation).
● Education on pain science and staying active (9).
Mid Phase:
● Strengthening postural muscles (deep neck flexors, spinal extensors, glutes, abdominals).
● Aerobic conditioning (walking, swimming, stationary bike).
● Introduce resistance bands or bodyweight exercises (wall push-ups, mini squats).
● Ergonomic and pacing advice for home/work.
End Stage:
● Return to regular gym-based strength work or Pilates.
● Introduce spinal loading with good technique (e.g. light deadlifts, farmer’s carries).
● Increase tolerance for daily or occupational tasks (gardening, stair climbing, desk work).
● Encourage self-management through consistent movement, mobility routines, and lifestyle support.
Final Thoughts from the Physio Bench
These three spinal conditions may sound similar, but they affect different age groups, tissues, and movement patterns – which is why physiotherapy rehab must be individualised.
The key to success is a phased rehab approach, where we manage pain early on, retrain the core and movement in the middle, and build strength and resilience in the later stages. Whether it’s an adolescent athlete with a pars stress fracture or an older adult with degenerative changes, there’s always a way forward through education, movement, and progressive rehabilitation.
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating all spinal conditions. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
- Leone, Antonio, et al. “Lumbar spondylolysis: a review.” Skeletal radiology 40.6 (2011): 683-700.
- Alqarni, Abdullah M., et al. “Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.” Physical Therapy in Sport 16.3 (2015): 268-275.
- Newman, P. H., and K. H. Stone. “The etiology of spondylolisthesis.” The Journal of Bone & Joint Surgery British Volume 45.1 (1963): 39-59.
- Vanti, Carla, et al. “Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment.” Archives of physiotherapy 11.1 (2021): 19
- Ferrara, Lisa A. “The biomechanics of cervical spondylosis.” Advances in orthopedics 2012.1 (2012): 493605.
- Middleton, Kimberley, and David E. Fish. “Lumbar spondylosis: clinical presentation and treatment approaches.” Current reviews in musculoskeletal medicine 2.2 (2009): 94-104.
- Garet, Matthew, et al. “Nonoperative treatment in lumbar spondylolysis and spondylolisthesis: a systematic review.” Sports health 5.3 (2013): 225-232.
- Vanti, Carla, et al. “Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment.” Archives of physiotherapy 11.1 (2021): 19.
- Aslan Telci, Emine, and Ayse Karaduman. “Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis.” Rheumatology international 32.4
(2012): 1033-1040.
