Lumbar Spndyllysis/listhesis Rehabilitatin Guideline This rehabilitatin prgram is designed t return the individual t their activities as quickly and safely as pssible. It is designed fr rehabilitatin fllwing a nn-perative lumbar spndyllysis/listhesis. Mdificatins t this guideline may be necessary dependent n physician specific instructin, specific tissue healing timeline, chrnicity f injury and ther cntributing impairments that need t be addressed. This evidence-based nn-perative rehabilitatin guideline is criterin-based; time frames and visits in each phase will vary depending n many factrs including patient demgraphics, gals, and individual prgress. This guideline is designed t prgress the individual thrugh rehabilitatin t full sprt/ activity participatin. The therapist may mdify the prgram apprpriately depending n the individual s gals fr activity fllwing the nn-perative rehabilitatin guideline belw. This guideline is intended t prvide the treating clinician a frame f reference fr rehabilitatin. It is nt intended t substitute clinical judgment regarding the patient s pst injury care, based n exam/treatment findings, individual prgress, and/r the presence f cncmitant injuries r cmplicatins. If the clinician shuld have questins regarding prgressins, they shuld cntact the referring physician. General Guidelines/ Precautins: General healing timeline expected Highly variable, but can expect anywhere frm 3-6 mnths; athletes wh stp sprts participatin fr at least 3 mnths are 16 times mre likely t have an excellent utcme 1 Precautins t certain exercises fr this injury Avid lumbar extensin, spinal lading and impact activity early in the curse f care ROM/ Strength expectatins at beginning f therapy? Limit lumbar extensin range f mtin and strengthening past neutral lumbar spine in the early phases f rehabilitatin Severity/ Irritability/ Nature/ Chrnicity f symptms that may affect prgressins Bilateral pars defects typically timeframe t return is lnger than a unilateral defect Increased risk t develp chrnic ankle pain, instability, and limitatin in hpping >6 after injury
Spndyllysis/listhesis Rehabilitatin Guideline Last Updated: 9/26/2016 Phase I Active Rest Weeks: 0-6 weeks Expected Visits: 2-4 Phase Suggested Interventins Gals/ Milestnes fr Prgressin Immbilizatin (usually determined by physician) Bracing is recmmended if patient is experiencing pain with activities f daily living If patient nly has pain with higher level and/r sprting activities they may nt require bracing Cntrl f inflammatry prcess Specific Instructins: avid lading the spine, lumbar extended psitins Mdalities as indicated: ultrasund, electrical stimulatin, heat, ice t cntrl pain ROM/flexibility (encurage decreased lumbar stress during extensin mvement): Shulder flexin and latissimus drsi stretching Hip flexr stretching Hamstring stretching Hip rtatin stretching Thracic extensin mbilizatin/manipulatin and selfstretching Strength Side lying clam shell side lying hip abductin Abdminal ismetric Gals f Phase: 1. Prtect the injured jint 2. Cntrl inflammatin 3. Cntrl pain Criteria t Advance t Next Phase: 1. Pain is cntrlled 2. Edema is cntrlled 3. Full lumbar range f mtin (extensin is an exceptin) Other Activities: May bike withut resistance as apprpriate
Phase II Early Strengthening Weeks 6-9 Expected visits: 4-6 Specific Instructins: - Cntinue t avid excessive spinal lading and spinal extensin - discntinue brace if n pain with activities f daily living Mdalities as indicated Ultrasund, heat, electrical stimulatin t cntrl pain and stiffness Manual therapy Sft tissue mbilizatin paraspinals, quadratus lumbrum, gluteals, pirifrmis as needed ROM/flexibility (cntinue frm phase I) Begin neutral trunk stabilizatin Frnt plank Side plank Curl up Bridging Arm-ppsite leg lifting Clsed-chain gluteal strengthening Side step band walk Band squat ismetric Standing clam Fcus n ismetric hlds t imprve endurance f the trunk and gluteals Cardivascular: treadmill walking, biking, elliptical if n pain during r after Gals f Phase: 1. Restre mbility 2. Restre strength in pain-free ROM 3. Imprve trunk and hip endurance 4. Imprve neurmuscular cntrl Criteria t Advance t Next Phase: 1. 60 secnd hld frnt plank, side plank, lumbar extensin endurance 2. ROM WNL 3. N pain withut brace fr all activities ther than sprt 4. Light jg at 50% intensity withut pain Phase III Fundamental Mvements and Advanced Strengthening Specific Instructins: -begin gradual lading t the lumbar spine Mdalities as indicated Ultrasund, heat, electrical stimulatin t cntrl pain and stiffness Gals f Phase: 1. Prepare fr return t running and plymetric activities 2. Imprve trunk and hip strength 3. Intrduce majr mvements while emphasizing cre stability
Weeks 9-12 Expected visits: 4-6 Manual therapy Sft tissue mbilizatin paraspinals, quadratus lumbrum, gluteals, pirifrmis as needed Cntinue neutral trunk stabilizatin prgress t unstable surface Frnt plank Side plank Curl up Bridging Arm-ppsite leg lifting Anti-extensin and anti-rtatin exercises fr the trunk Clsed-chain gluteal strengthening Side step band walk Gblet squat Single limb strengthening Upper bdy mvements Chest press Overhead press Pull-dwns Lwer bdy mvements Single leg squat Single leg dead lift Laded carry Farmer carry prgress t single arm carries including suitcase and waiter carry Fcus n increasing weight and decreasing repetitins Cardivascular: begin return t running prgressin if patient can walk fr 30 minutes withut pain Criteria fr Return t Sprt: 1. N pain with initial phases f return t running prgram 2. Minimal t n pain r difficulty with majr mvements Phase IV Sprt-specific Return t Sprt Specific Instructins: -intrduce sprt specific mvements -cntinue t gradually add lading Mdalities as indicated
Manual therapy Sft tissue mbilizatin paraspinals, quadratus lumbrum, gluteals, pirifrmis as needed Cntinue abve nted strengthening exercises Plymetrics Begin with duble limb and prgress t single limb Cardivascular: cntinue return t running prgram, sprt-specific cnditining **NOTE: all phases may need t be extended depending n patient symptms. Bilateral pars defect and lnger duratin f symptms can lengthen time f rehabilitatin REFERENCES: 1. Alvarez P. Cnservative treatment f lumbar spndyllysis in yung sccer players. Knee Surg Sprts Traumatl Arthrsc. 2011;19:2111-2114. 2. Standaert et al. Expert pinin and cntrversies in sprts and musculskeletal medicine: the diagnsis and treatment f spndyllysis in adlescent athletes. Arch Phys Med Rehab. 2007;88:537-40. 3. Jhnsn RJ. Lw-back pain in sprts: managing spndyllysis in yung patients. The Physician and Sprts Medicine. 1993;4:53-59. 4. Garet M. Nnperative treatment in lumbar spndyllysis and spndyllisthesis: a systematic review. Sprts Health. 2013; 10:1-8