Top 3 exercises for Lumbar Spondylosis, Spinal stenosis and Spondylolisthesis

By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM
Pinnacle Training & Consulting Systems

Background

There are a multitude of exercises available at the fingertips of a fitness professional. Choosing
the most accurate and objective exercise should be the cornerstone of any fitness
programming. Working with any client who has a spinal injury, should involve a thorough
history, fitness assessment and most importantly, a sound understanding of the pathophysiology
and programming of that movement dysfunction. In this article, we will review and clarify
the differences between spinal conditions that include spondylosis, spinal stenosis and
spondylolisthesis discussing the pathophysiology, common rehabilitation and post
rehabilitation training.

Clarifying the differences

Spondylosis is the degeneration of one joint on another also known as degenerative disc
disease(DJD). Patient will typically presents with tightness in the lower lumbar and may or may
not present with radicular symptoms in their legs. Physical therapy addresses these impairments
by conducting a comprehensive examination, using manual therapy, and targeted exercises.

Spinal stenosis is a narrowing within the vertebral canal
coupled  with hypertrophy of the spinal lamina and
ligamentum flavum or facets as the result of age-related
degenerative process. The patient who has spinal stenosis
usually has very tight hamstrings and lumbar extensors.
They often will complain of unilateral vs. bilateral numbness in  their legs due either having central lateral(to side) foraminal stenosis.
Physical therapy addresses these areas with myofascial
release, stretching, and joint mobilizations to address
mobility then teach flexion based exercises, which will
improve the opening of the spinal lamina.

Figure 1. Spinal stenosis

Spondylolistehsis is an anterior (forward) slippage or posterior (back) slippage of one vertebrae on another following bilateral fracture of the pars interarticularis. The slippage is graded from 1-4 (25% to 100%) from an x-ray. In degenerative spondylolisthesis, as the intervertebral disc loses height, the annulus may bulge circumferentially and the ligamentum flavum can buckle. These types of injuries are seen in wrestlers, due to the combined extension and rotation movements seen in the sport as well as in older patients due to their lifestyle. Physical therapy/training emphasis is on elimination of extension-based exercise (back extension, press ups, etc.). Biomechanically, this will force the vertebra forward causing more translation and instability. Training emphasis is on flexion-based exercises (strengthening of abdominals). Flexion based exercises will decrease shearing force and translation on the effected segment. Postural education is key, static and dynamic core strengthening should also be included. Core strengthening using medicine balls, cables and physioballs shoulder be personalized to the client.

Recommendations

All of the spinal conditions discussed previously are unique, requiring a thorough understanding, while designing a program that is personalized for the client. With respect to spondylosis, the three top exercises for this client are abdominal bracing with alternate leg lift, bridging with physioball and prone alternate leg lift/arm lift over physioball. All three exercises target the multifidus and transverse abdominis. Two essential muscles of the core.

 
Figure 2. Abdominal bracing with alternate leg lift     Figure 3. Prone alternate arm and leg lift

With respect to both spinal stenosis and spondylolisthesis, the focus is on flexion exercises.

My top three for both include reverse abdominal crunch, dead bug and prone alternate leg and arm lift over physioball, stopping at neutral(as seen in figure 3).

 

Figure 4. Reverse crunch                                          Figure 5. Dead bug

Summary

Lumbar Spondylosis, Spinal stenosis and Spondylolisthesis are three common spinal conditions affecting most adults today. Understanding the pathophysiology, mechanism of injury, common physical therapy treatments and a few targeted exercises, should help you, the fitness professional while designing a program for your client. If you should have any questions, please feel free to contact PTCS at ptcg1999@verizon.net or www.pinnacle-tcs.com