SPONDYLOLISTHESIS

Spondylolisthesis

Spondylolisthesis refers to a sports injury in children, usually associated with hyperextension. Hyperextension happens when a child is playing or participating in sports, and their spine becomes forced backward into an exaggerated arch. When this happens frequently it can cause a slipped vertebrae or spondylolisthesis. Also, it is becoming more common among children who participate in gymnastics, football, or wrestling.

Children and teens are especially at risk for spondylolisthesis because their bones are still growing, making their spines more vulnerable—particularly during growth spurts. Activities and sports that put repeated strain or stretching on the lower back, such as weightlifting, volleyball, ballet, and golf, can also increase the chances of developing this condition. Frequent hyperextension motions in these activities put extra pressure on the lower spine, which over time may lead to one vertebra slipping forward over the one below it.
Children and teens are especially at risk for spondylolisthesis because their bones are still growing, making their spines more vulnerable, particularly during growth spurts.

Activities and sports that put repeated strain or stretching on the lower back, such as weightlifting, volleyball, ballet, and golf, can also increase the chances of developing this condition. Frequent hyperextension motions in these activities put extra pressure on the lower spine, which over time may lead to one vertebra slipping forward over the one below it. Sports injuries in children have been increasing over the years as children play longer and more competitively.

Specifically, spondylolisthesis is a condition in which one of the bones of the spine (vertebrae) slips out of place. The slipped vertebrae slips off in front of the vertebra below it. If it slips too much, the bone can press on a nerve causing pain in the lower back. In addition, severe pressure on the nerves may also cause bladder dysfunction.

What Problems Can Happen?

If spondylolisthesis that causes symptoms isn’t diagnosed and treated, kids can develop chronic back pain and a loss of flexibility. Over time, the degree of slip can worsen, potentially making symptoms more severe. Early recognition is important, as persistent or worsening slippage can increase the likelihood of nerve involvement and long-term discomfort.

How Common Is Spondylolisthesis?

Spondylolisthesis is not an uncommon cause of back pain in teens and they can begin showing symptoms during a growth spurt. Furthermore, sports can cause a lower back strain that can contribute to a slipped vertebrae. Therefore, warm-up and stretching, especially during the growing years, are vitally important to keeping your child spine healthy.

Prevention and Risk Reduction

While spondylolisthesis can occur suddenly or develop over time, there are several steps young athletes can take to help reduce their risk of developing this condition—or prevent it from worsening if they already have spondylolysis:

• Limit time spent on high-risk sports such as gymnastics, football, and wrestling, especially if your child is experiencing back discomfort.
• Prioritize rest and recovery after physical activities to allow the spine to heal and adapt.
• Strengthen core muscles—a strong core helps support the lower back and stabilizes the spine during movement.
• Warm up properly before practices and games to prepare muscles and joints for activity.
• Stretch regularly to keep muscles flexible and reduce tension on the lower back.
• Use appropriate safety equipment and make sure it fits properly.
• Follow the rules and correct techniques for each sport to minimize undue stress on the back.
• Maintain a healthy weight, as excess weight can put additional strain on the spine.

Encouraging these habits in young athletes is a key part of keeping their spines healthy, particularly during periods of rapid growth or increased athletic participation.

Spondylolisthesis Symptoms

Oftentimes, children and adolescents with spondylolisthesis don’t have any pain. They don’t even know they have the condition. When symptoms do occur, the most common one is low back pain, because of the slipped vertebrae. The pain often spreads across the lower back. It may feel like a muscle strain. Spondylolisthesis can also cause muscle spasms in the hamstring muscles in the back of the thighs. Tight hamstrings can cause a child to walk with short strides and with the knees slightly bent. If the slipped vertebra is pressing on a nerve, the pain might spread down the leg to the foot. The foot might also tingle and/or feel numb.

Spondylolisthesis Diagnosis

To diagnose Spondylolisthesis, an examination and an X-ray of the lower back will be performed. It can identify any slipped vertebra, ones that are out of alignment. However, your doctor may order more tests if a more detailed image is needed. If so, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be ordered.

When to Pause Activities and Seek Medical Advice

If your child experiences back pain during sports or play, it’s important for them to take a break right away. Continuing activity can make the injury worse. Encourage your child to let you know about any discomfort in their back, especially if the pain doesn’t go away with rest.

You should have your child evaluated by a healthcare provider if:

• Back pain persists or worsens after resting
• They have trouble walking or standing upright
• There is pain radiating down their leg, or numbness and tingling in the foot
• They experience weakness or changes in bladder or bowel function

Always err on the side of caution—don’t let your child return to sports or physical activity until they’ve been examined by a medical professional and given the all-clear. This helps protect their spine and prevent further injury.

Treating Spondylolisthesis

Treating spondylolisthesis depends on several factors:

• Age and overall health of the child
• The extent of the slippage
• The severity of the symptoms.

Treatment is most often conservative. A more severe condition of spondylolisthesis may require surgery.

Non-Surgical Spondylolisthesis Treatments

This involves rest, medication, and moderate exercise. Taking a break from sports and other activities until the pain subsides. A non-steroidal, anti-inflammatory medicine purchased over the counter might be recommended. This would possibly help to reduce pain and inflammation. If it doesn’t provide pain relief, a stronger medication might be needed. Thus, your doctor may prescribe an epidural steroid injection. The injection places medication directly in the space surrounding the spine, near the slipped vertebrae. These types of injections may help reduce inflammation and ease the pain.

Spondylolisthesis Bracing

A back support or brace can help stabilize the lower back while it’s healing. It also might help with reducing pain. An exercise and/or physical therapy program can help as well. Support and increasing pain-free movement will improve flexibility and muscle strength. We periodically take X-rays to determine if bone slippage is still happening.

Physical therapy

An exercise program that strengthens the abdominal and/or back muscles, thus minimizing the bony movement of the spine, is normally prescribed. We generally recommend 8 to 12 weeks of aggressive, daily stabilization exercises. These exercises help to achieve clinical improvement. Focusing on stretching tight hamstrings, as well as core and spine extensor muscle strengthening, can sometimes help.

Surgery for Spondylolisthesis

A surgical procedure may be necessary if the slipped vertebra continues to slip or if the child is still in pain. The goal of surgery is to stabilize the spine by fusing the vertebrae that have slipped out of place. This procedure will help relieve the pain associated with an irritated nerve while helping your child return to normal activities.

In more severe cases, the surgical approach may involve several key steps:

• Reduction: The slipped vertebra is carefully moved back into its proper position.
• Decompressive laminectomy: Sometimes, a small portion of the vertebra is removed to relieve pressure on nearby nerves.
• Spinal fusion: Rods and screws may be used to hold the vertebrae in place as the bones fusr, resulting in greater stability for the spine during healing.

Your child’s orthopedic surgeon will determine the best surgical plan based on the extent of the slippage and your child’s overall health, always to restore function and relieve discomfort.

Returning to Sports: What Parents and Coaches Should Know

After a diagnosis of spondylolisthesis, it’s natural for both young athletes and their supporters to focus on returning to the field, court, or gym. However, ensuring a safe and appropriate return to sports is crucial for long-term spinal health.

Patience is Key:
Many children who excel at competitive sports are fiercely motivated, and their drive to “get back in the game” can be intense. Parents and coaches should remember that healing takes time—sometimes more than anyone wants to admit. Supporting your child’s emotional well-being during this break is just as essential as supporting their physical recovery.

Clearance Before Competition:
Before resuming any rigorous activities, your child must receive clearance from their orthopedic specialist or healthcare provider. This isn’t just a formality: it’s a safeguard to ensure that the spine is stable and pain-free before returning to high-impact movement.

Small Steps and Safe Practices:
Once cleared, a gradual reintroduction to activity is recommended. Encourage athletes to:

• Keep up with core-strengthening and flexibility exercises they learned during rehab.
• Use proper techniques tailored to their sport.
• Take regular breaks between practices, games, or competitions.

Neglecting these protective habits can lead to a recurrence of pain or even additional injury.

Spotting Red Flags:
Remind your child to immediately stop any activity that brings on back pain or discomfort. No game or practice is worth risking their recovery. If pain returns, consult the healthcare provider before resuming play.

Guidance for Coaches and Parents:
Cheering from the sidelines is important, but so is understanding each player’s unique journey. Coaches should foster an environment that prioritizes health over quick returns, working closely with parents and athletes to support long-term participation and wellness.

With patience, open communication, and the right precautions, most children and teens can safely rejoin their favorite sports—and stay there.

Preventing the Recurrence of Pain After Spondylolisthesis Recovery

Helping your child avoid a return of pain after recovering from spondylolisthesis starts with ongoing attention to healthy habits and body mechanics. While the competitive spirit and determination in young athletes can be impressive—think of future stars on the fields of FC Dallas or the Dallas Cowboys, maintaining spinal health is more important than any championship trophy.

Key steps to minimize recurrence include:

• Stick to the Plan: Encourage your child to continue with core strengthening and flexibility exercises they learned during physical therapy. These habits help support the spine and prevent future slippage.
• Prioritize Good Technique: In every sport or activity, using proper form matters. Coaches, physical therapists, and athletic trainers can help reinforce these fundamentals.
• Rest and Recovery: Make sure your child takes regular breaks between seasons, tournaments, and tough training periods. Rest is just as crucial as practice, even for the most driven athletes.
• Listen to the Body: Teach your child to recognize any warning signs from their body. If back pain returns, even if it seems minor, your child should immediately stop the activity and let you and their provider know.
• Medical Clearance: Always require a green light from your medical team, like the pediatric orthopedists right here at Medical City Children’s Orthopedic and Spine Specialists, before returning to demanding physical activities.

With ongoing support from you, dedicated medical professionals, and your child’s commitment, they can safely enjoy returning to their favorite activities and stay out of the orthopedic clinic’s “frequent flyer” club!

Why choose Medical City Children’s Orthopedics and Spine Specialists for your Child

At Medical City Children’s Orthopedic and Spine Specialists, our physicians have successfully performed 6,000 surgeries, so you can rest assured your child is in good hands. In the case that your child requires surgery, our compassionate medical team will sit down and discuss with you all the options available so your family can make an informed decision. Our physicians at Medical City Children’s Orthopedic and Spine Specialists take care of all types of sports-related injuries, including Spondylolisthesis. In case of an injury, we can examine your child right away. Also, you never have to wait long for an appointment. With convenient locations in Dallas, Arlington, Flower Mound,  Frisco, and McKinney, TX, we are never far away.

 

“Spondylolysis is a condition that commonly affects children in their growing years. A part of the back of the spine called the “pars” is injured with a small stress fracture, and this can lead to a condition known as spondylolisthesis, where one of the bones slips down over another, causing pain and significantly reducing their activity level.” – Dr. Kathryn Wiesman