Exercise for Sciatica from Isthmic Spondylolisthesis

Fig. 10
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Fig. 6
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Fig. 11
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Fig. 12
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Sciatica can be caused by isthmic spondylolisthesis if the condition results in nerve root irritation or impingement. In most cases, if isthmic spondylolisthesis affects or pinches a nerve root it will affect the L5 nerve root.

When treating sciatica resulting from isthmic spondylolisthesis with exercise, the spine specialist will typically recommend a program of sciatica exercises that is a hybrid of:

• Flexion based exercises (as when treating spinal stenosis), and

• Stabilization program (as when treating degenerative disc disease).

The goal of this type of sciatica exercise program is to teach the lumbar spine to remain stable in a flexed position. Therefore, the sciatica exercises for isthmic spondylolisthesis are a combination of both programs.

Sciatica Exercises for Isthmic Spondylolisthesis

These sciatica exercises often require specific hands-on instruction because they offer much less benefit if done incorrectly, and the exercises tend to be much more difficult to do than they appear.

Three sciatica exercises for isthmic spondylolisthesis that are commonly prescribed for sciatica pain relief include:

• Pelvic tilt. Specialists treating patients with sciatica pain from isthmic spondylolisthesis frequently recommend the pelvic tilt (Figure 10), as it will hold the lower spine in the flexed position. This includes lying on the back with knees bent and flattening the back by tightening the lower stomach muscles, pulling the navel in and up. Hold this position for 10 to 20 seconds, then relax the muscles. Aim to complete a set of 10 pelvic tilts to strengthen the lower stomach muscles.
Practical point The pain from isthmic spondylolisthesis can be minimized by training the lumbar spine to remain stable when flexed, such as it is when picking something up off the floor or tying one’s shoes.
• Curl-ups. Strengthening the abdominals with the curl-ups (Figure 6) will also help maintain a proper lower spine position. Lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back by pulling the navel (or belly button) in and up. Then curl-up, lifting the head and shoulders from the floor. Do not attempt to lift too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head to support the neck. Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls.
• Hook-lying march. As another form of stabilization exercise, the hook-lying march (Figure 11) and hook-lying combination (Figure 12) are again useful here as well. ). Aim to ‘march’ for 30 seconds, two to three repetitions, with 30-second breaks in between repetitions.

• Article written By:
• Ron S. Miller, PT

January 3, 2007

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