• Spondylolisthesis refers to slipping of part or all of one vertebra forward on another.
  • Usually associates with bilateral pars defects
  • Most common in children (9-14yr of age)
  • Familial predisposition. Athletes overuse injury (stress fracture) rarely progress to Spondylolisthesis
  • Usually L5 slips forward on S1


  • Grade 1 (<25% slip)
  • Grade 2 (25 - 50% slip)
  • Grade 3 (50 - 75% slip) 
  • Grade 4 (>75% slip)


  • Present with low back pain +/_ lower leg pain
  • A gap may be palpable on examination
  • Lateral Xray show the slip

Management for Grade 1 and 2 slip

  • Symptomatic approach
  • Rest from aggravating factors
  • Strengthening of abdominal and extensor + stretching Hamstring
  • Manipulation and mobilisation of stiff joints above and below (should not manipulate at the level of slip)
  • Can return to sports when pain free on lumber extension and 

Management for grade 3 and 4 slip

  • Symptomatic management
  • Should avoid contact sports and high speed sports
  • If slip progress, can consider Spinal Fusion 
ref: Brukner and Khan Clinical Sports Medicine