Home Exercise Program for Spondylolysis and Spondylolisthesis

What you are treating

Spondylolysis is a stress fracture in the small bridge of bone at the back of a vertebra, almost always the lowest one in the low back, from repeated arching and twisting in sport. Spondylolisthesis is what can follow when both sides have cracked: the vertebra slips forward a little on the one below. In both, the low back is being pulled into an arch too often and too hard, and the muscles that should hold it flat are not strong enough to stop it.

Two muscle groups drive that arch. Tight hip flexors tip the pelvis forward and pull the low back into an arch every time the child stands or runs. Tight hamstrings are almost universal in spondylolisthesis; they tighten as the body tries to pull the pelvis back, and they make the child walk with stiff knees and a short stride. Stretching both, every day, is as important as any strengthening exercise in this program, and the hamstring stretching is the part families most often skip. Please do not.

The exercise rule for the whole program: nothing that arches the low back. No back extensions, no "superman," no bridges with the back arched, no overhead presses with a swayback, and no backbends until cleared. Everything is done with the pelvis tucked and the spine neutral or slightly flexed. My spondylolysis recovery plan explains the rest from the sport, the brace decision, and how we check healing; this sheet is the exercise detail that goes with it.

Every day, in every phase: the stretches

Hold each for 20 to 30 seconds, 3 to 5 rounds per side, once or twice a day. A pull, not pain. My hamstring and hip flexor printouts show each one with a picture.

• Hamstring stretch, lying down. On the back, a strap or towel around one foot, raise the straight leg until the pull is felt behind the thigh. The low back stays flat on the floor, which is why this version is the right one here: a standing toe-touch arches and rounds the back instead.
• Hamstring stretch, seated on the floor with one leg straight, reaching toward the toes with a flat back, for older teens who do it well.
• Hip flexor stretch, half-kneeling. Back knee on a cushion, tuck the pelvis under first, then shift forward until the front of the kneeling hip pulls. The tuck matters; without it, the stretch just arches the back.
• Knee to chest, one leg then both.
• Child's pose, 30 seconds.
• Calf stretch at a wall, both versions.

Why the hamstrings matter

In spondylolysis the hamstrings are almost always tight; it is one of the first things I check. Stiff hips force the spine to make up the motion in both directions, which is exactly the repeated arching and twisting that stresses the healing pars. Here is why they matter so much: The hamstrings run from the sitting bones at the back of the pelvis to just below the knee. When they are tight, they pull the back of the pelvis down and tuck it under (a posterior pelvic tilt), which flattens the natural inward curve of the low back (the lumbar lordosis). A flat low back then has to round forward every time you bend, sit, or reach, because the hips cannot. Freer hamstrings reverse that chain: the pelvis can tilt forward again, the low back keeps its curve, bending comes from the hips (the hip hinge) instead of the spine, and the pressure inside the discs and the strain on the structures behind them fall. Stretch each hamstring for 20 to 30 seconds, 3 to 5 times, once or twice a day, with the low back kept flat, and roll the back of the thigh on a foam roller first if that helps. The gain comes from the nervous system allowing more length, so it stays only with regular stretching. The full explanation is in my core program for low back pain.

Phase 1: rest the bone and learn the tuck (weeks 0 to 6, or longer in a fresh fracture)

Pain-free work only. Daily.

• Posterior pelvic tilt. Lying on the back with the knees bent, flatten the low back into the floor by tightening the lower belly and tucking the tailbone under. Hold 5 seconds, 15 times. Then learn it sitting and standing. This is the position the whole program is built on.
• Abdominal bracing, 10-second holds, 10 times, without holding the breath.
• Heel slides with the back flat, 10 each side.
• Dead bug, small range, 10 each side, the back pressed down the whole time.
• Clamshells, 2 sets of 15 each side.
• Gluteal squeezes, 5 seconds, 15 times.
• Cat stretch (the rounding half of cat-camel), 10 times. Skip the sagging half.
• Walking, swimming (freestyle and backstroke, not butterfly or breaststroke), and a stationary bike are the allowed cardio.

Phase 2: rebuild (begins when pain-free with daily activities for two weeks, usually weeks 6 to 12)

Four days a week. Keep every exercise in a tucked, neutral spine.

• Curl-up. On the back, one knee bent, hands under the low back, lift the head and shoulders an inch. 5-second holds, 10 times.
• Side plank from the knees, then the feet, 20 to 30 seconds, 3 rounds each side.
• Bird-dog, only as far as the back stays flat, 5-second holds, 10 each side.
• Bridge with a tucked pelvis, hips up only to a straight line, never arched. 2 sets of 10.
• Front plank on the forearms with the pelvis tucked, 20 to 30 seconds, 3 rounds.
• Wall sit with the low back flat on the wall, 30 seconds, 3 rounds.
• Squat to a chair with the back flat, 2 sets of 10.
• Hip hinge with a dowel along the spine, 10 repetitions. Teaches bending from the hips so the back does not.
• Monster walks with a band around the knees, 10 steps each way, 3 rounds.
• Single-leg balance, 30 seconds each side, 3 rounds.
• Walk-jog intervals begin in this phase, on level ground, when cleared.

Phase 3: return to sport (when cleared at a visit)

• Straight-line running first, then cutting, then sport-specific movements at half effort, then full effort, each step pain-free before the next.
• The arching movements of the sport (the back handspring, the serve, the block, the butterfly) are the last to return, and only when the trunk can hold a neutral spine through them. A coach who can look at the technique and reduce the arch is worth the time.
• Keep the stretches daily and the core program three times a week for the rest of the season and beyond. It is the best protection against a recurrence.

Notes for the physical therapist

• Flexion-biased lumbar stabilization for spondylolysis and low-grade isthmic spondylolisthesis: posterior pelvic tilt control, transversus abdominis and multifidus activation, trunk endurance in neutral, gluteal strengthening, with daily hamstring and iliopsoas flexibility work.
• Avoid lumbar extension and loaded rotation until cleared; progress to sport-specific extension control last.
• Watch for the hamstring-tight, flat-back, short-stride gait of a slip; measure popliteal angles and track them.
• Brace use, if prescribed, follows my recovery plan; exercises are done out of the brace unless told otherwise.
• Refer back to me for any leg pain, numbness, or weakness, for pain that is not settling by 8 to 12 weeks, or for a change in gait or posture, which can mean the slip is progressing.

When to call

• Any leg pain, numbness, tingling, or weakness: these are not typical and need a visit.
• Back pain that returns and does not settle with a short step back to the previous phase.
• A change in the way your child walks or stands.
• New trouble controlling the bladder or bowels: go to the nearest emergency room or call 911.

Learn more

OrthoInfo, Spondylolysis and Spondylolisthesis: orthoinfo.aaos.org (opens in a new tab)

My guides to spondylolysis, isthmic spondylolisthesis, the spondylolysis recovery plan, and the hamstring stretching printout.

More for families

OrthoKids · POSNA

POSNA's OrthoKids: illustrated, family-friendly information on this condition.

Open on OrthoKids (opens in a new tab)

Scan for the OrthoKids page

This program is a starting place and a set of suggestions for your child's physical therapist, not a prescription. The therapist will adjust it to the exam and the scans, and return-to-sport dates are decided together at visits, not from this sheet. Stop and call us if an exercise causes sharp back pain or any leg pain.