Can I Exercise with Spondylolisthesis and Stenosis?

I am ACSM personal trainer and have a possible new client with spondylolisthesis and stenosis. Could you please advise me on how this condition is affected by exercise and what restrictions are necessary?

Spondylolisthesis is a condition where one vertebra slips forward over an adjacent vertebra. It typically occurs in the lumbar spine and is the result of an injury to, or degeneration of, one or both of the facet joints of the bone. Facet joints help support the weight of the spine and control movement (extension, flexion, and twisting). Symptoms of spondylolisthesis, although not present in everyone (it depends on the degree of slippage), can include pain in the low back, thighs, or legs. Pain is due to (1) inflammation of the facet joint itself or (2) compression or impingement of, or shear forces on, the disc. The condition is also associated with muscle spasms, weakness, and tightness (low back and hamstrings).

Exercises that emphasize proper body mechanics and stabilize the spine during movements like flexion and extension, and stretches for the low back and hamstrings, should be prescribed. Pelvic tilts, abdominal crunches with legs on a chair, leg raises (with knees bent and abdominal muscles contracted the bent knee is lifted), and gluteal, piriformis, and hamstring stretches can all be helpful. Proper ergonomics while seated at a desk, proper posture while standing, and safe lifting technique should all be taught. Exercises to avoid are forward bending without the knees bent and abdominals tight, bending forward while twisting, and any other movement that causes pain. Exercises should be individualized depending on the symptoms, type, and grade of spondylolisthesis.

No exercises should be performed if the individual is symptomatic, and exercises that cause pain should be stopped immediately. You should speak with your client's doctor before you prescribe any exercises, and I recommend that you become familiar with the anatomy and biomechanics of the injury, as well as the effects of different exercises on the spine. I also recommend The Back Pain Helpbook by James Moore.