Written by Ansu Susan Kuriakose, BPT · Clinically reviewed by Jasmal K, BPT, MPT · Last reviewed 5 October 2026
Spondylolisthesis (listhesis): what a slipped vertebra means and how it's treated
If your X-ray or MRI report mentions "spondylolisthesis" or "listhesis," it means one of the bones in your spine has slipped forward over the one below. That can sound frightening. But most slips are mild, and most people with spondylolisthesis who don't have nerve problems do well with non-surgical care.
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What is spondylolisthesis?
Spondylolisthesis is when one vertebra (spine bone) slides forward over the one below it. It's most common in the lower back, often at the L4-L5 or L5-S1 levels.
The two most common types are:
- Degenerative spondylolisthesis: caused by age-related changes in the discs and joints, usually after age 50.
- Isthmic spondylolisthesis: caused by a small defect or stress fracture in part of the vertebra, which often starts at a younger age.
Grades. Slips are graded by how far the vertebra has moved. Grade 1 is the mildest. Higher grades mean a bigger slip.
Symptoms
Some people have no symptoms at all. Others notice:
- lower back pain, often worse with standing, walking or bending backwards
- stiffness or tight hamstrings (the muscles at the back of your thighs)
- pain, numbness or tingling spreading into the buttocks or legs (sciatica)
- leg pain or heaviness when walking that eases when you sit or bend forward, if the slip narrows the spinal canal (spinal stenosis)
When it's an emergency
How it's diagnosed
At your Maana Spine assessment, your physiotherapist takes your history, checks how your back moves, tests the strength, sensation and reflexes in your legs, and reviews any MRI, X-ray or lab reports you bring. Spondylolisthesis is usually seen on X-rays taken from the side while you stand, and MRI shows whether nerves are affected.
You'll get a physiotherapy diagnosis and a personalised plan. You don't need a scan to book; if one would help, your physiotherapist will recommend an MRI or X-ray.
How we treat spondylolisthesis at Maana Spine
Treatment follows Maana Spine DTX™, our personalised, non-surgical Precision Spine Care program. For spondylolisthesis, your physiotherapist chooses the right therapies for the grade of your slip, its stage and your symptoms.
Assess: we review the grade of your slip, your symptoms and your nerve function, and rule out red flags.
Decompress or PST: for a grade 1 slip, computer-controlled spinal decompression using US FDA 510(k)-cleared technology may be part of your plan, depending on your symptoms and stage. Otherwise, your physiotherapist may use pulsed signal therapy (PST), a CE-marked treatment, instead.
Restore: gentle mobility work and physiotherapist-led stretching, including for tight hamstrings.
Strengthen: our four-level exercise roadmap (Level 1 Restore, Level 2 Stabilise, Level 3 Strengthen, Level 4 Maintain), with a focus on the deep muscles that stabilise your spine.
Empower: how to move, lift and stay active in ways that protect your spine, with written and app-based home exercise programmes.
Maintain: in-person follow-up at 1, 3, 6 and 12 months. The 1- and 3-month follow-ups are included in your program fee; the 6- and 12-month reviews are charged separately.
A DTX program is typically 15 to 25 sessions of 60 to 75 minutes each, usually with the same physiotherapist throughout.
What the research says
Most people do well without surgery. Reviews of degenerative spondylolisthesis report that most people with symptoms but no nerve damage do better with non-surgical treatment. People with nerve-related symptoms, such as weakness or worsening walking problems, are more likely to get worse without surgery.
Will my slip get worse? In long-term studies of both degenerative and isthmic spondylolisthesis, the slip progressed in about a third of people.
Exercise. A 2021 Cochrane review found moderate-certainty evidence that exercise probably reduces pain in long-lasting low back pain. It wasn't specific to spondylolisthesis, but structured exercise is central to non-surgical care for slips.
PST. PST is a type of pulsed electromagnetic field (PEMF) therapy. A 2022 review found PEMF reduced long-lasting low back pain more than placebo or other treatments alone, though it didn't improve physical function. These studies used a range of PEMF devices, not necessarily PST, and didn't focus on spondylolisthesis.
Decompression. Using decompression for grade 1 slips reflects our clinical experience. None of the decompression trials we've reviewed studied people with spondylolisthesis specifically.
When spondylolisthesis may need surgery
Surgery is usually considered if you have worsening nerve symptoms such as weakness, severe pain that hasn't improved with a good trial of non-surgical care, or significant instability in the spine. Surgery stays available, and if your assessment suggests you should see a surgeon, we'll tell you honestly.
Living with spondylolisthesis: practical tips
- Keep active. Walking, and the exercises from your programme, help more than rest.
- Be careful with backward bending. Movements that arch your back often aggravate symptoms. Your physiotherapist will tell you what suits you.
- Build core strength gradually. Stronger deep muscles help support your spine.
- Ask before returning to sport. If you play sport, especially one involving repeated backward bending, check with your physiotherapist first.
These are general tips, not a substitute for an assessment.
When to book a spine assessment
Book an assessment if you've been told you have spondylolisthesis, or if back or leg pain has lasted more than a few weeks, keeps coming back, or limits your daily life. Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.
Book a Spine Assessment · or call or WhatsApp +91 99950 09403
What patients say
I was suffering from lower back pain that radiated down my leg. The treatment I received at Maana Health was very effective. The therapies and excellent care helped reduce my pain and made it easier for me to return to my normal daily activities.
Steven B.Spondylolisthesis
Shared with each patient's written consent. These are individual experiences; results vary.
Frequently asked questions
Is grade 1 spondylolisthesis serious?
Grade 1 is the mildest grade. Many people with a grade 1 slip manage well with non-surgical treatment. It needs urgent attention only if it comes with warning signs such as numbness around your genitals or bottom, bladder or bowel changes, or worsening leg weakness.
Can spondylolisthesis be treated without surgery?
Often, yes. Reviews report that most people with symptoms but no nerve damage do better with non-surgical treatment. Surgery is considered for worsening nerve symptoms, severe pain that hasn't improved, or significant instability.
Can spinal decompression be used for spondylolisthesis?
At Maana Spine, decompression may be used for a grade 1 slip, depending on your symptoms and stage. Otherwise, your physiotherapist may use pulsed signal therapy (PST). This reflects our clinical experience; decompression research hasn't specifically studied spondylolisthesis.
Can the slipped vertebra go back into place?
Non-surgical treatment doesn't move the vertebra back into place. It aims to reduce pain, improve how your spine moves and strengthen the muscles that support it.
What exercises are good for spondylolisthesis?
Exercises that strengthen the deep core muscles, plus stretches for tight hamstrings, help many people. Your physiotherapist will choose exercises to suit your slip and symptoms.
Will my spondylolisthesis get worse?
In long-term studies, the slip progressed in about a third of people. Get reassessed if your symptoms change, and seek emergency help for the warning signs on this page.
What's the difference between spondylolisthesis and spondylosis?
Spondylosis is general age-related wear in the spine. Spondylolisthesis is when one vertebra slips forward over another.
References
- Degenerative spondylolisthesis: a narrative review. 2022. pubmed.ncbi.nlm.nih.gov/35075090
- Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurgery Clinics of North America, 2019;30(3):299–304.
- Natural history of lumbar spondylolisthesis. Neurosurgery Clinics of North America, 2025. neurosurgery.theclinics.com00070-1/abstract)
- Surgical and non-surgical management of spondylolisthesis: a comprehensive review. ncbi.nlm.nih.gov/pmc/articles/PMC12022737
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021. doi.org/10.1002/14651858.CD009790.pub2
- Sun X, Huang L, Wang L, et al. Efficacy of pulsed electromagnetic field on pain and physical function in patients with low back pain: a systematic review and meta-analysis. Clinical Rehabilitation, 2022;36(5):636–649. pubmed.ncbi.nlm.nih.gov/35077249