Chiropractic care is a nonsurgical treatment option for pain commonly assumed to be caused by spondylolisthesis (a forward slippage of a vertebra). If you have spondylolisthesis, chiropractic care may help reduce your back pain because, in most cases, spondylolisthesis isn’t the cause of pain—rather you have mechanical back pain, which chiropractors treat quite effectively.

How does a Chiropractor diagnose spondylolisthesis?
Chiropractors evaluate the spine as a whole—regardless of whether you complain of chronic low back pain or other spondylolisthesis-related symptoms. The entire spine is evaluated because even though your low back hurts, other regions of the spine may be affected too.

During your chiropractic evaluation:

• An extensive history (eg, medical history) is taken, and the chiropractor performs a comprehensive examination.

• An x-ray may not be needed, as an x-ray does not really help to determine the treatment, except in a patient who is unresponsive to conservative management.

• The chiropractor determines the areas with restricted joint motion, disc injury, muscle spasm, and/or ligament injury. He or she can do this through techniques called motion and static palpation, which is an examination by touch. The chiropractor feels for tightness, tenderness, and how well each of the spine's joints can move.

• Observes how you walk (“gait”), your overall posture and spinal alignment. This helps your chiropractor understand your body mechanics and how well your spine is working and moving.

• Determines the stability of the spondylolisthesis. In rare cases, it may be necessary to order special imaging tests, such as MRI or bone scan.

• Some patients with spondylolisthesis need a referral to a spine surgeon for further evaluation.

Goals of Chiropractic Care
The main goals of chiropractic care in the treatment of spondylolisthesis include:

• Optimize good spinal mechanics
• Improve posture
• Improve spinal function

Chiropractors do not reduce the slippage of spondylolisthesis. Instead, they address the spinal joints above and below the slipped vertebra—helping to address the mechanical and neurological causes of the pain, not the spondylolisthesis. This can help relieve low back pain and improve motion in the region.

Chiropractic Treatments for Spondylolisthesis
Your treatment plan depends on your symptoms. Your chiropractor may use one of the different types of spinal manipulation (also referred to as a “spinal adjustment”)—active, hands-on techniques that help restore spinal motion—to improve joint motion. Spinal manipulation techniques your chiropractor may use include:

• Specific spinal manipulation identifies the joints that are restricted or those that show abnormal motion. A gentle thrusting technique that helps to return motion to the joint by stretching the soft tissues and stimulating the nervous system.
• Flexion-distraction technique is a gentle, non-thrusting type of manipulation usually used for degenerative disc conditions and facet strain that may be related to spondylolisthesis. This treatment is hands-on and uses a specialized table to assist the chiropractor—but instead of direct force, it’s a slow pumping action.
• Instrument-assisted manipulation is another non-thrusting technique. With this technique, the chiropractor applies force using a hand-held instrument without thrusting into the spine.

Your chiropractor may also use manual therapies in addition to spinal manipulation to treat injured soft tissues, such as muscles.

• Trigger point therapy helps the chiropractor identify specific hypertonic (tight), painful points on a muscle. He or she puts pressure (using his or her fingers) on these points to reduce the tension.
• Manual joint stretching and resistance techniques, such as muscle energy therapy, can be used.
• Instrument-assisted soft tissue therapy can help treat injured soft tissue of the spine.

Although your chiropractor will use various techniques to help you increase daily activities, chiropractors emphasize prevention as the key to overall health. Your chiropractor can’t reduce the grade of spondylolisthesis, but he or she will work to address any underlying mechanical or neurological causes of your symptoms.