Not All Spondys Are The Same

When first diagnosed with either spondylolisthesis or spondylolysis, all the information available can be overwhelming. From the beginning stages, such as symptoms and causes, to later stages such as solutions, pain management and therapy, it can be very easy to get lost with information overload.

During all of this confusion, patients often overlook one important fact: spondylolisthesis or spondylolysis are unlike most other conditions. Spondys are unique and the term “spondy” is simply a general term that has several layers to consider.

For example:

  • You could have a spondylolisthesis or a spondylolysis.
  • If you have a spondylolisthesis, there are multiple categories of grades.
  • If you have a spondylolysis, there are several causes that may have lead to your diagnosis.
  • You could have one of several different types of spondylolisthesis.
  • Your pain levels and severity of the condition can be affected by various factors such as age, injury, activity levels, etc.
  • You could have accompanying issues or conditions that may affect your spondy. These conditions may involve the vertebral discs, nerve impingements, or a multitude of other conditions of the spine, nervous or muscular system.

Unlike most conditions, there is no perfectly set path for doctors and therapists to follow for the recovery process. Yes, the first steps are to get examined and to have an x-ray and/or MRI to determine the exact diagnosis. That is usually followed by therapy, chiropractic treatment, massage, etc. (in severe cases surgery), but due to these various factors mentioned earlier, it is very hard to set an EXACT path to recovery that works for each patient.

Having a spondy is not like having a broken arm. The road to recovery involves more than cast and rest. Spondys are much more complex.

This often leads to trial and error by the team that is leading the recovery charge. It may involve attempts at therapy, massage, dry needling, chiropractic care or other forms of treatment before finding a successful recovery method.


Massage is one of many different forms of treatment used in an attempt to give spondy patients relief from pain.

Whatever the form of therapy chosen, the outcome is usually one of four things:

  1. The pain becomes worse.

  2. No relief is found and the pain remains the same.

  3. Short term relief is found, but the pain soon returns.

  4. Long-term relief is found and the ability to manage and control the condition is improved.

Unfortunately, #4 (the most desirable outcome) is one of the least common results. In fact, 3 of these 4 outcomes are not successful and arguably the most common among patients. If we take a closer look at these 3 results that occur so often we notice a few things:

  • #1. If the pain becomes worse, the form of therapy or care that was used is often frowned upon and avoided. A majority of the time if the pain becomes worse, the cause of the pain becoming worse is often ignored; instead the activity or action as a whole is avoided. An example would be performing a certain exercise. If that exercise caused pain or discomfort, it is often eliminated completely from the recovery plan. The patient believes that exercise gave them pain and they should never attempt it again. But what if the cause of the pain was due to a movement-related issue such as tight hips that did not allow for the full and proper range of motion and correct exercise technique? What if fixing or improving the range of motion would allow the individual to complete the exercise with no compensations and thus free of pain? Often this is never being examined.
  • #2. If no relief is found, then the method(s) taken to determine this result are usually eliminated from the recovery process in search of a fast answer (this could simply be a result of an inexperienced physical therapist, chiropractor or massage therapist). In today’s world we have ever changing health care plans and people wanting quick results. If pain is not managed fast, practioners are sometimes too quick to move on to something else. The outcome may lead to the patient thinking, “Oh, I have already tried that and it didn’t work.”
  • #3. If short-term relief is found, yet pain returns, then the patient is soon visiting the doctor again and the cycle begins all over. This could be due to the poor movement or the patient returning to bad movement habits. Reducing inflammation is a prime example. One common cause of pain is inflammation. It may be inflammation of the surrounding tissues or other areas involved. If the practitioner is able to reduce the swelling, the patient has the perceived notion that all is well. If bad movement habits such as long hours behind a desk or impact sports are the culprits and contributing to the condition, then the inflammation is soon to return.

These examples show how finding relief from your spondy can be difficult. They also show you why failed therapy is so common. Because now not only do you need to find a therapy approach that is right for you as an individual, you need to find someone who has experience, knowledge and expertise in their field.

What many do not take into affect is that not all spondys are the same. These differences are what we mentioned earlier (type of spondy, grade of spondy, lifestyle factors, other conditions, etc.)

Another common problem occurs when patients go searching on the internet for answers and they do not take these factors into consideration.

Remember this: Just because you have a spondy, does not mean you are the same as everyone else who has a spondy. It is a must that these previously mentioned factors are taken into consideration during your search for a proper therapy recovery plan.

Bridge Finish

Just because a certain exercise works for some, that does not mean it will work for everyone.

Unfortunately, spondy patients are often lumped into one group. That one group tends to follow what others say works or does not work. But just because something helps someone else, doesn’t mean it will help you, and just because something did not help someone else doesn’t mean it will not help you.

So before you rule out therapy, massage, dry needling and other forms of non-surgical spondy treatment because someone else said it did not work, keep this post in mind. Focus on what your specific spondy situation involves and search for someone who will work with you as an individual to determine exactly what you need.

If you have questions or comments about the differences in spondys, please comment below. We encourage all questions, so don’t be shy!

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Leave A Reply (28 comments so far)

  1. Josephine Sustek
    4 years ago

    My MRI showed of course the grade one spondylothesis, complete loss of disk space L4 L5 and S1,Also a central spinal stenosis.I was wondering about traction, and or laser acupuncture..My MD just read me the report over the phone, and said I need to see a spinal surgeon, not ready for that. My chiropractor took the time to explain in detail everything on the MRI, and has my pain under control. Just wondering about traction the most from a pt stand point. Thank you

    • Spondy
      4 years ago

      Great question Josephine.

      I think the most important statement you made is that your pain is under control. I hope that means that any other symptoms are also under control (i.e., numbness, pins and needles, muscle weakness due to nerve compression) and there are no bowel or bladder issues due to the central stenosis. If these are true, then you do not have any emergent needs for more invasive procedures such as surgery – the spine surgeon may state the same thing. (As always, it is suggested to seek multiple opinions when the need for surgery is in question)

      As far as continuing conservative management of your symptoms, there isn’t any one method that will work for all people. Some methods have better track records than others in general, but in my opinion it is sometimes the talent / knowledge of the practitioner that produces successful outcomes when using various methods.

      I’m specifically referring to the use of traction. The research to date shows poor overall results with traction. My brief attempts at using it have not been worthwhile in my practice, but I must also state I haven’t put any effort into advanced training concepts in using traction. However, some practitioners swear by it, and may have developed an effective protocol that has not yet been put through the rigors of research. Keep in mind, that research articles typically describe the use of a modality like traction in very specific terms, and a practitioner may be utilizing traction by different terms and therefore getting different results.

      In my opinion, a mixture of treatment modalities is probably best when it comes to resolving pain complaints with a complex history. Degeneration at the discs (the loss of disc space you mentioned) means your treatment will likely fit into this “complex” category. Traction alone, or laser acupuncture alone, or any treatment modality used alone will likely be ineffective. But a knowledgeable practitioner who utilizes these in addition to other treatment methods to restore healthy movement patterns may be your answer.

  2. Andrew Marks
    3 years ago

    Hi Justin, i to have spondy at grade l4 l5 with central stenosis. The symptons which can really annoy, and I’m guessing emanating from stenosis are the twinges, small spasms muscle twitching at sides and hips. Prescribed 2mg diazapam, but also inquisitive as to what other folk do to elevate these symptons. In the main I’m pain free except the spikes and spasms,! I read your comments around training athletes in the gym, so assume you are for general weight training providing it makes sense to the individual. Big believer in stretching as this has pretty much made my sciatica disappear over the last few months.

    • Spondy
      3 years ago

      Hi Andrew. It is really hard to tell in regards to your small spasms and twitching, but this MAY be emanating from some kind of asymmetry or muscular imbalance that you have present. Many times the stenosis causes nerve irritation and radiating pain in the legs,ankles, and feet. This is not to say that the stenosis may be leading to these small spasms and twinges, but I would recommend seeking out some kind of screening method by a professional to help determine if you have any movement issues present that may be contributing to these. (Check out the SFMA or FMS certifications we recommend looking for on our spondy toolbox page by clicking the link on the navigation bar at the top of the page). I would look for someone close to you that is certified in the SFMA. That is our screening method of choice and best for someone experiencing pain and discomfort.

      I am a big believer of general weight training and stretching due to my background. But first and foremost you need to have a solid platform to build upon. Just like a house! We would always screen our athletes BEFORE any kind of weight training or stretching to help determine exactly what their weaknesses consisted of so we knew what to focus on. Basically, the same recommendation I am providing you with. Thanks for the post and best of luck! Please stay in touch with your improvement progress.

  3. Andrew Marks
    3 years ago

    Well done Justin, not sure how you find the time to seek solutions to folks ongoing probs, but you need to be congratulated on your website. So far I have had 2 consultations with spinal surgeons and they simply do not get it do they! Just a small amount of time reading and adapting the info on your site and people can be informed, in control and thus make a choice. That is def not the case post surgeon speak re spondy or stenosis, well at least not in the UK in my quest for knowledge so far keeps me retuning to your site,so thanks and keep up the good work.

    • Spondy
      3 years ago

      Thanks so much for the kind words Andrew. I hope others can read your information and gain some insight. Keep your head up and keep learning! Best of luck in your continued battle and stay in touch with your improvement stories!

  4. kalyan dasgupta
    3 years ago

    i have read one topic about herniated disc repair from outside with some injection, one of the component is omega 3 fatty acid.
    any way expecting more reserch going on how sondy can be treated successfully with external use in near future.
    unfortunately i am from INDIA not so advance in hitech treatment.
    some thing to say about the comment of mark, benzo like diazepam is addictive he wud have to tapper off gradually or switch over to other benzo(me not technical how ever).
    in my case also one of the benzo works better than any pain killer but i am afraid how long sud i continue it.

    • SpondyInfo
      3 years ago

      I will keep my eyes peeled for more research on this injection Kalyan. Thanks for the post.

  5. Debbie
    3 years ago

    I stumbled upon your website by searching on you tube. I was looking for exercises for Spondy. I seen you had a video there. Went to your website. You have lots of info. Spine doc and surgeon want me to get surgery. I have grade 1 spondy with some stenosis. Surgery is very last on my list. I’ve heard too many people getting surgery, then having to get repeated surgery to fix the first surgery. I enjoyed your article today. Not all spondy patients are the same. BUT that’s how we are treated. I’m trying to find ways to improve all this. I’m not in a lot of pain. I do have the symptoms of leg pain, hamstring pulling when its really cold or humid. I’m looking for ways that I can move more. So glad I’ve found your web page.

    • SpondyInfo
      3 years ago

      Hi Debbie. Thanks for finding the site. You are correct and it is unfortunate. Most people who are trying to help treat this condition as if everyone is the same. The battle is finding someone who understands and cares. If you are new to the site I encourage you to check out this article:

      I also encourage you to look around, read the reader comments and interact with questions and comments. Thanks again!

  6. Gaye Stewart
    2 years ago

    Hello. Reading these comments has made me realises that the actions I’ve taken over the past 12 months have been right for me. My GP was interested in my symptoms, pain & having very little faith in the NHS re backache treatment I sought help elsewhere.
    I was lucky & have found a chiropractor who is also a radiographer. After X-rays diagnosed with a L3 / L4 slippage & L5 degenerative disc.
    I already knew I had severe degeneration behind my patella’s & I’ve had bilateral bunion surgery in 2007/8. He told me I had a twisted pelvis. I’d been looking for solutions re foot wear since my ops & having had bio mechanical assessments was told to but shoes with rocker soles. It took several years searching then Shoe Med in Stratford upon Avon opened. They specialise in feet problems. I now buy mainly Finn Comfort shoes & pay to have rocker soles put on all my shoes. Also I have had bespoke orthotics made. My left leg was 1.5″ shorter than my right leg. Since having the orthotics in December 2014 I’ve had relatively no pain in my knees & the haven’t given way either. I’m 60, over weight & sit at a desk all day. I started treatment with chiropractor when my back completely ‘went’ & pain was excruciating & walking almost impossible. I was off work for 10 weeks & had treatment twice a week & walked everyday (10 minute walk took 40 mins & needed walking stick). Last week I did an aqua class & will be having 12 weeks of personal training, weight & stretching with a very qualified PT at a Nuffield gym beginning of September.
    So sorry if this is long winded but I’ve had symptoms of spondy since my teens, bunion from I was 11yrs old painful knees for 40yrs. Numerous visits to GP, orthopaedic surgeons, chiropodist a since my teens. All these professionals are so blinkered none of them joined up the dots. Spondy is insidious, makes you feel out of sort for decades & in my experience all the NHS wants to do is chuck tablets or surgery at it. These will all cripple or kill you quicker than looking for alternatives.
    This website is right in abdicating stretching & exercise.
    Obviously I still have pain & I still go to my chiro every 3 weeks. But I’ve got through the last year with minimal pain killers (I’ve had too many over the years & have had 2 nasty internal bleeds). I am also starting to move better. Not walking very far but last week spent 8 hours at the Shewsbury
    A flower show & not in a wheelchair. Which is what GP & others have predicted I’d need by 50!

    • SpondyInfo
      2 years ago

      Thanks so much for sharing your story Gaye! It really sounds like you are on the right path and I hope experience improvement in how you feel. Keep the positive mind frame, keep pushing forward and always feel free to post any experiences you go through along the way. Best of luck!

  7. Lisa michelson
    2 years ago

    Hi, thanks for email… Only question I have is who would I contact to help with an excercise and stretching program for me? A PT or someone else? Thanks

  8. Roxie
    2 years ago

    I’m waiting for the results of my MRI and referral to a Spinal Surgeon! I’ve found out a lot by researching Spondy myself but your news letters have provided even more clear and concise information! Thanks – after all – it’s spines we’re talking about!

    • SpondyInfo
      2 years ago

      No problem Roxie…Best of luck!

  9. Sherry
    2 years ago

    Hello, I haven’t seen my MRI report but, my doctor said my neck is the worst he has ever seen. He told me my neck is the worst he has ever seen and that every single disk is bulging and he wants to do two surgery’s to take out four or five disk and fuse my neck leaving me with 20 to 30% range of motion . the first surgery he’ll go through the front of my neck and the second surgery he’ll go through the back of my neck. Right now I get pins and needles down my left arm and my thumb feels like I pulled all the muscles in it and I have lost most of my control of my bladder; I get head aches everyday with pain in my face,jaw and ears also. But, I scared to death to have this surgery and I don’t understand why I’m so scared because I have had many other surgery’s and haven’t ever been scared of any of them. i guess it may be because I don’t have as much information about what is all going on with my neck. I don’t know what to do I’m feeling lost.

    • SpondyInfo
      2 years ago

      Hi Sherry.

      I understand your fear. Anytime the neck and spine are combined with the word surgery we all get worried. Its natural because we all know just how important these areas are.

      My recommendation would be to seek out a few other opinions. Just because one doctor came to this conclusion does not mean others will. With a decision as big as surgery you owe it to yourself to research ALL options. Search around your area for other docs and compile a list of questions to ask them. Weight the results and use that info to help you make the best decision you can. Best of luck!

  10. Aisha Dixon
    1 year ago

    Thank you for this article. It pretty much sums up my last 4 years since diagnosis.

    I remember at the beginning thinking acupuncture would fix this and it did for about 2 nights and then I was woken up in staggering pain. Then trying to reduce pain killers and finding myself in unmanageable positions- crying in pain at work for example. Learning that sitting is no longer comfy – changing jobs for a position that had more dynamic movements. Finding that squats almost impossible. Physio, chiro, sleeping on my stomach and drugs have been my number 3. it’s been quite the journey navigating by the altitudes of pain. It’s hard to find information about it and it’s difficult to explain it to.

    • SpondyInfo
      1 year ago

      No problem Aisha! I hope you have found the information and site helpful. I understand your pain and frustration. This condition can be a real rollercoaster both mentally and physically. One thing I would encourage you to do is to keep a journal of what helps and what makes your pain worse. It is the best way to eliminate and reduce what causes pain and discomfort while at the same time you can add or keep doing what helps with the pain. Thanks for commenting!

  11. Chuck
    1 year ago

    Can spondylolisthesis be reduced?…Mine was x-rayed after some trauma and mis-diagnose SI condition…Doing the wrong stretches..Borderline 1-2. Some disc space…Can it be reduced to lower grade through andy therapy or technique?

    • SpondyInfo
      1 year ago

      Good question Chuck. As far as I know there are no non-surgical methods available that can reduce the grade. If you have a spondylolysis (fracture with no slip) and catch it early enough, the spot can heal. However, once the slip occurs there is no going back. I am in the process of researching this more for my next blog post. So hopefully I can provide you with a better, more detailed answer once I gather more information and resources. Thanks!

  12. wrsides
    11 months ago

    My Profile Jan 2016

    male,71 yr. , regularly work-out and active outdoors(favorite hobbies: golf, fishing, aerobics, and swimming. Jan 2016 hit the wall when I changed my golf swing. Intermittent pain in my left glut, left oblique muscle combined with RLS that wakes me up almost every night. I had surgery last June 2016 -Bilateral microdecompression of low back L4-5 with laminectomy and foraminotomy. Unfortunately I still battle the same lo back symtoms.
    Mision #1: Appt. with my Sports Dr…and awaiting his reply to your Doctor Spondy Questionnaire.
    Briefly he mentioned that have compensating issues with my lo back;
    1.October 2016 follow-up analysis from Surgeon: Previous noted issues of L3-L4 show significant improvement of the central canal and the lateral recess stenosis; plus no lateral disc protrusion and improved left neutral foramen.
    2. SPONDY @L4-L5…5cm…considered Stage I..( good news??)
    A. MRI noted: Severe facet arthrosis is associated with 5mm anterolistthesis of L4 on L5. Mild stenosis of the left lateral recess and moderate to severe stenosis of the right lateral recess. Foramina are moderately stenosed.
    B.MRI-continue..At L5-S1 moderate to severe facet arthrosis. No bulge. the right neural foramen is moderately stenosed
    Positively speaking, I also made an appointment with a local (thank goodness) practitioner of SFMA
    to more completely understand my current status (weaknesses) and form a plan to “Rehabilitate myself”.

    I welcome your thoughts, advise and insights.


    • SpondyInfo
      11 months ago

      Hello Wrsides,

      Thanks for the information. It sounds like you are taking some great steps to put yourself in the best position possible to improve how you move and feel. Unfortunately I have seen this so many times before. Patients who have surgery and the symptoms of pain quickly return. Please realize that I cannot make any statements that should be taken as the absolute. I can only make broad comments based on what I have seen. Each case is unique and your specific issues could be from a multitude of things. Your doctors should be the go-to for exact and accurate answers.

      With that being said often times those who are having pains and discomforts caused by movement related issues opt for surgery without focusing on the movement or dysfunctions that may have lead to the extra stress and strain on the back. Sometimes poor movement and dysfunctions force the body into compensations that put the stress on the low back (leading to pain). The surgery addresses the area of the back that has taken on the brunt of the forces, but it fails to address the possible cause. After surgery, the poor movement and dysfunctions continue and the pain sometimes returns. There could be several possible causes, too many to guess because I simply do not know enough about you. One guess would be the new golf swing. Perhaps you have some restrictions, tightness or weakness issues in your hips, core and glutes that make achieving certain positions in the golf swing very hard. Instead, your body compensates to achieve these positions, but it does so at the cost of putting stress and strain on your back. Perhaps leading to nerve compression, disc issues, etc.

      Again, this is just a generalized statement and not what I think is going on with you, but it is a possibility.

      You are taking the right steps. Your SFMA appointment will go along way to help you discover possible movement issues that may be contributing to your pain. Make sure to discuss with the practitioner about this and make sure to mention your history and how you believe improper movement patterns, etc may be contributing to your pain. Also, make sure to mention this new golf swing. Hopefully they will be able to provide you with some direction from there.

      Please keep me informed on your appointment and progress. Best of luck!

  13. margaret barnes
    10 months ago

    how do I find out what grade of spondylolisthesis I have?

    • SpondyInfo
      10 months ago

      Hi Margaret. The best and most effective way is to ask your doctor. If you have had any testing done in the form of MRI or bone scans the doctor can take a look and measure just how severe the slip is. Here is some more information on Spondylolisthesis grades you may find helpful:

  14. Patti Moon
    9 months ago

    Hey there- I just wanted to thank you for having this information available to the public. I am an athlete and injured my back training for a Spartan Race and not listening to my body. I had this “go big or go home” mentality which led me into spondylothesis L3/L4 Grade 1/2. I’ve never been injured like this before and being a young woman (45) and fit – it has been humbling and a good learning experience.

    The biggest help has been being given accurate information I can use to take to my doctor but also feeling like I’m not alone. I feel like my docs are used to couch potatoes, etc. and I’m not given straight answers. Not one PT or doc has evaluated me for what movements may work for me, etc.

    I’m not going to sit on the couch and give up. I’m going to look at this injury like a gift so that I can educate and empower others. I’m a Registered Dietitian and see sick patients every day. Maybe I can focus on giving a little more sympathy and empowerment now, too:)

    • SpondyInfo
      9 months ago

      Hi Patti. Thanks for finding the site. I love your attitude and it will go a long way in helping you move and feel better. Feel free to share any dietary tips you may have that you feel can help other spondy patients along the way. I hope you continue to find the site helpful. Best of luck!

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