Sliding vertebrae - stability through targeted movement

May 28

What physiotherapy and occupational therapy can do for spondylolisthesis

A slipped vertebra - medically known as spondylolisthesis - can cause back pain, restricted movement or radiating symptoms. Many sufferers are unsettled when they receive this diagnosis. But the good news is: In the vast majority of cases, a slipped vertebra can be treated well conservatively and without surgery. Pain can be reduced and stability significantly improved with targeted physiotherapy, functional strengthening and everyday occupational therapy.

What is a gliding vertebra?

A slipping vertebra occurs when a vertebral body is displaced forward (rarely backward) relative to the vertebra below it. A distinction is made between:

Congenital forms (often in youth, e.g. due to malformations)
Acquired forms (e.g. due to wear, instability or traumatic stress)

The most common location is the transition between the lumbar spine and the sacrum (L5/S1) .

Typical symptoms:

deep-seated back pain when under stress or standing for long periods
muscular tension in the lumbar region
radiating pain in the buttocks or legs
Feeling of instability in the lower back
In severe cases, neurological symptoms (rare)

Important: Not every slipped vertebra has to cause pain – and not every instability is a case for surgery.

Why exercise is so important

In the past, the treatment for slipped vertebrae was rest, protection, and a brace. Today, we know that targeted exercise improves muscle coordination and significantly reduces symptoms. Functional training stabilizes the spine – without stiffening it.

Aim of conservative therapy:

Build muscular stability in the lumbar-pelvic area
Improve movement control to avoid incorrect loading
Reduce pain through stimulus regulation and sensorimotor training
Cope with everyday stress safely and without putting strain on your back

Physiotherapy – functional stability instead of protective posture

In physiotherapy, spondylolisthesis is not about maximum strength building, but rather about targeted deep stabilization and motor control in everyday life.

Therapeutic focus:

Activation of the deep trunk muscles (especially transversus abdominis, multifidus, pelvic floor)
Training of pelvic and lumbar control during movement (e.g. standing up, lifting, turning)
Avoiding hyperextensions and unfavorable strain
Mobilization of adjacent structures (e.g. hip, thoracic spine) to relieve the lumbar spine
Medical Yoga for conscious movement, breathing and vegetative calming

Guiding principle: Stability comes from controlled movement , not from avoidance.

Occupational therapy – adapting everyday life and regulating stress

Especially when it comes to physical lower back pain , everyday life is often the biggest stress factor. Occupational therapy addresses this: How can I work, move, and live without causing pain—and without limiting myself?

Occupational therapy approaches:

Analysis and adaptation of everyday routines (e.g. bending, lifting, sitting, carrying)
Training back-friendly movement patterns in everyday life and at work
Pacing strategies to reduce stimulus and avoid fatigue
Advice on aids and ergonomic optimization (e.g. workplace, household)
Strengthening self-awareness and movement autonomy

Goal: More stability – not only in the back, but also in the rhythm of life.

Biopsychosocial approach – stability begins in the nervous system

At Hockenholz, we consider back pain not only structurally, but also neurophysiologically, autonomically, and psychosocially . A slipped vertebra can cause physical insecurity—often accompanied by anxiety, protective behavior, or chronic muscle tone.

That’s why we integrate:

Pain education – why a slipped vertebra does not necessarily mean danger
Vegetative regulation through breathing, movement and perception
Resource-oriented training to strengthen self-efficacy
Interdisciplinary collaboration in more complex cases

Conclusion: A slipped vertebra is no reason to panic – but a good reason for targeted exercise

The diagnosis of spondylolisthesis often sounds more dramatic than it actually is. With an individually tailored treatment plan, clear movement goals, and functional daily training, the back can be sustainably stabilized and relieved . Physical and occupational therapy offer an evidence-based, holistic approach – for an active life despite (or even with) a slipped vertebra.

Are you a therapist and would like to deepen your knowledge of functional back therapy?
Discover our advanced training courses for pain physiology, medical yoga and therapeutic movement training at:
www.hockenholz.com/weiterbildungen

Are you affected yourself?
In our practice in Berlin – or via online consultation – we will accompany you empathetically and professionally on your way back to movement.

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Florian Hockenholz https://www.hockenholz.com