Spondylolisthesis Stretch For Back Pain & Sciatica Relief

Spondylolisthesis, the forward slippage of one vertebra on another, could be considered a more severe cause of lower back pain and sciatica. While there are details on causes we have covered elsewhere, today we’re going to dive into one of the biggest challenges that those with spondylolisthesis in the lower back face, and offer one stretch, with some explanation and guidance to help take pressure of the low back, ease tension and reduce strain on the discs.

The big challenge with spondylolisthesis.

Most with a spondylolisthesis are graded from 0 to 2, the more minor variations, and while the top grades of 3 and 4 do happen, they are thankfully much less common. Grading 0 to 2 simply means that the one vertebral body for example, the L5 on the S1 has moved forwards by 50%, with grade one being 25%. The movement that provokes this forward slip is an extension which most are clearly instructed to avoid. 

Mechanistically, forcing more backward bending in the low back through a cobra, especially in the shorter term is something most are instructed to avoid. However, instruction on flexion, forward bending is often not given. As such most will routinely round the low back to make the spaces where the nerves come out of the spine larger, and thus “relieve pressure”. Which can provide quite quick relief even if only short term. 

The problem with this is that it unfortunately aggravates the other aspect of the issue not spoken of. When the vertebra shifts forwards the efficiency of the disc to bear load is going to be impaired relative to the normal alignment of the lower back. And so the disc is frequently the source of a lot of the discomfort that those with spondylolisthesis suffer. And through this constant aggravation of the disc with practices such as hugging the knees or curling into a ball, it can make it difficult to get momentum with your rehab…

So if you cannot bend forwards and shouldn’t bend backwards, what do you do?! We’ll clarify this a little later but now for the stretch that will help you!

The best stretch for spondylolisthesis

We talk about the towel stretch, this stretch is a way to GENTLY support the natural neutral position of the lumbar spine, whilst creating a small amount of elongation of the spine, meaning offloading of the discs in the lower back.

How to do the towel stretch

• Roll a towel the size of a normal foam roller, about 3-4 inches in diameter
• Lie on your back with knees bent, feet on the floor
• Brace your core and lift your bum off the floor
• Slide the towel into the space below your low back, where the arch is
• Slowly lower yourself back over the towel
• You should feel the towel gently pressing into the lower back
• KEEP YOUR KNEES BENT and relax into the position
• After 20 seconds to 5 minutes, roll off to the side, WITHOUT twisting your spine.

Question: But isn’t the towel stretch doing extension I should avoid?

This is a very valid question that many have, however there are a couple of considerations that make this VERY different to doing a pure extension movement that you would want to avoid, such as the cobra.

Gently supporting neutral is not the same as extending the spine

The towel is there to support the natural curve, i.e. the lower back should have a smooth arch to it, the towel is simply, and broadly supporting the curve through the entire lumbar spine, as opposed to the cobra which tends to focus extension, meaning an increase in the natural curve beyond the neutral position.

The towel is not pressing solely on the L5/S1 or segment with spondylolisthesis

We might be concerned if using a sharper pivot point pressing directy, and only on the back of the L5 vertebra to push it forwards. The towel DOES NOT DO THIS. Instead the towel supports, generally from S1 through to about L3 (L3,L4,L5,S1) and does not “poke” L5 forwards. (or L4 if you have an L4/L5 spondylolisthesis.

Why is the towel stretch so effective for spondylolisthesis?

The great thing about the towel stretch is firstly its gentle nature. It supports this natural arch whilst also creating a little decompression of the vertebral discs. It takes the “tension” off the Lumbar muscles and ligaments too by resting the spine in its natural position. It also meets a need for being able to do something to relieve the strain that builds up in a spine where you really want to avoid the forward or backward bending in the extreme. 

The towel is also very versatile, from experience with our patients, when you begin it can be uncomfortable for many (spondylolisthesis or not), but modifications are possible in a number of ways. Firstly, you can adjust to a larger or smaller towel than the standard size mentioned above, simply test them out at separate times if you struggle with the size of a foam roller. It is difficult to predict which will be more easy for you to start with but both are so very gentle you’ll often find one works more easily so go with the easiest option when you begin. 

You can also adjust the time you’re on the towel, this could be for as little as 20 seconds, and over time you will find that longer durations of 5 minutes feel great as a means of relaxing and taking pressure off the back. 

Most of our members and patients with spondylolisthesis find that it is something that quickly becomes very pleasant and relieving as a routine daily practice to ease the pressure on the back. Some choose to combine it with the bed decompression as we did in a recent live routine linked below, to help them manage the strain that can build up in the back from daily life and too much sitting. 

Recent Video Release: Live back pain relief routine

Important technical points when doing the towel stretch

We find when it comes to back pain, how you do the thing is often as important as the thing itself. With the towel there are a couple of considerations that ALL should make, but those with a spondylolisthesis should make SURE they consider and avoid, as they are likely causes of aggravation. Granted they’re not going to do much in the way of “objective damage” at all, but a minor flare up in the back with spondylolisthesis will often come with more in the way of pain than the individual with a minor disc strain, as you might expect. 

• Do NOT roll down backwards over the towel: Make sure that you lie down first and place the towel in as mentioned above, rolling down with a reverse sit up over the towel is a recipe for trouble.
• Do NOT sit up off the towel: The reverse of the previous point, do not finish your allotted time and do a sit up to get off! 
• Do NOT twist your spine to get off the towel: As instructed, and demonstrated in the video, you should tip yourself off while keeping your spine as still as possible, with a little practice you’ll find this is easy. 
• Do NOT lift your bum after doing the towel: Roll off to the side instead of doing a glute bridge to slide the towel out.
• Do NOT lie with your legs outstretched: This position tends to increase the extension pressure at the L5/S1 in particular and could be more aggravating for the segment with spondylolisthesis and should be avoided!
• Be CAREFUL how you get down onto the floor and up again after: Try to think about your spine and what you’re doing as you get onto and off the floor as carelessness here can often be a reason for irritation in the early days of recovery.

A guide to long term relief for those with spondylolisthesis

As you’re hopefully aware, the spondylolisthesis will not “go back” but that does not mean it needs to be a “problem” for the long term. For most, this will have been there in the lower back long before the pain came on, and so with the right rehab strategy, you can get there again, we’ve seen it time and time again. Unfortunately due to the nature of this problem, individuals diagnosed with it often end up getting really stuck with what to do and come to us when they’re in a bit of trouble, both with their back, but more importantly mentally, with their confidence. The good news is; you can turn it around!

Stretches like the towel stretch above, and the routine we linked to can offer great relief for the strain that the back is under, but you must be committing to long term rehabilitation work to rebuild the strength in your back! Without this you will struggle tremendously.

Commit to learning good spine control, we talk about this in tutorials on exercises like the dead bug exercise. Learn to control your spine in everyday life, through movements like the hip hinge and squat, which you’re already doing every day anyway! With time, add load to these exercises so you can help guide the healing and regenerative process taking place in your low back, and protect it from future irritation and re-injury. 

Our bodies are remarkable, and with the right work and some patience, we can transform an area of vulnerability into something unrecognisable. If you need help with more structure and support you can always check out the free resources on the website or get signed up to the Back In Shape Program and we will work with you to help you on the pathway to recovery!

Principles for a strong back in spite of spondylolisthesis

Set the goal for the following 4 areas to be “above average”, the better they are, the better you will be, it takes time and for general purposes, no matter who you are, do not artificially set an upper limit on these!

1. Control of a neutral spine position: So your spine is less easily pulled off centre by building up the muscles of the trunk, your core and back muscles. 
2. Strength of your lower body: So your legs, hips and knee joints are more powerful and competent to take more than their fair share of work, so your back can remain in a more efficient position.
3. Mobility of your hips, knees and ankles: So these great joints can contribute to more of the movement required for daily life, before your back has to get involved.

Capacity to bear load: So you are less likely to be exposed to a load in everyday life which you are not prepared or conditioned for.