A physical therapy program is one of the more effective ways to treat spondylolisthesis for 2 main reasons: (1) It can help strengthen the muscles that support your spine, and (2) it can teach you how to keep your spine safe and prevent further and future injury.

Physical therapy includes both passive and active treatments.

• Passive treatments help to relax you and your body. They're called passive because you don't have to actively participate. Your physical therapy program may start with passive treatments to give your body an opportunity to heal, especially if you have a pars interarticularis fracture.
• The goal is to get into active treatments. These are therapeutic exercises that strengthen your body and help prevent a recurrence of possible pain from spondylolisthesis.

Passive Treatments
Your physical therapist may give you passive treatments such as:

• Deep tissue massage: This technique targets spasms and chronic muscle tension that perhaps builds up as your body readjusts to the slipped vertebra. The therapist uses direct pressure and friction to try to release the tension in your low back's soft tissues (ligaments, tendons, muscles).

• Hot and cold therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.
  
  Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.

• TENS (transcutaneous electrical nerve stimulation): A TENS machine stimulates your muscles through variable (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it may increase your body's production of endorphins, your natural pain killers. The TENS equipment your physical therapist uses is relatively large. However, a smaller machine for "at home" use is also available. Whether large or small, a TENS unit can be a helpful therapy.

• Ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Active Treatments
In the active part of physical therapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with spondylolisthesis.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This is all part of the "self-care" or "self-treatment" aspect of physical therapy: Through physical therapy, you learn good habits and principles that enable you to take better care of your body.

Your physical therapist may also suggest a personalized exercise program for you. This can help reduce the likelihood of your back pain recurring and can also improve your overall health. For spondylolisthesis, the physical therapist will likely recommend abdominal strengthening and hamstring work because both of those muscle groups are crucial to low back support.