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Home  /  Health Conditions  /  Spondylolysis & Spondylolisthesis (Back Stress Fractures & Slipped Vertebra)

Spondylolysis & Spondylolisthesis (Back Stress Fractures & Slipped Vertebra)

Spondylolysis is a stress fracture in a small bridge of bone in the lower spine, common in young athletes who repeatedly arch their backs, such as gymnasts and football players. If the crack weakens the bone enough, the vertebra can slip forward (spondylolisthesis); in older adults a slip can also come from wear and tear. Most people do well without surgery. A few warning signs — especially bladder or bowel changes, saddle numbness or new leg weakness — need emergency care.

Go to the emergency room or call 911 right away if you or your child has back pain together with any of these:

  • Changes in bladder or bowel control — the NHS lists difficulty peeing, or peeing or pooing yourself, as an emergency sign with back pain (NHS). The American Association of Neurological Surgeons (AANS) says trouble emptying the bladder is the most common symptom of cauda equina syndrome, in which the bundle of nerve roots at the base of the spinal cord is squeezed. Left untreated it can cause permanent paralysis and incontinence, and treatment within 48 hours of onset gives a significant advantage in recovery (AANS).
  • Numbness in the “saddle” area — a loss of feeling around the genitals or anus, or changes in sexual feeling or function (NHS). The AANS says the numbness can include the buttock region (AANS).
  • New weakness in the legs, or weakness or numbness in both legs. The NHS lists pain, tingling, weakness or numbness in both legs as an emergency sign (NHS), and the AANS lists weakness or paralysis among its red-flag symptoms (AANS). A new foot drop — trouble lifting the front of the foot and toes — is also a reason not to wait: the NHS says foot drop can get better but is sometimes permanent (NHS). The NHS page advises seeing a GP for foot drop on its own; MBHA suggests going to an emergency room the same day for new leg weakness or foot drop, especially if it is getting worse.
  • Back pain that started after a serious accident, such as a car crash or a hard fall. The NHS lists this, and chest pain with back pain, among its 999 signs (NHS). MedlinePlus also advises medical attention for back pain after an injury (MedlinePlus).

The NHS advises not driving yourself to the hospital: ask someone to drive you or call for an ambulance, and bring your medicines (NHS).

Get medical help promptly (the same day if you can) for:

  • Severe back pain that starts suddenly or is getting worse quickly, or back pain with feeling hot, cold, shivery or generally unwell — the NHS advises urgent medical advice for both (NHS).
  • Pain that does not ease with rest or is worse at night, unexplained weight loss, or a lump or change in the shape of the back — the NHS lists these as reasons to see a GP (NHS). In children, AAOS OrthoInfo adds fever, weight loss, weakness or numbness, trouble walking, bowel or bladder problems, and pain that keeps a child from sleeping to its list of signs that point to a more serious cause (AAOS OrthoInfo).

Do not wait for a chiropractic, acupuncture or massage appointment, and do not try an herb or supplement first, if you have any of these signs.

What are spondylolysis and spondylolisthesis?

Your spine is a stack of small bones called vertebrae. Between and behind each pair sit small facet joints, and a thin bridge of bone called the pars interarticularis connects the upper and lower facet joints of each vertebra. AAOS OrthoInfo calls the pars the weakest part of the vertebra and so the part most vulnerable to repeated stress (AAOS OrthoInfo).

  • Spondylolysis (spon-dee-low-LYE-sis) is a crack or stress fracture through the pars. It most often happens in the fifth bone of the lower back (L5) and sometimes the fourth (L4), on one side or both. OrthoInfo says it can be found in up to 5% of children as young as 6 with no known injury, and can occur at any age (AAOS OrthoInfo).
  • Spondylolisthesis (spon-dee-low-lis-THEE-sis) is a vertebra that slips forward over the one below it. If the fractured pars separates, the vertebra can shift forward; in children this most often happens during a growth spurt (AAOS OrthoInfo).

Many people with either condition have no symptoms, and it may only be found on an X-ray taken for something else (AAOS OrthoInfo). OrthoInfo's adult page estimates that about 4% to 6% of the U.S. population has spondylolysis and spondylolisthesis (AAOS OrthoInfo, adult page). When symptoms do appear, the most common one is lower back pain that can feel like a muscle strain, may travel into the buttocks and the backs of the thighs, and tends to worsen with activity and ease with rest (AAOS OrthoInfo). Muscle spasm can add back stiffness, tight hamstrings and trouble standing or walking, and more serious slips can bring tingling, numbness or weakness in one or both legs from pressure on a nerve root (AAOS OrthoInfo). See also our back pain guide and sciatica guide.

Young athletes

OrthoInfo says stress fractures can develop in adolescents in sports with repeated stress on the lower back, naming gymnastics, football and weightlifting, because these sports involve frequent overstretching (hyperextension) of the lower spine. It adds that some people may be born with thinner vertebral bone, which may make them more vulnerable (AAOS OrthoInfo). Its page on back pain in children also names diving, and says a child with spondylolysis may walk with a stiff-legged gait (AAOS OrthoInfo, children's back pain page).

A review of 201 adolescent athletes aged 10 to 19 treated in one program found that the most common age at injury was 15, the most common sport was football followed by baseball or softball, and the main mechanism of injury was weight training, closely followed by football (Choi et al., 2022). Parents and coaches can read more in the “Young athletes” section below.

How it is diagnosed

The doctor will ask about sports and symptoms and examine the back, looking for tenderness, limited movement, muscle spasm and weakness, and watching how the person stands and walks (AAOS OrthoInfo). Imaging confirms the diagnosis:

Grades of slippage

Doctors describe a slip by the percentage of the vertebra's width that has moved forward. The Meyerding classification, as summarized in a StatPearls article, is grade 1 for less than 25%, grade 2 for 25% to 50%, grade 3 for 50% to 75% and grade 4 for 75% to 100%, with spondyloptosis meaning more than 100% (StatPearls). OrthoInfo uses a simpler split: low grade versus high grade, where a high-grade slip is more than 50%. People with high-grade slips are more likely to have significant pain and nerve injury and to need surgery (AAOS OrthoInfo).

What to expect over time

The most reassuring evidence is a long study that followed 500 first-graders from 1955. Thirty were found to have pars defects, and at the 45-year check those who had defects had a clinical course similar to the general population: those with one-sided defects never slipped, slip progression slowed with each decade, progression of the slip was not linked to back pain, and nobody reached a 40% slip (Beutler et al., 2003). The study is small, but it was not limited to people who sought care for pain. OrthoInfo adds that in adults a pars fracture does not always lead to a slip, and a slip very rarely grows significantly (AAOS OrthoInfo, adult page).

In adolescents with a fresh fracture, a 2025 study followed 57 people for two years: 5 developed a slip (averaging 4.2 mm), and a fracture that did not knit (nonunion) predicted a slip (Virkki et al., 2025). Healing matters, then, but most young athletes do well: see the next sections.

When to see a provider (not an emergency): if your child's or your lower back pain comes on with arching or sports and eases with rest, does not improve after a few weeks, or limits everyday activities. The NHS advises seeing a GP if back pain does not improve after a few weeks of home care or stops you doing day-to-day activities (NHS); MedlinePlus says to call your provider if pain is severe or has not improved after three days (MedlinePlus). Bring a list of every medicine and supplement you or your child takes. If you have osteoporosis, tell every provider before any hands-on treatment (see our osteoporosis guide).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Diagnosis with X-ray, MRI or CT; for a young athlete, a break from the aggravating sport or early supervised physical therapy, sometimes a brace, pain relief if needed, then gradual return to sport. Surgery (pars repair or fusion) for high-grade or worsening slips, nerve compression, or pain that does not improve. Medicare Part B covers medically necessary outpatient physical therapy (20% coinsurance after the deductible). Other costs: being researched. Most young athletes improve without surgery: 91% of competitive athletes in one 8-year follow-up were back to their sport at the same level or higher. A rigid brace did not beat a placebo support in one study. For adults, trials of fusion versus decompression alone give mixed results.
Chiropractic Spinal manipulation or mobilization, flexion-distraction, exercise and advice, usually only after a diagnosis is confirmed by imaging. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation (20% coinsurance after the deductible). We found no controlled trial of manipulation for spondylolysis or spondylolisthesis, only single case reports, one of which describes symptoms being aggravated after chiropractic care. Tell the chiropractor your diagnosis and slip grade. Never a substitute for emergency care.
Acupuncture A course of needle treatments for pain, alongside the medical plan. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain of no known cause, so ask before assuming a diagnosed slip qualifies. We found little research: only two registered trial plans for slipped vertebra and no results. Acupuncture helps some people with low back pain in general. It does not heal a pars fracture.
Herbal medicine No herb has been shown to heal a pars fracture or correct a slip. Cost estimate being researched. We found little research: a 2008 report of two patients. Willow bark can act like aspirin, devil’s claw has been linked to ulcers and bleeding, and comfrey can harm the liver.
Massage therapy Gentle soft-tissue work for muscle tension and tight hamstrings, as a comfort measure beside the medical plan. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. Medicare doesn’t cover massage therapy. We found little research on massage for this condition: one inconclusive case report. Low risk with gentle pressure, but a case report describes a fracture in a lower-back vertebra after a back massage in an older man with osteoporosis and slipped vertebra.
MBHA Wellness Coach Pacing, a return-to-sport plan your team approves, sleep, rest-day and nutrition habits, and support for young athletes and families through time away from the sport. Cost estimate being researched. Supports — never replaces — medical care. A coach does not diagnose, clear anyone to return to sport, or treat the fracture.

Approach 1 of 6

Conventional medicine (AMA)

For a young athlete with a recent pars fracture, OrthoInfo lists the goals of treatment as reducing pain, allowing a recent fracture to heal, and returning the patient to sports and daily activities. For most people with spondylolysis and low-grade slips, symptoms improve with nonsurgical treatment (AAOS OrthoInfo).

1. Rest, activity changes and early physical therapy

OrthoInfo says avoiding sports and activities that place excessive stress on the lower back for a period of time can often help (AAOS OrthoInfo). Newer research questions how long complete rest is needed. In a multicenter trial of 64 adolescent athletes aged 10 to 19 with an active fracture, those who started physical therapy within 7 days did better at one month on a pain and disability scale, returned to sport 38 days sooner and had fewer recurrences of back pain over 12 months (3% versus 29%) than those who rested until symptoms settled; no adverse events were reported (Selhorst et al., 2026). A related analysis of the same trial (same registration number) used MRI in 53 of the athletes and found 81% showed healing at three months, with no more worsening in the early-therapy group; no rigid braces were used (Sweeney et al., 2026). These are recent, fairly small trial results, so ask your own doctor which approach fits your child.

2. Bracing

OrthoInfo says some patients may need a back brace for a period to limit spinal movement and allow a recent fracture to heal. It says athletes with sudden-onset pain are candidates, but people with longer-standing pain are not, because in them the fracture has a low chance of healing even after several months in a brace (AAOS OrthoInfo). Evidence for braces themselves is mixed. A study of 57 adolescents with acute spondylolysis compared a rigid brace with an elastic lumbar support used as a placebo for four months; only the first 14 were randomized, and the rest chose their treatment. Bone union (20 of 30 versus 17 of 27) and quality of life did not differ, and the authors concluded that a rigid brace is not necessary (Virkki et al., 2025). Braces were used in 38% of the 150 patients in an 8-year follow-up of nonsurgical care (Nguyen et al., 2026).

3. Medicines

We don’t list doses; ask your doctor or pharmacist what is safe for you or your child. OrthoInfo says anti-inflammatory medicines (NSAIDs, such as ibuprofen and naproxen) can help reduce swelling and relieve back pain (AAOS OrthoInfo). The NHS notes that anti-inflammatory medicines may not be suitable for everyone and that a pharmacist can help you choose (NHS). In adults, OrthoInfo lists pain relievers and NSAIDs, and cortisone injections around the nerves or in the epidural space, which are likely to reduce pain and numbness but not leg weakness and should not be given more than a few times a year (AAOS OrthoInfo, adult page). In the 201-athlete review, 18% eventually received facet or epidural steroid injections for continued pain (Choi et al., 2022).

4. Physical therapy and core stabilization

OrthoInfo says specific exercises can improve flexibility, stretch tight hamstrings, and strengthen the back and abdominal muscles (AAOS OrthoInfo). The research is small but encouraging:

  • In a 1997 trial of 44 people with chronic back pain and a spondylolysis or spondylolisthesis on imaging, 10 weeks of specific exercise training the deep abdominal muscles and the multifidus muscles of the back reduced pain and disability, with the improvement still present at 30 months; the comparison group did not change (O’Sullivan et al., 1997).
  • A 2024 meta-analysis of five randomized trials (198 people) of lumbar segmental stabilization exercises found a trend toward less disability that just missed statistical significance overall (it was significant when the exercises were the only treatment) and no significant pain effect (Lin et al., 2024).
  • A 2003 review found only two studies good enough to appraise, both suggesting that specific exercise helps back pain from these conditions, and said few conclusions could be drawn (McNeely et al., 2003).
  • In 92 people over 50 with chronic back pain and degenerative spondylolisthesis, stabilization and flexion exercises gave similar results at six months, so neither was clearly better (Nava-Bringas et al., 2021).

5. Healing and returning to sport

Healing rates depend on how they are measured, so numbers vary. After three months of nonsurgical care, 93 of 100 adolescent athletes in one series showed partial or complete healing on CT, and all seven fractures that did not heal affected both sides (Zeller et al., 2026). Another series using brace, stopping sports and a bone stimulator found bony healing in about half on CT at three months, yet 98% still returned to sports or similar activities (Choi et al., 2022). A systematic review of 14 studies (592 athletes, mostly lower-quality designs) reported that 92% of those treated without surgery returned to sport at some level and 89% to their previous level, on average after 4.6 months (Grazina et al., 2019). In a retrospective series of 150 patients followed about 8 years, 91% of competitive athletes returned to the same level or higher, the average disability score was very low, and only 5 had later back surgery (Nguyen et al., 2026). OrthoInfo says that to help prevent future injury a doctor may recommend exercises to stretch and strengthen the back and abdomen, with regular check-ups (AAOS OrthoInfo). Your treating doctor and therapist should decide when your child is ready to return.

Surgery

Surgery is covered in its own section below, including what the trials show for fusion and decompression.

What it costs

Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it. After the Part B deductible you pay 20% of the Medicare-approved amount, with no yearly limit on medically necessary therapy (Medicare.gov). Physical therapy without insurance, imaging, braces, medicines, injections and surgery: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors use spinal manipulation (a controlled thrust applied to a joint of the spine by hand or with a device), mobilization (similar but without a thrust), flexion-distraction, exercise and advice (NCCIH). AAOS OrthoInfo's pages on spondylolysis and spondylolisthesis do not mention chiropractic care.

What the research says

We found no randomized trial of spinal manipulation for spondylolysis or spondylolisthesis. The only systematic review we found on manipulation for degenerative spondylolisthesis was a 2019 protocol (a plan for a review), with no results to read (Sun et al., 2019 protocol). What exists are case reports:

  • A 43-year-old veteran with long-standing back pain, a grade 1 slip at L3 and a grade 2 slip at L4, received 10 flexion-distraction treatments plus activity changes over 8 weeks. His pain score fell by 25% and a disability score by 22%. The authors, who worked in a Veterans Affairs chiropractic clinic, wrote that conservative care should be explored for people without neurologic deficits and with a slip below grade 3. One patient cannot tell us whether the treatment caused the change (Dunn et al., 2009).
  • An elite heptathlete with stress fractures on both sides of the L2 pars was described as helped at first by chiropractic care and then aggravated by it; after a second opinion and imaging confirmed the fractures, she was managed with rest and avoidance of extension and rotation, then graded return (Castlereagh and Pollard, 2005). Its lesson, per the authors, is to consider a stress fracture when back pain is not responding.

For general low back pain, NCCIH says spinal manipulation may lead to small improvements in pain and function (NCCIH), but that does not tell us how it affects a cracked or slipped vertebra.

Safety

NCCIH says mild side effects such as more pain, stiffness or headache are common after manipulation and usually go away within 24 hours. Serious problems are very rare, and may be more likely in people with underlying health problems that raise their risk of injury; it says practitioners should assess patients thoroughly and patients should share their health conditions (NCCIH). NCCIH does not name spondylolisthesis in that safety section. Because a spondylolysis can be an unhealed fracture and a slip can mean extra movement at one level, MBHA suggests the following: get the diagnosis and slip grade from imaging first; tell any hands-on practitioner your exact diagnosis and show them your imaging report; ask whether forceful, twisting or arching techniques are appropriate for you; and stop and call your doctor if pain, numbness or weakness gets worse. Take particular care if you have osteoporosis.

Medicare coverage

Part B covers only spinal adjustments by a chiropractor to correct a subluxation, by hand or with a device called an activator. It does not cover X-rays, massage or acupuncture ordered by a chiropractor. After the deductible you pay 20% of the Medicare-approved amount (Medicare.gov).

What it costs

Published cash prices run about $55 to $100 for a follow-up visit and about $90 to $200 for a first visit (The Pricer). Ask about package prices and what insurance covers.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture inserts thin needles at points on the body. We found little research on acupuncture for spondylolysis or spondylolisthesis, and what exists is not results.

What the research says

  • A 2014 plan for a pilot trial noted there had been no study of acupuncture's efficacy for low back pain due to spondylolisthesis, and described a planned comparison of 14 patients, all receiving epidural steroid injections, with or without added acupuncture (Lee et al., 2014 protocol). A 2018 protocol described a planned trial of a five-week program (Chuna, acupuncture and patient education) against conventional nonsurgical care (Kim et al., 2018 protocol). We read only these plans, not any results.
  • A 2021 systematic review of 12 articles on spondylolysis treatments said electro-acupuncture, along with low-intensity ultrasound and pulsed electromagnetic fields, was effective for bone union (Tanveer et al., 2021). When we read the open-access full text, the only electro-acupuncture study in its table is a 50-person trial whose reference title concerns postnatal low back pain, so we do not treat that statement as evidence for spondylolysis.

For ordinary low back pain, NCCIH describes a 2017 analysis of 49 studies with modest benefit for acute and moderate benefit for chronic pain (NCCIH, low back pain). That may be a reason to try it for pain, but it says nothing about repairing a fracture or stopping a slip.

Safety

Relatively few complications have been reported, but they have followed non-sterile needles and improper treatment. The FDA requires acupuncture needles to be sterile and labeled for single use (NCCIH). Choose a licensed practitioner, and tell them about your diagnosis.

Medicare coverage

Part B covers acupuncture (including dry needling) only for chronic low back pain: pain lasting 12 weeks or longer, with no known cause such as spread cancer or an inflammatory or infectious disease, and not linked to surgery or pregnancy. Whether pain from a diagnosed slipped vertebra counts is not something the Medicare page answers, so ask before assuming coverage. Where it applies, Medicare covers up to 12 treatments in 90 days, with 8 more if you improve, from a doctor or other practitioner with the required degree and license — Medicare cannot pay licensed acupuncturists directly — and you pay 20% after the deductible (Medicare.gov).

What it costs

Published cash prices run about $125 to $230 for a first private visit and $90 to $185 for follow-ups; community clinics can be near $50 to $90 a visit (The Pricer). Ask about package prices and insurance.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little research on herbs for spondylolysis or spondylolisthesis, and none showing that any herb heals a pars fracture or corrects a slip. The only report we opened was a 2008 article describing two women, one with a slipped vertebra in the lower back and one in the neck, who were given several herbs and reported less pain over weeks. Two patients cannot show that the herbs caused the change, and the authors presented it only as hinting at a possible role (Case report, 2008).

What is known from low back pain research

NCCIH reviewed herbs tested for low back pain, which is not the same as a fracture or a slip. It found evidence that cayenne used on the skin reduces pain, said devil’s claw or white willow bark by mouth, and comfrey, Brazilian arnica and lavender essential oil on the skin, might be beneficial, and cautioned that natural does not always mean safe and herbal products may cause side effects or interact with medicines (NCCIH, low back pain).

Safety of the most-mentioned herbs

  • White willow bark may have aspirin-like side effects. Memorial Sloan Kettering advises against it with warfarin or other blood thinners (more bleeding risk) or NSAIDs (more risk of stomach and intestinal damage and bleeding), and says children should not be given it because of Reye syndrome (Memorial Sloan Kettering). Because many young patients are children or teenagers, check with a doctor first.
  • Devil’s claw root has been linked to ulcers and gastrointestinal bleeding (Memorial Sloan Kettering).
  • Comfrey contains compounds that are toxic to the liver, and cases of liver toxicity have been reported (Memorial Sloan Kettering).

Tell your doctor and pharmacist about any herb or supplement before you start it. For a young athlete, MBHA suggests asking before using any herb or supplement at all. Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage cannot repair a fracture or stop a slip. It may help with the muscle tightness that often comes with these conditions, such as the tight hamstrings and spasm OrthoInfo describes (AAOS OrthoInfo). We found little research on massage for spondylolysis or spondylolisthesis.

What the research says

A 2012 case report followed one 30-year-old woman with isthmic spondylolisthesis through seven sessions of muscle-energy and myofascial techniques. Pain took longer to set in during walking and standing, but the author called the data inconsistent and the results not conclusive (Halpin, 2012). For ordinary low back pain, NCCIH says only weak evidence suggests massage may help, and that a 2015 review of 25 studies had very little confidence in the result because the studies were low quality (NCCIH).

Safety

NCCIH says the risk of harm from massage appears low, but there have been rare serious problems such as a blood clot, nerve injury or bone fracture, some after vigorous massage such as deep tissue work or in people at higher risk of injury, such as elderly people (NCCIH). One 2013 case report describes a 66-year-old man with osteoporosis, long-standing back pain, bilateral spondylolysis and a slip at L5/S1 who had a fracture of the L5 pedicle after a back massage; he needed surgery. It is a single case, but the authors raised it as a reminder to be aware of this possibility (Guo et al., 2013). MBHA suggests choosing gentle pressure, telling the therapist your diagnosis, and avoiding forceful or deep work directly over the lower spine, especially with osteoporosis or a high-grade slip.

Medicare coverage

Original Medicare doesn’t cover massage therapy, and you pay all costs; some Medicare Advantage plans offer extra benefits, so ask your plan (Medicare.gov).

What it costs

One national chain’s membership runs about $70 to $90 a month on a 12-month term, about $840 to $1,080 for the first year before tips and extras (The Pricer). Independent therapists price differently; cost estimate being researched.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can support the habits around treatment — alongside, never instead of, medical care. A coach does not diagnose, decide when anyone is cleared to play, or treat a fracture.

Following the plan, one step at a time

Time away from a sport is hard, especially for a teenager whose friends and identity are tied to a team. A coach can help set small, realistic goals, track physical therapy exercises, and keep a simple log of pain, activity and sleep to share with the care team. OrthoInfo's advice on bone stress injuries is that return to sports after clearance should be slow and gradual, perhaps alternating activity and rest days or adding low-impact cross-training such as biking and swimming, over many weeks (AAOS OrthoInfo, stress fractures). That page covers stress fractures in general (it names the foot and lower leg as especially vulnerable), not the spine specifically, so ask your own provider which activities are safe now.

Rest, fuel and training load

The same OrthoInfo page lists modifiable risk factors for bone stress injuries: low energy intake relative to training, getting less than 7 hours of sleep and skipping rest days, low vitamin D (which it says may lead to poor bone healing), and sudden jumps in training volume or intensity (AAOS OrthoInfo, stress fractures). A coach can help an athlete and family plan regular meals, a steady sleep schedule and a gradual build-up of training. Ask your doctor about checking vitamin D before taking any supplement; we don’t list doses.

Staying active and facing fear of movement

For ordinary back pain, the NHS advises staying active and not staying in bed for long periods (NHS); if you have a confirmed fracture, follow your doctor’s instructions instead. A trial of 98 people after spinal fusion for spondylolisthesis found that a 12-month progressive home-exercise program was not better than a single physiotherapy instruction session at lowering fear of movement or raising physical activity (Ilves et al., 2017) — a reminder that extra support is not a guaranteed fix, and that a coach’s role is encouragement and accountability rather than a proven treatment.

Making decisions and coping

A coach can help you prepare questions for the surgeon or therapist, such as how long until sport, whether imaging will be repeated to check healing, and which activities to avoid, and can offer pacing ideas and relaxation or sleep routines.

What it costs

Cost estimate being researched.

Another approach

Young athletes: what parents and coaches should know

Early reporting helps. OrthoInfo says spondylolysis often shows up as lower back pain that worsens with activity and improves with rest, sometimes with tight hamstrings (AAOS OrthoInfo). In the 14-year-old soccer player described above, back pain returned when he resumed training and competition, and a first plain X-ray looked normal (Piper and Degraauw, 2012). If an athlete’s back pain keeps coming back, especially when arching the back, ask the doctor about further imaging.

Imaging choices. MRI can avoid radiation and can show early injury, while CT shows bone detail (AAOS OrthoInfo, Ledonio et al., 2017). It is reasonable to ask which test is best for your child and why.

Healing matters. In the 2025 brace study, teens whose fracture united had higher quality-of-life scores at two years than those whose fracture did not, and nonunion predicted a later slip (Virkki et al., 2025). In the 2026 trial analysis, athletes whose MRI showed healing were more likely to be pain-free at three months and had less pain recurrence in the following year (Sweeney et al., 2026). Following the care plan and not rushing back are worth it.

Reducing overuse. OrthoInfo links these injuries to repeated arching and overstretching of the lower spine (AAOS OrthoInfo), and its general stress-fracture page recommends cross-training, gradual increases in training, enough sleep and rest days, and enough fuel (AAOS OrthoInfo, stress fractures). We did not find a trial showing that any specific prevention program lowers the risk of a back stress fracture.

See our back pain guide for other causes of sports-related back pain, and the osteoporosis guide for bone health in adults.

Another approach

Adults: degenerative and isthmic slippage

OrthoInfo says the two most common types of spondylolisthesis in adults are degenerative and isthmic (spondylolytic) (AAOS OrthoInfo, adult page).

  • Degenerative spondylolisthesis comes from wear and tear: as disks lose height and dry out, the joints and ligaments that hold the vertebrae in line weaken. It is more common after 50 and in women, and it is often accompanied by spinal stenosis. Typical symptoms are a feeling of weakness in the legs with long standing or walking, numbness, tingling or pain, relieved by bending forward or sitting (AAOS OrthoInfo, adult page). See our spinal stenosis guide.
  • Isthmic spondylolisthesis starts with a pars fracture, usually in adolescence and often unnoticed until adulthood; disk degeneration later can stress the fracture and let the vertebra slip. Symptoms often begin in middle age, mostly activity-related back pain, sometimes with leg pain (AAOS OrthoInfo, adult page).

OrthoInfo says nonsurgical treatment (exercise, pain relievers and anti-inflammatory medicines, and occasional steroid injections) will not repair the slip but many patients say it relieves symptoms, and nonsurgical treatment is successful in most cases (AAOS OrthoInfo, adult page). For isthmic slips, the authors of one long-term trial noted that the course of the conservatively treated group probably reflected the natural course, and concluded that adults with symptomatic isthmic spondylolisthesis should not expect much spontaneous improvement over time (Ekman et al., 2005).

Another approach

Surgery: pars repair, fusion and decompression

When surgery is considered. For children and adolescents, OrthoInfo lists high-grade or worsening slips, symptomatic nerve compression, and pain that has not improved after a period of nonsurgical treatment (AAOS OrthoInfo). For adults, it suggests considering surgery after 3 to 6 months of nonsurgical treatment for degenerative slips, and after 6 to 12 months for isthmic slips, or sooner with worsening nerve symptoms such as weakness, numbness or frequent falls, or signs of cauda equina syndrome (AAOS OrthoInfo, adult page).

The operations. Spinal fusion joins the affected vertebrae into one solid bone, usually with a bone graft and often screws and rods; it takes away some flexibility. Pars repair uses screws in the fractured vertebra only, with bone graft around the break, and can keep motion at that level; OrthoInfo describes it as an alternative for less severe slippage and for adults without significant degenerative changes. For degenerative slips, decompression (laminectomy) relieves pressure on the nerves, and if the spine is stable enough, fusion may not be needed. Recovery from a laminectomy alone may take 1 to 2 months; pars repair and fusion take longer, and a brace is often used at first (AAOS OrthoInfo, AAOS OrthoInfo, adult page). Risks of fusion listed by OrthoInfo include infection, bleeding, pain at the graft site, return of symptoms, failure of the bone to fuse (more likely in smokers, people with diabetes and older patients), nerve damage and blood clots (AAOS OrthoInfo, spinal fusion). OrthoInfo reports successful clinical outcomes in more than 85% of surgically treated adults and, citing the largest spine outcomes trial, substantially greater pain relief and function with surgery than without (AAOS OrthoInfo, adult page). The trial evidence is more mixed:

  • Surgery versus no surgery (degenerative). In the SPORT study (304 randomized and 303 observational patients), about 40% crossed over in each direction in the randomized group, so the as-randomized comparison showed no statistically significant effect; the as-treated comparison favored surgery at 2 years, with little evidence of harm from either approach (Weinstein et al., 2007).
  • Cochrane review. A 2005 Cochrane review of 31 randomized surgical trials for degenerative lumbar spondylosis said seven heterogeneous trials on spondylolisthesis, stenosis and nerve compression allowed only limited conclusions. Two fusion trials conflicted: one found fusion better than conventional physiotherapy, another found it no better than a modern exercise and rehabilitation program. Eight trials found instrumented fusion raised the fusion rate but did not improve clinical outcomes, and may bring more complications (Cochrane review, 2005). It is old, with searches ending in 2004.
  • Decompression alone or with fusion (degenerative). Norway’s Nordsten-DS trial found decompression alone non-inferior to decompression plus instrumented fusion at 2 years (about 71% versus 73% reached the main target) (Austevoll et al., 2021) and at 5 years (63% in both groups), with 16% versus 18% having another lumbar operation (Nordsten-DS five-year follow-up, BMJ, 2024). A smaller trial of 66 people found a slightly greater gain in physical quality of life with fusion at 2 years, more blood loss and longer hospital stays, and fewer repeat operations (14% versus 34%) (Ghogawala et al., 2016).
  • Isthmic slips in adults. In a 2021 trial of 84 people with low-grade isthmic slips, fusion plus decompression gave better results than decompression alone at two years, with reoperation in 13% versus 47%; the authors said this should not be applied to degenerative slips (Azizpour et al., 2021). In a trial of 111 adults aged 18 to 55 with isthmic slips, about 9 years after treatment 76% of the surgery group and 50% of the exercise group rated their outcome much better or better; fusion improved long-term outcome only modestly (Ekman et al., 2005).
  • Young athletes. A review of surgery for unilateral spondylolysis in athletes found the evidence too limited to compare surgery with nonsurgical care (Scheepers et al., 2015). In one series of 22 young athletes after surgery, 18 (82%) returned to their previous sport after about 7 months of rehabilitation (Debnath et al., 2003).
  • High-grade slips in children. A 2016 review of five observational studies found low-quality evidence of no significant difference between surgery and non-surgery in quality of life or slip progression (High-grade slip review, 2016). A 2023 meta-analysis of 228 patients found reduction plus fusion and fusion in place were both effective, with reduction less likely to fail to fuse (High-grade slip meta-analysis, 2023).

Ask your surgeon what the goal is (nerve pressure, instability or pain), what alternatives exist, and the numbers for your type of slip.

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