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Many individuals with spondylolysis and spondylolisthesis have no symptoms. When symptoms are present, they do not always correlate with the degree of defect - i.e. they may be much worse or milder than the severity of the slip indicated by imaging studies. Young people often develop symptoms during the preadolescent growth spurt. If symptoms are present, back and leg pain are the most common.

Symptoms associated with spondylolysis include:

• Low-back pain during hyperextension of the spine
• Pain appearing initially during sports and progressing to pain during daily activities which may eventually interfere with sleep.
• Pain when bending backward
• Hyperlordosis - increased "inward" curvature of the lower back, sometimes called 'swayback'
• Tightness in the hamstring muscle

Acute spondylolysis is usually painful with any activity involving pressure on the back (e.g., running and jumping). Sitting is usually better tolerated. The individual may experience spinal spasms, pain with lumbar extension and/or tight hamstring muscles.

Symptoms associated with spondylolisthesis include:

• Back pain on lumbar hypertension and/or flexion (often intermittent, aggravated by strenuous activity, relieved with rest)
• Hamstring tightness or weakness
• Pain aggravated with lifting or bending
• Knee-flexed, hip-flexed gait (Phalen-Dickson sign)
• Leg pain - worse with activity and relieved by rest; frequently seen in adults
• Radiculopathy - low back pain that radiates into the buttocks and down the legs, numbness, and disturbances in sensation, such as tingling, in the extremities. Radiculopathy may occur with more severe degrees of slippage. The pain follows directly along the path of a specific spinal nerve root. It is usually secondary to compression, inflammation, or injury to the nerve root.
• Bladder and bowel dysfunction - may occur with severe degrees of slippage and stretching of L5-S1 nerve roots
• Tenderness and irregularities in bony alignment that may be felt or palpated
• Shortened appearance of the trunk and lumbar hyperlordosis (inward curvature of the spine)

Back pain is the most common symptom of spondylolisthesis. Usually patients present during a growth spurt in adolescence. Parents often bring in a child because of poor posture or irregular gait. Sometimes muscle spasms make the lower back stiff and painful. Also tight hamstrings may cause the child to walk with knees bent and short stride. The pain is often associated with a history of trauma from sports-related activities or cumulative stress.

Pain in the back and buttocks is present in up to 80% of individuals with spondylolisthesis. It is usually exacerbated by standing, walking, and other activities. Initially pain may be felt only at extremes of lumbar range of motion. The pain may be exacerbated as the individual continues their specific sport or particular activity responsible for the condition. Relief comes with resting.

Hamstring tightness is almost always present, even with low grade slipping. If the hamstring tightness is severe enough to shorten the length of each step, a waddling gait may be noted.

Neurological symptoms related to nerve compression (e.g., radiculopathy) may be unilateral or bilateral, intermittent or chronic, and are associated with higher grades of slippage.