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Back pain is a major health issue in the United States and a leading cause of disability. Although sometimes the intensity of symptoms and imaging studies make the diagnosis relatively clear, there are other patients in whom the intensity of the symptoms is often out of proportion to radiographic finds, for example when a small degree of slippage causes severe pain. This is a frequent finding among people with degenerative disk disease and these patients are more difficult to treat. As it is well known that psychological factors can impact strongly the magnitude of pain and related disability, some clinicians include in the diagnostic workup an assessment of behavioral or psychological factors that may be important to consider, such as depression.

Spondylolisthesis can have a significant impact on function and quality of life due to pain and restrictions on activity. This can be frustrating especially for a young, active person. In addition, it is difficult for many young people not to participate in some type of sports, especially one at which they might excel or particularly enjoy. It is important for the patient with spondylolisthesis to choose a sport carefully and to determine together with a health care provider the degree of participation (e.g., if involved in gymnastics, hours of practice may be limited or alternate sports may be preferred, such as swimming or bicycling). Athletes need to be educated regarding the risk of progression and the importance of continued exercise to promote stretching and good muscle tone.

The reported incidence of low back pain among children and adolescents is correlated with increased exposure time to sports and the increase in the variety of sports that affect the lumbar spine. Prepubertal children with any indication of spondylolysis or spondylolisthesis should not be lifting weights as this puts a significant strain on the spine. The general consensus is that if a child is found to have asymptomatic spondylolysis, there need not be any activity restriction.

Some suggestions that may be helpful for minimizing the risk of further slip progression in children and adults include:

• Maintaining ideal weight
• Muscle strengthening exercises
• Education regarding daily living activities (e.g., how to bend properly)
• Education regarding the condition and its treatment options is very important for providing the individual with a sense of control, as well as the information necessary to make informed decisions regarding treatments.