Patients with a spondylolisthesis generally experience an increase in pain during activities that straighten or extend the spine especially if these activities are repetitive, excessive, or, maintained for long periods of time. Conversely, activities that bend the spine (e.g. sitting) tend to ease symptoms. It is important to note, that many patients may experience no symptoms and be completely unaware of the defect.

X-ray investigation is usually required to confirm diagnosis of a spondylolisthesis. This is best performed in the position that reproduces the patient's pain.

Treatment of a spondylolisthesis is determined by the severity of symptoms and grade of injury. Typically, treatment involves abdominal and lower back strengthening exercises. If symptoms do recur upon resuming sport, then that activity should be ceased. Patients with a Grade III or IV spondylolisthesis should avoid high speed or contact sports altogether.
Alternative exercises placing minimal force through the spondylolisthesis should also be performed to maintain fitness provided they do not increase symptoms. Better activities include: cycling, cross trainer, rowing, water running and clinical Pilates.

The spine consists of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. These joints are designed to support body weight and enable spinal movement.
A spondylolisthesis refers to the slipping of one vertebra forward on another. This generally occurs due to defects in the bone which develop during childhood. The defect is due to an absence of a section of bone known as the pars inarticularis on each side of the vertebral column, which assists in holding the vertebra in alignment. Although uncommon, a spondylolisthesis may also occur due to stress fractures in each pars interarticularis. This may occur due to excessive athletic or sporting activity involving repetitive hyperextension of the spine.
A spondylolisthesis is graded according to the degree of slip of the vertebra relative to the vertebra below.
A Grade I slip indicates a slip of less than 25%, Grade II – 50%, Grade III – 75% and Grade IV > 75%.

Despite appropriate chiropractic management, some patients with a spondylolisthesis fail to improve adequately or deteriorate. When this occurs, other intervention may be required. This may include further investigations such as X-rays, CT scan or MRI, or assessment from a specialist. Although it is rare for a slip to progress, spinal fusion surgery may be indicated if there is evidence of progression. The treating chiropractor can advise if this may be required and can refer to the appropriate medical authority if it is warranted clinically.

There are several factors that may contribute to the development of symptoms in patients with a spondylolisthesis, which may include:

• poor posture
• poor core stability
• muscle weakness
• poor flexibility
• joint stiffness.