Q: Hey Tony — I had a pretty severe L5 spondylolisthesis a couple years ago, and it took nearly a year to recover. I’m back to training and feel good. I’ve read that I should avoid excessive anterior pelvic tilt, so should I focus on building glute, hamstring, and hip strength? I know core strength is important too. Besides planks, side planks, anti-rotation work, and roll-outs, is there anything specific you’d do to keep the lumbar spine strong and healthy to prevent re-injury? Thanks for your input—I really enjoy your videos and blog posts.
A: I’m glad you’re feeling better, and I’m sorry you went through that. Back pain is tough, but you’re taking a smart step by thinking about your form and strength.
Spondylolysis is a fracture of the pars interarticularis, usually at L5, which connects the front of the vertebra to the joints at the back. It can affect people differently, but it’s fairly common among weightlifters and athletes who require a lot of extension and rotation. Spondylolisthesis is when one vertebra slips forward over the one below. It’s seen in athletes who put heavy axial stress on the lumbar spine but also occurs in the general population. With that in mind, here are practical points to guide you.
1) Address excessive anterior pelvic tilt. There’s a natural curve in the spine, but reducing tilt that seems to worsen symptoms can help.
2) Don’t rely on hip flexor stretching alone. If the anterior core is weak, hip flexor stretches won’t fix the problem. Prioritize strengthening the anterior core. Start with exercises like Pallof presses, rotational chops and lifts performed with solid bracing, and planks done with proper form. Many people perform planks poorly, letting the hips sag or twist the torso. If you’re doing planks, make them correct: brace the abs, keep the spine neutral, and avoid any compensation. A reverse crunch can be a good progression for those further along in recovery. Note that flexion from an extended position to neutral is different from moving from neutral to end-range flexion, so progress with care. External obliques help tilt the pelvis posteriorly and are preferable to creating compression through the spine, since they don’t attach to the sternum like the rectus abdominis.
The key principle here is spinal stability. If the spine isn’t stable, the exercises won’t help much and may cause more issues. A detailed discussion on this topic by Dean Somerset is worth a read.
3) Include movements that promote a posterior pelvic tilt and build glute strength. In addition to anterior core work, add glute training. Start with supine bridges several times a day, holding each rep for 5–10 seconds at the top. Then progress to single-leg variations and one-legged hip thrusts, beginning with your back on a bench and feet on the floor. If you feel confident, you can add some range of motion with your feet on a bench. Make sure there’s no lumbar compensation—every repetition should come from the glutes. If you feel it in your back, regress and focus on glute activation.
4) Keep a neutral spine as much as possible. Some athletes with spondylolisthesis succeed with trap-bar deadlifts, but these can be too demanding early on. Start with lower-load options that minimize direct spinal load while still providing a training effect: pull-throughs, one-legged hip thrusts, various single-leg movements, and goblet squats may be appropriate. Building strength in the active muscles helps take some load off the passive structures (ligaments).
This isn’t a comprehensive guide, but I hope it gives you a clearer direction and helps you train safely.
