Thanks for the additional info, John and Frank.

When doing repeated tests, ie extensions, I only made
her do 5 repetitions, as the pain increased, after the
second rep, and continued increasing after each
repetition.  I do not know whether I should push this
further.  I guess being somewhat cautious given the
x-ray diagnosis.
As for lumbar stabilization, my knowledge is maybe
somewhat limited.  I started with recruiting,
transverse abdominus, in supine, for teaching and
awareness of the patient.  This followed by being able
to recruit in sitting and standing.  Also doing
alternate leg lifts, in supine while contracting
transverse and maintaining a neutral spine.
Teaching multifidi, first in sidelying, or in prone.
Sidelying during this case.  Have followed that by
going on all 4s, concracting transverse, then
simultaneously lifting the arm and alternate leg,
maintaining neutral spine.  In this case I am not
allowing full leg extension.
Should I be adding anything to this regime....
Was thinking of adding some ball exercise when I am
confident in her recruitment of lumbar stabilizers.

Nabil

 --- Frank Conijn <[log in to unmask]> wrote: > John,
>
> I know that there is a difference between juvenile,
> overtraining-related spondy and adult, degenerative
> spondy. That difference may even be enormous (it is
> not even sure that the complaints in adults with
> spondies are caused by that spondy, since it is also
> seen in asymptomatic subjects). Nevertheless, in
> adults Spratt et al (1) found an extension regime to
> be more effective than a flexion. That study was one
> of the two found to be inclusion-worthy, in a recent
> systematic review (2). (The other one was the one by
> O'Sullivan et al [3], who found positive results
> with a stabilization program.)
>
> Avoiding extension would seem logical, since that is
> the painful movement. However, you cannot be sure
> until you do a repeated-movements assessment (a la
> McKenzie): response to repeated movements can be
> very different from the response to a single or just
> a few movements.
>
> My advice to have the girl (at least for the time
> being) give up gymnastics still stands, regardless
> of what kind of treatment would work. But to avoid
> extension? I'd suggest to Nabil to have a McKenzie
> assessment done first (by a credentialled McK. PT).
> Stabilization exercises can be given without a
> problem, and should have effect.
>
>
> References:
> 1. Spratt KF, Weinstein JN, Lehmann TR et al.
> Efficacy of flexion and extension treatments
> incorporating braces for low-back pain patients with
> retrodisplacement, spondylolisthesis, or normal
> sagittal translation. Spine 1993 Oct
> 1;18(13):1839-49.
> 2. McNeely ML, Torrance G, Magee DJ. A systematic
> review of physiotherapy for spondylolysis and
> spondylolisthesis. Man Ther. 2003 May;8(2):80-91.
> 3. O'Sullivan PB, Phyty GD, Twomey LT, Allison GT.
> Evaluation of specific stabilizing exercise in the
> treatment of chronic low back pain with radiologic
> diagnosis of spondylolysis or spondylolisthesis.
> Spine 1997 Dec 15;22(24):2959-67.
>
>
>
> R.,
> Frank
>
> F.J.J. Conijn, PT
> Editor, Physical Therapist's Literature Update
> The Internet Journal of Literature Updates for
> Clinicians in Primary Care Orthopaedic Medicine &
> Rehabilitation
> www.ptlitup.com
>
>
> ----- Oorspronkelijk bericht -----
> Van: John Willenbruch
> Aan: [log in to unmask]
> Verzonden: donderdag 7 augustus 2003 11:51
> Onderwerp: Re: spondylolisthesis!
>
>
> Dear all,
>
> I remember reading a study a while back about
> patients who were put in braces to prevent extension
> which seemed to have reasonably good results if it
> was over a long period of time and included
> cessation of provoking activity (diving, fast
> bowling and gymastics).
>
> As a physio all I could suggest is advice (avoiding
> extension and ? rapid deceleration) and transversus
> abdominus exercises.  I had an asymptomatic
> spondylolisetheis surgically fixed which was OK
> (although it cramped my style at uni in a hip
> spica), it was apparently to prevent degeneration in
> later life, which might be a consideration.
>
> Good luck,
>
> John Willenbruch
>
> PS Which lumbar stabilisation exs have you been
> doing?
>

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