 Okay everyone, today I want to go through a client that I just had today and kind of his situation with his back and what he's running into and what we tried to do to help him fix it. So this client is seeing a physical therapist for all sorts of stuff, but namely today, a spondylolisthesis. So for those who don't know, you have your sacrum bone and it comes down at the bottom. This is my posterior side, this is my anterior side, right? And you have your little vertebrae here and they come up and your lumbar spine, there's five of them, four and five. Five. Okay, now you got 12 more and then you got seven more way up here and your head and your face over here. There's a nose and a mouth, look at that. Smug, smug bastard, okay. Now, what this particular client I had is dealing with is a spondylolisthesis. So there are two terms you might run into here. There's the spondylolisthesis and spondylolisthesis. If I have the body of my vertebrae here, there are wings that kind of attach the body of it to the rest of it, which we would call then the arch of it. There is a little piece that kind of comes out forward at us and out into the whiteboard here as well and then there's this spine part of it here. And we have these little other facets where other pieces of the next piece of bone might run into, you have little projections down that way, but they're all kind of organized the same way. So we have a transverse process here, we have a spinous process there along the back and superior and inferior articular processes. In spondylolisthesis, we have a small crack or fracture in the pars articularis of the vertebra here. I'm realizing this one. This pars articularis is way too big. It's normally a little bit more narrow that way. Okay, I'm gonna just delete that. So we have all these other pieces. Basically, I think it's more helpful to look at it from the top here. So if I have the body of the vertebrae and then I have this arch behind it, I have my transverse process, I have my spinous process and then I have another transverse process out on this side. This joint right here, that's where our pars are interarticularis is and that's where we have a lot of leverage. If I jack up on one of these spinous processes here, I have a lot of leverage to break that, what did we call that? The pedicle of the vertebra. So if I put stress on this area, or well, this area either way, I can get this stress crack, stress fracture in this region of my vertebra. When I have a spondylolisthesis, what happens is it actually breaks off, actually totally slips out. And so a spondylolisis is a concern and a spondylolisthesis is something that you're really gonna probably have to work around. What I had today in my final client of the day, he has a spondylolisthesis and he has this step off is what he calls it. And so if we look at this spine right here, let's draw one next to it. He has something that kind of looks like this. So if this one's here, his other one appears to be there. Hey everyone, so I'm sitting here editing this video and I want to make a clarification. This picture of this spondylolisthesis of my client is not an actual picture of what is happening. If his discs or his vertebra bodies were slipped like this, he wouldn't be able to hold any sort of pressure at all. So don't take this as a very literal interpretation. This is when I'm going back there and I'm feeling his spine, this is just kind of what it seems like. He has something that kind of looks like this. So if this one's here, his other one appears to be there. And then the rest of them are kind of in line with each other. But you'll notice two things. One, you'll notice there is a different color that I'm going to use. There is a big disparity between here. This is where we call the step off. If I run my finger along his back and I feel I palpate these bony spinous processes, you can feel it sinks in once I pass this top vertebra here in my diagram. And then the other thing you'll notice is that there is a much larger curve whereas this is maybe a normal lorodotic curve. This is a hyper lorodotic curve, especially if we consider this top one where it really comes out there. Now he's got other stuff going on but I wanna keep our focus very focal on this here. What I tried to do today to help him reduce the amount of step off that he has is I cued him to take this gapping part, this deeper curved area here and I cued him to push that backward. Okay, so when we started this, I had him, let's create some room here, I had him doing a squat on a wall and not a deep squat, it's not a huge, sorry for the camera shake there, it's not a huge leg burner but what we're using it as is a ab facilitator and a spinal relocator. So if the wall is way back here, he puts his back on the wall and his butt on the wall and then he just has a little bit of a squat this way. His head's up here and he's maybe most of the time reaching and trying to feel his belly which comes out forward here. There, shoulders are a little higher. So what we did was we tried to take that back into the wall and restore some curves. So even more specifically, we're trying to take, my finger's gonna be so gross now, trying to take his hips, point them backwards, get them as flat backwards as we can so that this spine starts in the wall but with this step off, there's always gonna be this little bit of gap there. And so what I said was, okay, I took my finger along his back, I palpated this step off area and I said, this part right here, this steeper curved part, I want you to bring that into the wall, okay? I want you to use the wall as a cue, I want you to feel the wall and now he has a sensation that he can search for to get this cue. Now, this is not gonna make this step off go away but I will tell you that it moved it. I don't really know how else to say it. We put it kind of in a different spot and definitely lessened the severity of the curve that he had just that resting posture. This posture, this spondylolisthesis is very tiresome for somebody's back. It takes a lot to be efficient because you don't have good compression forces because if he just loads a bunch of compression, he's gonna get some shear force where this one top one comes backward more and further exacerbates this step off. So we wanna try to align those back together, kind of push them back together. This is just a good way to do it. You can use the wall as a cue so that they have something to feel. A lot of times, especially with something like this and especially with, you know, you might have somebody who's overweight and it's harder to see something or they're kind of unfamiliar with some of these exercises. Maybe they're a new person for you. Using an external cue like this wall and in concert with an internal cue like, hey, feel this part of your back pushing into it. Those things work really well together.