 Hey everybody, I'm Lance Coyke and today I want to go through some consideration, some special considerations that you might want to take into account when you're working with somebody who has a spondylolisthesis or a spondylolisis. Now for those who don't know, I'm going to try to give the quick explanation. If I take a spinal vertebra here, we have this arch of the spinal vertebra in the back. This is my top down view. And then we have these three processes, the transverse processes on the side and the spinous process in the back. If I have a spondylolisis or a spondylolisthesis, I have lost the integrity of this connection between the arch of the spinal vertebra, there we go, that's the word I was looking for, and the body of the vertebra, okay. So what you'll notice is people who have this problem don't have the best alignment of their spine when we consider how each vertebra works together. And so if you see this little drawing and we look at it very detailed, I've got my sacrum this way, which actually curves the other way, oops. If we look at it with some detail, we'll notice that this curve here is sharper than these curves here, okay. And this little thing we might call a step off. This is where I am noticing that my something's up with my spine, okay. Now it might not actually be that a body has slipped on the on top of another body because your spinal cord still has to go through all this stuff, right. And if I get all that, I'm probably going to have a lot of numbness in my leg. That's probably not what's happening here. What's probably happening is that I have a little bit more of an alignment like this. And then I have my arch and my spinous process, my arch and my spinous process. And then maybe my arch and my spinous process is just out further away, okay. Maybe there is some spongy tissue here or maybe it is literally broken off and detached and the whole thing here has moved away from the body. So now when I'm working with someone like this, I need to consider that I have muscles going through all this stuff, right. I have muscles connecting to these points, controlling how each vertebra works. And if I am pulling on something that isn't very well attached, I'm not going to transfer forces very well. If the idea is to arch my back and I pull down on a erector spinae muscle, then I am losing, I'm gaining a lot of leverage on this one point. And what it's going to do is it's going to force this stuff into further, further extension. It's going to force the surrounding vertebra within, like let's say I'm connected to my sacrum here, the bottom of this muscle and it comes up to this spinous process here. I am really emphasizing that curve there and I'm getting an anterior translation of the vertebra in the middle there. Okay, so I want to consider that when I'm looking at this. I want to minimize whatever is going to further exaggerate this heavy, heavy curve. So what I also need to think about is if I'm not stacking vertebra very well, even if this scenario here where one is shifted far in front of the other one, even if that's not the case, I still have lost the interplay between my various tissues, right. And so if I try to really, really compress you, here's your legs. And here's a really heavy two ton weight. That spine doesn't have a good straightness about it. It has something that looks maybe a little bit more jagged like this. And if I push all the way down through this one little piece, then I've created, that was an arrow, that was terrible. Then I've created an angular momentum, a torque we might say, that will then have to be resisted, okay. So people with a spondylolisis and a spondylolisthesis might not deal with compressive loads quite as well. For those people, it is very important then, let's get rid of this one, it is very important that they have abdominal tone. And that's what we're going to talk about next time.