The specific answer, in my opinion, would be that, first of all (if we are talki ng about symptomatic spondylolisthesis), it is only

low-grade (<50% translation) and relatively stable spondylolisthesis that could (and should) be successfully treated conservatively by brief periods of activity restriction, immobilization , and physiotherapy (Cavalier R, Herman MJ, Cheung EV, Pizzutillo PD. Spondyloly sis and spondylolisthesis in children and adolescents: I. Diagnosis, natural his tory, and nonsurgical management. J Am Acad Orthop Surg 2006: 14(7): 417-424). In general, the physiotherapy in patients with symptomatic spondylolisthesis wou ld be aimed at decreasing the extension stresses at the lumbar spine and include s abdominal muscle strengthening exercises and flexibility exercises for the spi nal extensor muscles, hamstrings, and lumbodorsal fascia (Wong LC. Rehabilitatio n of a patient with a rare multi-level isthmic spondylolisthesis. J Can Chiropr Assoc 2004; 48(2): 142-151). The physiotherapy treatment would typically (at least, here in South America) in clude: 1. Spinal stabilisation exercise programme, targeting at activation of the trans verses abdominus and multifidus muscles during different ativities. 2. Strengthening of predictable muscles that have a tendency to become weak in s pondylolisthesis (gluteals, abdominals, quadriceps femoris). 3. Flexibility exercises/stretching of predictable muscles that have a tendency to become tight (iliopsoas, hamstrings, lumbarerector spinae, gastrocnemius, hip adductors). 4. Spinal movilisation/manipulation directed to the joint fixations above and be low the spondylolisthesis and to the sacroiliac joints when indicated (direct ma nipulation of the involved area is avoided). 5. Electrophysical agents, thermotherapy, soft tissue mobilisation and/or dry ne edling for symptomatic relief of pain and muscle spasm when indicated. 6. Patient education (proper ergonomics, activities, sleep, and sitting posture) . 7. Home exercise programme upon discharge. If you think "evidence based", however, as far as I know, there is only one, qui te outdated, systematic review of the topic (McNeely ML, Torrance G, Magee DJ. A systematic review of physiotherapy for spondylolysis and spondylolisthesis. Man ual Therapy 2003; 8(2) :80-91), whose conclusions, however, confirmed the spinal stabilisation exercises as the main focus of the physiotherapy in spondylolisth esis (you can read it here in PDF format). Here is also a link to some discussion of the topic on the Physio Forum web-site : Spondylolisthesis and disc protrusion - The Physio Forum. McNeeley et al. (4) performed a systematic review on physiotherapy for spondylol ysis and spondylolisthesis including 71 articles published in peer review journa ls. Only two randomized controlled studies showed acceptable quality and were in cluded in the systematic review. Both studies indicate that an exercise regimen is superior to control groups. O'Sullivan et al. (10) evaluated the effect of st rengthening of abdominal muscles with co-activation of the lumbar multifidus for 10 weeks compared to a treatment recommended by medical practitioners. Forty-fo ur patients (Slippage Grade 0-2) participated; they were randomly allocated to t wo groups. The results for stabilizing exercises were effective up to 30 months and clinically and statistically significant for pain reduction and disability p erception. The authors and systematic reviewers concluded that the proposed exer

cise regimen lends itself to reproducibility in clinical settings. Spratt et al. (11) randomized patients (n = 65) to one group with flexion exerci se and a flexion brace; a second group with extension exercise and an extension brace; and a third group as control group with sham exercise. The study group wi th extension exercise and an extension brace showed significantly better results than the two other groups. The authors suggest that these results may indicate advanced disc diseases as the underlying pathology. There was a larger dropout r ate in the flexion group, and the results suffered consequently. Both studies pr ovide some evidence to suggest that specific exercise interventions alone or in combination with other treatments may have a positive effect on pain and functio n in patients with spondylolysis or spondylolisthesis. Summarizing these two stu dies and the systematic literature review, there is weak to moderate evidence th at an exercise regimen will reduce pain and perceived disability in patients wit h low-grade spondylolisthesis. Exercises including those to stabilize the trunk and extension exercises are possibly superior; however, more research is needed to confirm these statements. Moller and Hedlund (12) performed a prospective randomized study with the purpos e of determining whether posterolateral fusion in patients with adult isthmic sp ondylolisthesis results in an improved outcome compared with an exercise program . One hundred eleven patients were randomly allocated to an exercise program (n = 34) or posterolateral fusion with or without transpedicular fixation (n = 77). The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at l east 1 year of low back pain or sciatica, and a severely restricted functional a bility in individuals 18 to 55 years of age. The patients were followed up for 2 years; the follow-up rate was 93%. The functional outcome, as assessed by the D isability Rating Index and pain reduction, was better in the surgically treated group than in the exercise group at both the 1-year and 2-year follow-up assessm ents (P <0.01). In the exercise group, the Disability Rating Index did not chang e at all, whereas the pain decreased slightly (P <0.02). This study showed that careful patient selection and surgical management of adult isthmic spondylolisth esis improves function and relieves pain more efficiently than an exercise progr am over 2 years. In a follow-up 9 years later of the same patients, the same aut hors conclude: Posterolateral fusion in adult lumbar isthmic spondylolisthesis results in a mod estly improved long-term outcome compared with a 1-year exercise program. Althou gh the results show that some of the previously reported short-term improvement is lost at long term, patients with fusion still classify their global outcome a s clearly better than conservatively treated patients. Furthermore, because the long-term outcome of the patients conservatively treated most likely reflects th e natural course, one can also conclude that no considerable spontaneous improve ment should be expected over time in adult patients with symptomatic isthmic spo ndylolisthesis (13). This statement stands until further longitudinal studies are performed. this is some evidence based rehab advice from the book Spondylolysis, Spondyloli sthesis, and Degenerative Spondylolisthesis by Robert Gunzburg and Marek Szpalsk i