PT Pro Talk Ep 195. Beyond the Slip: How to Assess and Treat Spondylolisthesis with Dr. Robert Medcalf
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Jan 15, 2026 Dr. Robert Medcalf, a physical therapist and McKenzie Institute senior faculty known for spine and MDT expertise. He discusses what spondylolisthesis is and why imaging can mislead. He explains where pain likely comes from and how mechanical exams guide flexion versus extension. He covers rehab strategies, when to consider imaging for instability, and indications for surgery.
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Patients Who Look Like Derangements
- Robert describes patients who presented with spondylolisthesis yet behaved like MDT derangements, centralizing with extension.
- He says without imaging he wouldn't have known and would have treated them successfully with extension.
Test Movement, Don't Treat The Film
- Do not base treatment direction solely on imaging; perform a mechanical MDT examination to find a directional preference.
- Use symptom response (centralization/abolition) to guide loading direction rather than x-ray findings.
Most Slips Don’t Move Much On Motion Films
- Flexion-extension films show varied behavior: ~70% stable, ~15% accentuate slip with flexion, ~15% paradoxically worsen with extension.
- Most grade 1 slips do not increase on extension, so fear of extension worsening slip is often overstated.