Forty-eight patients with symptomatic back pain secondary to spondylolisthesis who were treated conservatively were followed for three years after initial examination to compare the outcomes of two exercise programs. The patients were divided into two groups -- those doing flexion and those doing extension back strengthening exercises. All patients received instructions on posture, lifting techniques, and the use of heat for relief of symptoms. After three months, only 27% of patients who were instructed in flexion exercises had moderate or severe pain and only 32% were unable to work or had limited their work. Of the patients who were instructed in extension exercises, 67% had moderate or severe pain and 61% were unable to work or had limited their work. At three-year follow-up, only 19% of the flexion group had moderate or severe pain and 24% were unable to work or had limited their work. The respective figures for the extension group were 67% and 61%. The overall recovery rate after three months was 58% for the flexion group and 6% for the extension group. At three years these figures improved to 62% for the flexion group and dropped to 0% for the extension group. The literature is scarce regarding the applicability of conservative treatment programs for lumbar spondylolisthesis. On the basis of our findings, we suggest that if a conservative treatment program is elected, back flexion or isometric back strengthening exercises should be considered. The three-year follow-up data presented here lend support to this point of view.

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