Pain which is worsened by increasing the lumbar lordosis, standing and walking is called posterior element pain. Posterior element pain is eased by maintained forward flexion, sitting, hip flexion ( with or without knee extended). Patients who have structural or postural hyperlordosis, who have facet arthropathy, and who suffer from foraminal stenosis show feature of posterior element pain. Pain from extension and rotation are usually of facet origion. Flexion treatment frequently improve the facet disease, spondylolysis, flexion dysfunction and certain types of derangement. Prescription of hyperextension exercises may make the condition worse. The goal of exercises should be to improve the abdominal strength and flexibility. As the hamstring muscles are often tight, so the stretching exercises for the hamstrings should also be emphasized. Pelvic tilt exercises also help to reduce any postural component causing increased lumbar lordosis. Myofascial release may also play a role in reducing pain from the surrounding soft tissues.

The role of bracing for reducing the pain of acute spondylolysis is controversial. The most commonly prescribed braces are thoracolumosacral spinal orthosis (TLSO) or modified Boston Brace.

The use of modalities can be given. These are used in isolation or in combination therapy according to the experience of the therapist. Superficial heating methods like Infra reds, electrical heating pads, moist heat pads & deep heating methods like Short wave Diathermy, Microwave Diathermy, ultra sound therapy & electrical stimulation like TENS, Interferential, high voltage pulsed current generators and diadynamic currents all can be used accoring to individual choice and case selections.

So advice about the spinal flexion exercises, bicycling and walking on sloped treadmill will improve the condition of patient. Patient should be restricted from the provocative activities that increase pain. Activities and exercises that reduces the extension stress are helpful in reducing pain especially in the acute episodes.