# Effectiveness of a Progressive Rehabilitation Approach Without Sport Activity Restriction for Acute Lumbar Spondylolysis in High-Level Athletes: A Retrospective Case Series

## TL;DR

This study shows that high-level athletes with acute lower back injuries can return to sports quickly using a rehab program without activity restrictions.

## Contribution

A progressive rehab approach without activity restriction enables faster return to sport for athletes with acute lumbar spondylolysis.

## Key findings

- 100% of athletes returned to sport with a median recovery time of 65 days.
- MRI improvement was observed in 83.3% of patients.
- No recurrence was observed during follow-up.

## Abstract

Objective: This study aimed to examine the characteristics and clinical outcomes of high-level athletes with acute lumbar spondylolysis (ALS) treated with a progressive rehabilitation (PR) approach without rigid bracing or activity restriction.

Methods: This retrospective consecutive case series included seven high school or collegiate athletes competing at the national level who underwent a PR approach for ALS at our institution between January 2023 and December 2024. One athlete was excluded due to loss to follow-up, leaving six athletes for analysis. The intervention consisted of a PR program without rigid bracing or activity restriction, emphasizing stepwise mobility, stability, strengthening, and pain-based progression of functional movements. Main outcomes included MRI findings, pain status, return-to-sport (RTS) rate and period, and follow-up duration.

Results: Traumatic episodes were the most common etiological factor (66.7%), involving high ground reaction force movements or excessive lateral bending. MRI improvement was observed in five patients (83.3%), and pain resolution occurred in all six patients (100%). The RTS rate was 100%, with a median RTS period of 65 days (range, 54-112), which was shorter than previously reported for conservative treatment. No recurrence occurred during follow-up (median, 109 days).

Conclusions: A PR approach without rigid bracing or activity restriction enabled early RTS in high-level athletes with ALS, with symptom improvement and no recurrence. This approach may allow modification of pain-provoking or injury-related movements and help minimize declines in physical fitness and body composition associated with activity restriction. It may be suitable for post-growth high-level athletes who understand the risks related to bone healing and require timely RTS, although further research is needed to clarify stage-specific indications and long-term outcomes.