Spondylolysis Recovery Plan

What you are treating

Spondylolysis is a stress fracture in a small bridge of bone at the back of a vertebra, almost always the lowest one in the low back. It comes from repeated arching and twisting, which is why it is common in gymnasts, divers, dancers, football linemen, wrestlers, rowers, and throwers in their preteen and teen years. The pain is in the low back, worse with arching, and usually there is no leg pain.

The good news: it heals, or it stops hurting, in nearly every child without surgery. The plan has three phases, and the total time is usually three to six months. Rushing phase one is the most common reason it takes longer.

Phase 1: rest the bone (usually 6 to 12 weeks)

• Stop the sport and anything that arches or twists the back. No running, jumping, lifting, or backbends. Walking, swimming (freestyle and backstroke, not butterfly or breaststroke), and a stationary bike are fine and encouraged.
• A brace: I use a low-profile rigid brace for a fresh fracture with a crack visible on CT, for pain that does not settle with rest alone, or for a child who cannot stay out of the sport without one. For many children, strict rest from the sport works as well as a brace. We decide together. If a brace is used, it is worn during the day for activities and can come off for sleep and showers.
• Pain control: acetaminophen if needed. I avoid anti-inflammatories for the first weeks, because they may slow bone healing.
• Physical therapy starts in this phase, with pain-free work only: posterior pelvic tilts, lower-belly tightening, hamstring and hip flexor stretching, and gentle core holds that keep the spine neutral.
• Rest means rest. Gym class, practice "just to watch" that turns into drills, and backyard play all count.

Phase 2: rebuild (usually 4 to 8 weeks)

Begins when your child has been pain-free with daily activities for at least two weeks.

• Core and hip strengthening in neutral: curl-ups, side planks, bird-dogs, bridges, and later squats and hip hinges with the back flat. The goal is a trunk that resists arching under load.
• Flexibility of the hamstrings and hips, which pull the low back into an arch when they are tight.
• Gradual return to running: walk-jog intervals, then straight-line running, then cutting.
• Sport-specific movements added last, in a controlled setting, at half effort, then full effort.
• The brace, if used, is weaned during this phase.

Phase 3: return to sport

• Full practice before full games. One sport at a time.
• Your child must be pain-free with every sport-specific movement, including the arching ones, before clearance.
• Keep the core program going for the rest of the season and beyond. It is the best protection against a recurrence.
• Technique matters: a coach or therapist who can look at the landing, the swing, the block, or the serve and reduce the arch is worth the time.

Why the hamstrings matter

In spondylolysis the hamstrings are almost always tight; it is one of the first things I check. Stiff hips force the spine to make up the motion in both directions, which is exactly the repeated arching and twisting that stresses the healing pars. Here is why they matter so much: The hamstrings run from the sitting bones at the back of the pelvis to just below the knee. When they are tight, they pull the back of the pelvis down and tuck it under (a posterior pelvic tilt), which flattens the natural inward curve of the low back (the lumbar lordosis). A flat low back then has to round forward every time you bend, sit, or reach, because the hips cannot. Freer hamstrings reverse that chain: the pelvis can tilt forward again, the low back keeps its curve, bending comes from the hips (the hip hinge) instead of the spine, and the pressure inside the discs and the strain on the structures behind them fall. Stretch each hamstring for 20 to 30 seconds, 3 to 5 times, once or twice a day, with the low back kept flat, and roll the back of the thigh on a foam roller first if that helps. The gain comes from the nervous system allowing more length, so it stays only with regular stretching. The full explanation is in my core program for low back pain.

How we check healing

• The X-ray and MRI at diagnosis tell me how fresh the fracture is. A fresh fracture with swelling in the bone has a good chance of healing solidly with rest. An older fracture may not heal with bone, but it usually stops hurting, and that is what matters for returning to sport.
• I often repeat a low-dose CT scan after phase one in a fresh fracture, to see whether bone has bridged the crack. It guides how long to protect it.
• Pain-free movement is the main test for return to sport.

What to watch for

• Pain that returns after return to sport usually means a short step back to phase two, not starting over.
• If the two sides of the bone have both cracked, the vertebra can slip forward a little over time (spondylolisthesis). I follow this with standing X-rays through growth. Most slips are small and stay small.
• Leg pain, numbness, or weakness are not typical of spondylolysis and need a visit.

If it does not settle

A small number of children have pain that continues after six to twelve months of a proper program. For them, a direct repair of the fracture with screws, or a fusion of the single level, has excellent results and a return to sport afterward. Surgery is reserved for when it is truly needed, and it rarely is.

Learn more

OrthoInfo, Spondylolysis and Spondylolisthesis: orthoinfo.aaos.org (opens in a new tab)

My guides to spondylolysis and isthmic spondylolisthesis.

More for families

OrthoKids · POSNA

POSNA's OrthoKids: illustrated, family-friendly information on this condition.

Open on OrthoKids (opens in a new tab)

Scan for the OrthoKids page

This plan is general guidance for Dr. Wey's patients and their families and does not replace the advice we discuss in clinic about your child's specific injury. Return-to-sport dates are decided together at visits, not from this sheet.