Spine Symposium Spotlight: Supporting Young Athletes with Spondylolysis

Insights shared by Trella Allen, Rebekah Wallach, and Karlie Gross

When working with adolescent athletes diagnosed with spondylolysis, Trella Allen, Rebekah Wallach, and Karlie Gross approach care as a team, prioritizing a safe, confident return to sport grounded in function rather than timelines alone. Their focus begins with ensuring full pain-free lumbar range of motion, appropriate joint mobility and stability, symmetrical trunk and lower extremity strength, and movement patterns that match the specific demands of each athlete’s sport and position.

Beyond physical readiness, the team emphasizes the importance of psychological recovery. Confidence, fear of re-injury, and trust in the body all factor into clinical decision-making, along with completion of a progressive return-to-play program before athletes are cleared for unrestricted activity.

Treatment plans are individualized and athlete-centered. Rather than relying solely on radiographic healing, the team progresses care based on criterion-based milestones and functional ability, recognizing that imaging findings do not always reflect quality of life or readiness to return to sport. Programs are tailored to the demands of each sport, ensuring athletes develop sufficient mobility, strength, and endurance across key regions, including the trunk, hips, shoulders, and ankles.

Education plays a critical role throughout the rehabilitation process. Helping athletes and families understand that spondylolysis is a temporary setback and that recovery is a collaborative effort can significantly reduce fear and improve consistency with physical therapy. When athletes understand how rehabilitation supports their return to play, adherence and outcomes improve.

Maintaining motivation during recovery is another priority. The team emphasizes goal-setting, both short- and long-term, to help athletes track progress through phases such as returning to running, jumping, sport-specific drills, and ultimately competition. Reframing rehabilitation as an opportunity to become a stronger, more resilient athlete, and encouraging continued connection with teammates and coaches helps reinforce a strong support system throughout the process.

From a broader clinical perspective, the team notes an important gap in current practice. To date, there is no formal return-to-play criteria for spondylolysis established in the literature, highlighting the need for continued research and collaboration in this area. When mentoring students and new clinicians, they stress the importance of early referral for imaging when spondylolysis is suspected, noting that timely diagnosis even when it requires rest from sport, can ultimately shorten recovery and support a safer return to play.