Rehabilitation Strategies for Adolescent Athletes with Spondylolysis

Adolescent spondylolysis requires a clear rehabilitation plan: timing of physical therapy (PT) influences symptom control and return-to-play for youth athletes. Clinicians therefore face a practical question—when to begin PT to best balance pain relief, functional recovery, and safe sport resumption?

Available studies show inconsistent links between early PT initiation and radiographic healing. The literature—largely retrospective cohorts and case series, with sample sizes from small institutional reports to multicenter compilations—uses endpoints such as radiographic union, symptom resolution, and time-to-return-to-play. Heterogeneity across study designs and endpoints supports an individualized approach to timing in adolescent spondylolysis.

Timing of rehabilitation must be considered alongside concrete nonoperative measures: activity modification, bracing, structured core-strengthening, and graded return-to-play progressions. Across reports, bracing and early activity restriction often accelerate pain control; structured core and lumbar-stabilization programs commonly improve function and reduce symptoms; and graded progressions align with safer time-to-return-to-play. Integrated nonoperative management components therefore remain central determinants of clinical recovery and typically guide decisions about advancing sport activity.

Clinicians currently implement PT timing variably, with three common patterns: initiate PT at diagnosis, defer until radiographic healing is documented, or stage PT after a period of bracing and activity restriction. The trade-offs are familiar—earlier PT can yield faster symptom control and functional gains, while radiographic healing rates are often unchanged by the timing of therapy. In sum, practice is heterogeneous and standardized guidance for PT initiation is lacking.