Spine and Sports Program

As recently as the 1970s, spinal stress fractures (spondylolysis) largely went untreated. Spondylolysis was considered a condition that could not be fixed.

Physicians at Boston Children’s recognized a high rate of the condition in athletes and suspected that it was, in fact, a sports injury. By showing that many spinal stress fractures would heal with treatment, they changed the way athletes with spondylolysis were diagnosed and treated. Several years later, our physicians further updated the spondylolysis treatment protocol, once again influencing practices around the country and further improving patient outcomes.

Today, sports medicine programs around the country follow this protocol with their patients with spondylolysis.

Rehabilitation of spondylolysis

We continue to refine treatment protocols for spondylolysis. The treatment of spondylolysis involves focused physical therapy dedicated to strengthening the muscles of the front of the core of the body, while avoiding extension of the spine and stretching the muscles of the posterior core of the body. In addition, bracing that limits extension of the spine helps the fracture to heal.

How risk factors for spondylolysis vary by sport

Sports that involve repeated arching of the back or twisting of the back increase the risk of spondylolysis. In addition, tightness of the muscles increases the risk of spondylolysis, especially during periods of growth. We continue to investigate risk factors for spondylolysis and how to reduce that risk in young athletes.

Returning to sport with Chiari malformation

Chiari malformation is an abnormality of the relationship between the brain and the top of the spine. In patients with a Chiari malformation, some of the brain tissue rests in the upper spinal canal as opposed to the skull. For years, children diagnosed with this condition have been advised to avoid sports, however, no data existed showing that athletes with Chiari malformation were at higher risk of serious injury than other athletes.

We conducted a study of patients at Boston Children’s with Chiari malformations and showed that for many, the risk of suffering a catastrophic injury is low. Thus, instead of making a blanket recommendation for all athletes with Chiari malformation to avoid sports, we help guide the athletes through the process of weighing the risks of participating against the benefits and reach a decision. Most athletes with Chiari malformations are able to return to sports safely.