Rehabilitation and Return to Competition of a High Level Athlete with Spondylolysis and Contact Sport Related Recurrent LS Radiculopathy

Background: The management of lumbar spondylolysis in the adolescent athlete is an evolving arena of sports medicine.

Purpose: This study presents a case report of a high level adolescent athlete with lumbar spondylolysis who sustained multiple episodes of stretch injury to the L5 nerve root.
Study Design: Case Report.

Methods: The patient has been followed for one year after presentation and a case report was constructed after chart review.

Results: The authors report on a case of a 15 yr. athlete who presented with an acute onset of left sided foot drop after being tackled in the left flank during a high school football game. The patient had a similar episode of transient left sided foot numbness and tingling and weakness after suffering a forceful tackle one year prior. Examination and imaging confirmed left sided L5 dermatomaland myotomal deficits secondary to bilateral pars interarticularis defects at L5. There was no spondylolisthesis or compressive lesion. The patient was treated with activity restriction and eight weeks of aggressive physiotherapy. Within four months of his injury, the patient had regained complete L5 nerve root function and was released to compete in non-contact sports. He gained state-wide distinction in his first track and field event after completion of his therapy. At one year follow-up, the patient has no neurological difficulties and only intermittent episodes of back pain.

Conclusion: This case provides an opportunity to review management of and return-to-play protocols for athletes with spondylolysis. It demonstrates that a patient with a L5 nerve root subjected to repeated stretch injury can nevertheless heal completely with an appropriate designed physiotherapy regimen.
This case report also shows that a young athlete presenting with spondylolysis and neurological deficit after a contact sport injury can recover fully and still successfully continue athletic pursuits in noncontact competitive sports.