Lumbar Spondylolysis / Spondylolisthesis — Non-Operative

Sanford Health

Weight-Bearing

WBAT; avoid spinal loading and impact activities early; bracing reserved for patients whose symptoms fail to improve with conservative treatment

Key Restrictions

Avoid lumbar extension, spinal loading, and impact activities early; limit lumbar extension ROM and strengthening past neutral in early phases; bracing if conservative treatment fails; bilateral pars defects = longer timeline; athletes stopping sports ≥3 months are 16x more likely to have excellent outcome; earlier PT initiation leads to faster RTS; repeat imaging only if symptomatic after 12 wks

Timeline & Phases

4 phases: Phase I Immobilization (0-6 wks, usually determined by physician; avoid pain-provoking and loaded lumbar extension), Phase II (criteria-based: neutral trunk stabilization, trunk and hip endurance, light jog at 50% intensity to progress), Phase III Fundamental Movements and Advanced Strengthening (criteria-based: anti-extension/anti-rotation trunk work, goblet squat, single-leg squat and deadlift, prepare for running and plyometrics), Phase IV Return to Sport (return to running program, agility, plyometrics, sport-specific loading). General healing 3-6 months; bilateral defects lengthen timeline

Published

02/2024