Non-Operative — Spinal Instability / Spondylolysis (Non-Operative)

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

WBAT; bracing may be recommended Phase I; avoid lumbar extension with all activity Phase I

Key Restrictions

AVOID lumbar extension with activity, positioning, manual therapy, and exercise Phase I (critical — pars interarticularis stress fracture); bracing Phase I; no lumbar extension criteria to progress Phase I; avoid lumbar extension with strength training throughout

Timeline & Phases

4 phases: Phase I (0-6 wks, 2-4 visits — no lumbar extension, STM, thoracic/hip mob, local TA/MF core, hip strengthening, walking/bike/NuStep), Phase II (6-9 wks, 4-6 visits — neutral stabilization: dead bug/bird dog/side-bridge, hip strengthening, closed chain — squats/hip ER/side-step, D/C brace if pain-free ADLs), Phase III (9-12 wks, 4-6 visits — front/side plank, anti-rotation, squats, deadlifts, overhead press, plyometrics, return to run), Phase IV (12+ wks — sport-specific, medicine ball, reactive training)

Notes

January 2025; for pars interarticularis stress fracture / spondylolysis / spondylolisthesis; lumbar extension is the critical precaution Phase I; FABQ and STarT Back Tool for chronic; side bridge 80 seconds required for Phase II criteria; prone DL raise >30 sec and supine DL lowering <70 degrees for Phase III. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-06-16.]

Surgeon / Author

MGH Sports Medicine

Published

January 2025