Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine.
Evidence Acquisition:
Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015.
Study Design:
Clinical review.
Level of Evidence:
Level 4.
Results:
Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed.
Conclusion:
Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.
BanerjeeRFadalePPalumbiM. Cervical spine injuries in the athlete. In: JohnsonDHPedowitzRA, eds. Practical Orthopedic Sports Medicine and Arthroscopy. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:54-69.
6.
BanerjeeRPalumboMAFadalePD. Catastrophic cervical spine injuries in the collision sport athlete. Part I. Epidemiology, functional anatomy, and diagnosis. Am J Sports Med. 2004;32:1077-1087.
7.
BeckNAMillerRBaldwinK. Do oblique radiographs add value in the diagnosis of spondylolysis in adolescents?J Bone Joint Surg Am. 2013;95:e65.
8.
BrighamCDCapoJ. Cervical spinal cord contusion in professional athletes: a case series with implications for return to play. Spine (Phila Pa 1976). 2013;38:315-323.
9.
BurnettMGSonntagVK. Return to contact sports after spinal surgery. Neurosurg Focus. 2006;21:E5.
10.
CantuRC. Functional cervical spinal stenosis: a contraindication to participation in contact sports. Med Sci Sports Exerc. 1993;25:316-317.
11.
CantuRCLiYMAbdulhamidMChinLS. Return to play after cervical spine injury in sports. Curr Sports Med Rep. 2013;12:14-17.
12.
CiulloJVJacksonDJ. Pars interarticularis stress reaction, spondylolysis, and spondylolisthesis in gymnasts. Clin J Sports Med. 1985;4:95-110.
13.
DebnathUKFreemanBJGregoryPde la HarpeDKerslakeRWWebbJK. Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes. J Bone Joint Surg Br. 2003;85:244-249.
14.
d’HemecourtPAZurakowskiDKriemlerSMicheliLJ. Spondylolysis: returning the athlete to sports participation with brace treatment. Orthopedics. 2002;25:653-657.
15.
EckJCRileyLH3rd. Return to play after lumbar spine conditions and surgeries. Clin J Sports Med. 2004;23:367-379.
16.
EddyDCongeniJLoudK. A review of spine injuries and return to play. Clin J Sport Med. 2005;15:453-458.
17.
ElattracheNFadalePFuF. Thoracic spine fracture in a football player. Am J Sports Med. 1993;21:157-160.
18.
EllisJLGottliebJE. Return-to-play decisions after cervical spine injuries. Curr Sports Med Rep. 2007;6:56-61.
19.
FredricksonBEBakerDMcHolickWJYuanHALubickyJP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am. 1984;66:699-707.
HausBMMicheliLJ. Back pain in the pediatric and adolescent athlete. Clin J Sports Med. 2012;31:423-440.
22.
HeleniusILambergTOstermanK. Scoliosis research society outcome instrument in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients. Spine (Phila Pa 1976). 2005;30:336-341.
23.
HerzogRJWiensJJDillinghamMFSontagMJ. Normal cervical spine mophometry and cervical spinal stenosis asymptomatic professional football players. Spine (Phila Pa 1976). 1991;16(6 suppl):S178-S186.
24.
HsuWK. Outcomes following nonoperative and operative treatment for cervical disc herniations in National Football League athletes. Spine (Phila Pa 1976). 2011;36:800-805.
25.
HsuWKMcCarthyKJSavageJW. The professional athlete spine initiative: outcomes after lumbar disc herniation in 342 elite professional athletes. Spine J. 2011;11:180-186.
26.
JensenMCBrant-ZawadskiMNObuchowskiN. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69-73.
27.
KeplerCKVaccaroAR. Injuries and abnormalities of the cervical spine and return to play criteria. Clin J Sports Med. 2012;31:499-508.
28.
LiYHreskoMT. Lumbar spine surgery in athletes: outcomes and return-to-play criteria. Clin J Sports Med. 2012;31:487-498.
29.
MarkeyKDiBenedettoMCurlW. Upper trunk brachial plexopathy: the stinger syndrome. Am J Sports Med. 1993;21:650-655.
30.
McHugh-PierinaVLZillmerDAGiangarraCE. Thoracic compression fracture in a basketball player. J Athl Train. 1995;30:163-164.
31.
MorgantiCSweeneyCAAlbaneseSABurakCHoseaTConnollyPJ. Return to play after cervical spine injury. Spine (Phila Pa 1976). 2001;26:1131-1136.
32.
National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Information Network—Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham; 2014.
33.
RadcliffKEKalantarSBReitmanCA. Surgical management of spondylolysis and spondylolisthesis in athletes: indications and return to play. Curr Sports Med Rep. 2009;8:35-40.
34.
ReitmanCAEssesSI. Direct repair of spondylolytic defects in young competitive athletes. Spine J. 2002;2:142-144.
35.
RihnJAAndersonDTLambK. Cervical spine injuries in American football. Sports Med. 2009;39:697-708.
36.
RossiFDragoniS. Lumbar spondylolysis: occurrence in competitive athletes: updated achievements in a series of 390 cases. J Sports Med Phys Fitness. 1990;30:450-452.
37.
RuberyPTBradfordDS. Athletic activity after spine surgery in children and adolescents: results of a survey. Spine (Phila Pa 1976). 2002;27: 423-427.
TallaricoRAMadomIAPalumboMA. Spondylolysis and spondylolisthesis in the athlete. Am J Sports Med. 2000;28:57-62.
40.
TorgJS. Cervical spine injuries and the return to football. Sports Health. 2009;1:76-383.
41.
TorgJSNaranjaRJPavlovH. The relationship of developmental narrowing of the cervical spinal canal to reversible and irreversible injury of the cervical spinal cord in football players. J Bone Joint Am. 1996;78-A:1308-1314.
TorgJSVegsoJJO’NeillMJSennettB. The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma. Am J Sports Med. 1990;18:50-57.
44.
VaccaroARKleinGRCiccotiM. Return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis. Spine J. 2002;2:351-356.
45.
VaccaroARWatkinsBAlbertTJPfaffWLKleinGRSilberJS. Cervical spine injuries in athletes: current return-to-play criteria. Orthopedics. 2001;24:699-703.
46.
WatkinsRG4thHannaRChangDWatkinsRG3rd. Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes. Am J Sports Med. 2012;40:2530-2535.
47.
WeinsteinJLurieJDTostesonTD. Surgical vs nonoperative treatment for lumbar disc herniation: the spine patient outcomes research trial: a randomized trial. JAMA. 2006;296:2451-2459.
48.
WeistrofferJKHsuWK. Return-to-play rates in National Football League linemen after treatment for lumbar disk herniation. Am J Sports Med. 2011;39:632-636.
49.
ZmurkoMGTannouryTYTannouryCAAndersonDG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin J Sports Med. 2003;22:513-521.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
