This is a very good question and one that has come under debate and discussion as well as study by physical therapists and other orthopedic health care specialists. In an effort to identify the most helpful conservative (nonoperative) care for these patients, a group of physical therapists recently conducted a systematic review and reported their findings.
They conducted a computer-assisted search of articles published in English over a span of 46 years (from 1966 to 2012). After gathering all the acceptable articles and compiling all the information, the authors organized the data into five tables. Information in these tables included:
1) Description of each study (design, patient demographics, training type and duration)
2) Type of injury (acute versus chronic, severity) and type of surgery (decompression, fusion, fusion with or without instrumentation)
3) Comparison of outcomes for nonoperative treatments (bracing versus activity restriction)
4) Comparison of outcomes for nonoperative treatments (bracing and physical therapy versus placebo/control)
5) Results for exercise interventions (core training, back strengthening, postural exercises, general exercise)
Although the information was carefully organized, as it turned out, many of the studies collected (and reported on) different things. There wasn’t enough consistency across studies to make comparisons with meaning. The authors report “limited investigation” and “lack of homogeneity” as the two main reasons there was no consensus on the role of conservative care or on outcomes of nonoperative care versus surgery for this condition.
There was one other major stumbling block in studying the effects of exercise: poor patient compliance. In other words, the patients didn’t do the exercises as prescribed (or didn’t do them at all)! With the limited evidence available, the best that can be said is that exercise to strengthen the core muscles (abdominals and trunk stabilizers) decreases pain and improves function.
No evidence but clear consensus (based on expert opinion or case studies suggest) suggested that bracing works better for healing the fracture when compared with restricted activity for children and teens with spondylolysis (fracture without separation). Some case series studies showed that more young people return to full activity (and sports participation) when bracing was combined with specific exercises.
There is also some evidence that specific core training to strengthen the abdominal muscles and trunk stabilizing muscles can aid conditions like spondylolysis. These findings may offer some direction in your child’s situation. It may be best to work with your physician and physical therapist to identify the most appropriate treatment for your young teenager.
Location and severity of injury, activity level, and likelihood of compliance are all important considerations in the planning process. There’s no sense in spending money on a brace that gets left under the bed or an exercise program that is never carried out. Having a physical therapist involved may provide the incentive needed to ensure or improve your child’s compliance with the recommendations.