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Abstract and Introduction
Abstract
Decisions regarding the return of injured athletes to contact sports after spinal surgery can be complicated. The authors offer a brief overview of the return-to-play guidelines used successfully at their institution for the past two decades when caring for professional and amateur athletes after spinal surgery.
Introduction
Postoperative care of athletes after spinal surgery can be challenging. Athletes are often model patients, following doctors' orders faithfully and working hard in physical therapy. They are highly motivated to make a rapid recovery and to return to full participation in sports. Unfortunately, this desire to return to play can make a protracted rehabilitation period frustrating for both physician and patient. The decision to prohibit athletes from returning to play can have significant emotional and financial implications. Surgeons may feel pressure from patients (or their employers in the case of professional athletes) to shorten the customary postoperative period for rest or bracing. Surgeons also may be pressured to allow athletes to participate in sports after surgery when it is contraindicated. The current medicolegal climate further complicates decision making because fear of future litigation can prompt physicians to be overly conservative in their recommendations about returning to full competition.
Given the external pressures physicians must face regarding postoperative care and return-to-play restrictions, a discrete body of literature to aid decision making or at least a set of consensus guidelines developed by spinal surgeons to assist treating physicians would be beneficial. Unfortunately, there are no such guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than on postoperative care issues. Consequently, there is little information to guide practitioners.
In this article we attempt to provide a framework to assist decision making with regard to return to play after spinal surgery. Because the literature is incomplete, we have integrated published research with the senior au thor's (V.K.H.S.) current practice paradigm for dealing with college and professional athletes. As a general matter of practice, athletes requiring a repeated operation or additional surgery in the same spinal region are absolutely prohibited from returning to contact sports. Therefore, the following discussion is limited to first-time surgery.
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