Transverse Process Fractures in Athletes: Mechanisms, Management and Return-to-Play Considerations

Transverse process fractures (TPFs) are typically considered minor stable spinal injuries. However, in professional athletes, these fractures can significantly impact function, training and return-to-play decisions. This narrative review examines the anatomy of transverse processes, mechanisms of injury, clinical presentation, imaging modalities, management strategies, rehabilitation principles and return-to-play considerations. A comprehensive review of the literature was conducted, incorporating case studies, sports medicine reports and trauma data to provide an evidence-based approach to TPF diagnosis and management in professional athletes. TPFs in athletes typically result from high-energy direct trauma, excessive rotational forces or muscular avulsion. While inherently stable, they may be associated with concomitant injuries, necessitating a thorough clinical and radiologic evaluation. Despite emerging imaging techniques (e.g. magnetic resonance imaging [MRI] three-dimensional [3D] T1 volumetric interpolated breath-hold examination [VIBE]), computed tomography (CT) imaging remains the gold standard for diagnosis, with MRI useful for detecting soft tissue pathology. Treatment is predominantly non-operative, focusing on multimodal pain control, early mobilization and structured rehabilitation to restore spinal function while preventing complications. Return-to-play is individualized, with most athletes resuming full activity within 3-6 weeks for isolated TPFs, though multi-level fractures or associated injuries may prolong recovery. TPFs require careful assessment and management to ensure optimal recovery and a safe return-to-play. A multidisciplinary approach involving orthopaedic surgeons, musculoskeletal radiologists, sports physicians, physiotherapists, sport scientists and coaching staff is essential to balance expedient recovery without long-term sequelae. Understanding sport-specific demands and implementing tailored rehabilitation protocols can allow athletes to make a complete recovery with minimal risk of recurrence.