Working Diagnosis:
Left L2 to L4 transverse process fractures

Treatment:
She was treated conservatively with rehabilitation and analgesics. TLSO brace was prescribed as needed.

Outcome:
She returned to low-level activity 54 days after the injury and to outdoor training on day 73. Her injury occurred at the end of the season, but she felt as though she would have been able to return to competitive play 90 days post injury. She no longer required oral opiate analgesics after day 34. The recovery was otherwise unremarkable and her gait returned to her self-reported baseline.

Author's Comments:
In sports, transverse process (TP) fractures are involved when there is high impact activity such as football, hockey, soccer, or snowboarding and skiing. Some cases have been reported from repeated micro trauma on the spine. The mechanism of injury is direct trauma and/or violent spasm of the quadratus lumborum or psoas muscles. TP fractures have been associated with abdominal injury in the general population in up to 48 percent of cases, but a study done in the NFL only identified 1 athlete of 29 with visceral injury. If uncomplicated, treatment includes RICE and analgesics. There is no specific recommendations on return to play, but the range for the study done in the NFL was 16-36 days.

Editor's Comments:
In athletes who suffer transverse process fractures, the treatment is typically conservative. However, RTP criteria are sport-specific, always keeping the athlete's safety as a priority. For instance, aquatic sport athletes should be restricted from water activity, especially if there is a requirement to swim because pain may prevent the athlete from swimming to safety.

References:
Tewes, Douglas P., Fischer, David A., Quick, Donald C., Zamberletti, Fred & Powell, John. (1995). Lumbar Transverse Process Fractures in Professional Football Players. The American Journal of Sports Medicine, 23 (4), 507-509.
Miller, CD, Blyth, P & Civil, ID. (2000). Lumbar transverse process fractures--a sentinel marker of abdominal organ injuries. Injury, 31 (10), 773-776
Bali, Kamal, Kumar, Vishal, Krishnan, Vibhu, Meena, Dharm & Rawall, Saurabh. (2011). Multiple lumbar transverse process stress fractures as a cause of chronic low back ache in a young fast bowler - a case report Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 3(1), 8.

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