Spondylolysis — when to begin PT?

SNL’s Jane Curtain and Dan Ackroyd may have found spondylolysis an interesting subject for debate!

One of the perennial ‘hot topics’ in pediatric sports medicine has to do with the diagnosis of spondylolysis — specifically, adolescent isthmic spondylolysis [an acquired stress injury of the pars interarticularis].  As with many controversies, people who treat this condition are often passionate about the specific issues under debate.

Among the more burning issues are to brace or not; what imaging modality to use (plain film, CT scan, SPECT scan, MRI); how long to ‘rest’ a patient before re-introducing a level of physical activity or instituting physical therapy (PT); and how to determine treatment success (clinical measures such as PROMs, or imaging to verify bony union of the pars interarticularis).

We recently published an original research article on the subject of when to begin PT in these athletes:  The Timing of Physical Therapy in Adolescent Athletes with Acute Spondylolysis

I am happy to report I was part of the team that conducted this study, and we found that in patients who began PT early, recovery to sport was faster:  ‘early PT’ athletes returned to their sport a mean of 25 days earlier than their counterparts who initially rested from all activity.  Moreover, there were significant differences in adverse reactions between the groups studied.

How do you approach the initiation of PT in your adolescent athletes with spondylolysis?  Take the poll and share your thoughts!