Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis

Selhorst, Mitchell; Fischer, Anastasia; Graft, Kristine; Ravindran, Reno; Peters, Eric; Rodenberg, Richard; Welder, Eric; MacDonald, James

doi:10.1097/jsm.0000000000000334

Cited by 17 publications

(15 citation statements)

References 23 publications

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“…4,[19][20][21] More on the features of these conditions is listed in TABLE 1. [1][2][3][4][5][6][7][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30] History: Focus on onset, timing, and duration of symptoms As with adults, obtaining a history that includes the onset, timing, and duration of symptoms is key in the evaluation of low back pain in children, as is obtaining a history of the patient's activities; sports that repetitively load the lumbar spine in an extended position increase the risk of injury. 10 Specific risk factors for low back pain in children and adolescents are poorly understood.…”

Section: Strength Of Recommendation (Sor)mentioning

confidence: 99%

“…26,43,44 When returning athletes to their sport, aggressive PT, defined as rest for < 10 weeks prior to initiating PT, is superior to delaying PT beyond 10 weeks of rest. 27 ❚ Idiopathic scoliosis. Much of the literature on the treatment of scoliosis is focused on limiting progression of the scoliotic curvature.…”

Section: Images Courtesy Of Penn State Milton S Hershey Medical Centermentioning

confidence: 99%

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Low back pain in youth: Recognizing red flags

Phillips¹

2020

The Journal of Family Practice

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Low back pain in youth: Recognizing red flags Although low back pain in children and teens is usually benign, recognizing red flags that indicate the need for imaging, referral, bracing, or surgery is critical. L ow back pain in not uncommon in children and adolescents. 1-3 Although the prevalence of low back pain in children < 7 years is low, it increases with age, with studies reporting lifetime prevalence at age 12 years between 16% and 18% and rates as high as 66% by 16 years of age. 4,5 Although children and adolescents usually have pain that is transient and benign without a defined cause, structural causes of low back pain should be considered in school-aged children with pain that persists for > 3 to 6 weeks. 4 The most common structural causes of adolescent low back pain are reviewed here. Etiology: A mixed bag Back pain in school-aged children is most commonly due to muscular strain, overuse, or poor posture. The pain is often transient in nature and responds to rest and postural education. 4,6 A herniated disc is an uncommon finding in younger school-aged children, but incidence increases slightly among older adolescents, particularly those who are active in collision sports and/or weight-lifting. 7,8 Pain caused by a herniated disc often radiates along the distribution of the sciatic nerve and worsens during lumbar flexion. ❚ Spondylolysis and spondylolisthesis are important causes of back pain in children. Spondylolysis is defined as a defect or abnormality of the pars interarticularis and surrounding lamina and pedicle. Spondylolisthesis, which is less common, is defined as the translation or "slippage" of one vertebral segment in relation to the next caudal segment. These conditions commonly occur as a result of repetitive stress. In a prospective study of adolescents < 19 years with low back pain for > 2 weeks, the prevalence of spondylolysis was 39.7%. 9 Adolescent athletes with symptomatic low back pain are more likely to have spondylolysis than nonathletes (32% vs 2%, respectively). 2,10 Pain is often made worse by extension of the spine. Spondylolysis and spondylolisthesis can be congenital or acquired, and both can be asymptomatic. Children

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Section: Strength Of Recommendation (Sor)mentioning

confidence: 99%

Section: Images Courtesy Of Penn State Milton S Hershey Medical Centermentioning

confidence: 99%

Low back pain in youth: Recognizing red flags

Phillips¹

2020

The Journal of Family Practice

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“…Second, the extensive therapeutic resources at the disposal of American professional baseball players range far beyond what is routinely available to amateur athletes. A recent investigation by Selhorst et al 34 supports this assertion, as athletes referred to physical therapy sooner after a spondylolytic episode made a full return to sport nearly 1 month faster than their late referral counterparts, with no difference in adverse effects between the groups.…”

Section: Discussionmentioning

confidence: 90%

Epidemiology, Treatment, and Performance-Based Outcomes in American Professional Baseball Players With Symptomatic Spondylolysis and Isthmic Spondylolisthesis

et al. 2020

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Background: Repetitive lumbar hyperextension and rotation during athletic activity affect the structural integrity of the lumbar spine. While many sports have been associated with an increased risk of developing a pars defect, few previous studies have systematically investigated spondylolysis and spondylolisthesis in professional baseball players. Purpose: To characterize the epidemiology and treatment of symptomatic lumbar spondylolysis and isthmic spondylolisthesis in American professional baseball players. We also sought to report the return-to-play (RTP) and performance-based outcomes associated with the diagnosis of a pars defect in this elite athlete population. Study Design: Descriptive epidemiology study. Methods: A retrospective cohort study was conducted among all Major and Minor League Baseball (MLB and MiLB, respectively) players who had low back pain and underwent lumbar spine imaging between 2011 and 2016. Players with radiological evidence of a pars defect (with or without listhesis) were included. Analyses were conducted to assess the association between player-specific characteristics and RTP time. Baseball performance metrics were also compared before and after the injury episode to determine whether there was an association between the diagnosis of a pars defect and diminished player performance. Results: During the study period of 6 MLB seasons, 272 professional baseball players had low back pain and underwent lumbar spine imaging. Overall, 75 of these athletes (27.6%) received a diagnosis of pars defect. All affected athletes except one (98.7%) successfully returned to professional baseball, with a median RTP time of 51 days. Players with spondylolisthesis returned to play faster than those with spondylolysis, MLB athletes returned faster than MiLB athletes, and position players returned faster than pitchers. Athletes with a diagnosed pars defect did not show a significant decline in performance after returning to competition after their injury episode. Conclusion: Lumbar pars defects were a common cause of low back pain in American professional baseball players. The vast majority of affected athletes were able to return to competition without demonstrating a significant decline in baseball performance.

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“…También estudian el uso de órtesis sin obtener resultados claros acerca de su eficacia. Las principales órtesis usadas en los estudios analizados son toracolumbosacras y lumbosacras 17, [19][20][21][22]31 . También se incluyen otras ortesis alternativas 20,22,25 , pautándose incluso cambios en ella a lo largo del tiempo 25 .…”

Section: Discussionunclassified

“…En los conservadores, se establecen tiempos de medias cercanas a 2.5 meses 21, 22 . Se genera la hipótesis de si el tiempo de reposo afecta al retorno deportivo, lo cual se puede comprobar en los resultados de Selhorst et al 20 donde los pacientes con menos reposo vuelven al deporte antes que los de mayor periodo de descanso. Al comprobar que un menor tiempo de reposo puede generar los mismos buenos resultados, se debería prescribir el reposo mínimo imprescindible para evitar debilidad muscular y otros problemas físicos y psicológicos en los pacientes.…”

Section: Discussionunclassified

Tratamiento y vuelta a la práctica deportiva en jóvenes con diagnóstico de espondilosis. Revisión sistemática

García-Sequeiros

Taboada-Iglesias

2020

Rev And Med Dep

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Objetivo: analizar los tratamientos aplicados en pacientes menores de edad con espondilólisis y ver su relación con la vuelta al deporte. Método: se revisaron los artículos en inglés, español o portugués publicados entre 2015 y 2020 publicados en PubMed, Medline, Cinahl, Scopus, Sport Discuss y Web Of Science, seleccionando aquellos que reflejasen el tratamiento de espondilólisis en menores de 18 años y su vuelta al deporte. Se seleccionaron 10 artículos que cumplieron con los criterios de inclusión y exclusión y fueron analizados. Conclusión: el tratamiento conservador es la primera opción para todos los pacientes con espondilólisis, pero parece ser efectivo en las etapas tempranas y progresivas, siendo la opción ideal para las espondilólisis terminales una intervención mínimamente invasiva. Ambos tratamientos deben constar de un periodo de reposo de la actividad deportiva y una rehabilitación física progresiva antes de retomarla.

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Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis

Abstract: Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.

Cited by 17 publications

References 23 publications

Low back pain in youth: Recognizing red flags

Low back pain in youth: Recognizing red flags

Epidemiology, Treatment, and Performance-Based Outcomes in American Professional Baseball Players With Symptomatic Spondylolysis and Isthmic Spondylolisthesis

Tratamiento y vuelta a la práctica deportiva en jóvenes con diagnóstico de espondilosis. Revisión sistemática

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