{"id":27298,"date":"2026-02-12T12:00:33","date_gmt":"2026-02-12T11:00:33","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=research&p=27298"},"modified":"2026-02-11T21:31:23","modified_gmt":"2026-02-11T20:31:23","slug":"active-lumbar-spondylolysis-in-adolescents","status":"publish","type":"research","link":"https:\/\/www.physiotutors.com\/research\/active-lumbar-spondylolysis-in-adolescents\/","title":{"rendered":"Early or Delayed Physiotherapy for Active Lumbar Spondylolysis in Adolescents"},"featured_media":27305,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"featured-tag":[],"tracking_tag":[2204,2192],"class_list":["post-27298","research","type-research","status-publish","has-post-thumbnail","hentry","tracking_tag-exercise","tracking_tag-lumbar-sij"],"acf":{"free_access":"unfree","app_link":"https:\/\/app.physiotutors.com\/research-reviews\/active-lumbar-spondylolysis-in-adolescents","sections":[{"acf_fc_layout":"page-header-small","background":{"background_image":27304,"background_image_alt_text":""},"heading":"Early or Delayed Physiotherapy for Active Lumbar Spondylolysis in Adolescents","subheading":"Selhorst et al. (2026)","benefits":[{"benefit":"Starting physiotherapy immediately leads to much faster pain reduction and functional improvement"},{"benefit":"Secondary outcomes confirm: early physiotherapy gets the athlete back to their sport over a month sooner, and drastically reduces the chances of their low back pain coming back in the next year"},{"benefit":"Importantly, beginning physiotherapy right away does not compromise the healing of the bone"}]},{"acf_fc_layout":"content","background_color":"none","content_alignment":"left","content_editor":"

Introduction<\/h2>\r\nPain in the lumbar area in young individuals is uncommon and should be identified accordingly. Active lumbar spondylolysis is a condition in which a stress fracture occurs in the pars interarticularis in one of the lumbar spine vertebrae, and it is classified as a form of specific low back pain. It is a condition that merely affects the young and active adolescent population. Rest and activity cessations have been typically prescribed in the past. Due to the negative consequences of detraining and activity avoidance, more efforts have been put into studying alternative ways of helping youngsters affected by this condition. In 2021, we made a video about a single-arm prospective study by Selhorst et al.<\/a>, which studied the feasibility and safety of an immediate functional progression program for active lumbar spondylolysis in adolescents. Back then, the evidence was still preliminary but promising and calling for a full-scale randomized controlled trial (RCT). Now that full-scale RCT is available, we will break it down step by step in this research review.<\/span>\r\n\r\n \r\n

Methods<\/h2>\r\nThis study included adolescent participants between the ages of 10 and 19 years who had an MRI-verified active lumbar spondylolysis, defined as observable edema in the posterior elements of the lumbar vertebrae at the pars interarticularis, with or without a fracture. They had to be engaging in organized sports at least twice per week at the time of diagnosis or onset of their low back pain. All participants were recruited from the sports medicine departments of two pediatric hospitals in the USA. Exclusion criteria were rest from activity for more than 4 weeks due to low back pain, numbness or tingling in any lumbar dermatome, previous lumbar spine surgery, or a prior injury or condition that would make the physiotherapy plan inappropriate (for example, a co-existing knee injury).<\/span>\r\n\r\nEligible candidates were randomized into one of two groups: the \u201cearly physiotherapy\u201d or the \u201crest before physiotherapy\u201d groups.\u00a0<\/span>\r\n\r\nNone of the participants received a brace. All participants had to take a break from all sports activities at the time of their study participation. Every participant, regardless of group assignment, received two personalized 1-hour physiotherapy sessions per week until they met the return to sport criteria.<\/span>\r\n\r\nImmediate physiotherapy<\/strong>\r\n\r\nAdolescents with active lumbar spondylolysis who were randomly assigned to the immediate physiotherapy group started the rehabilitation within seven days of their diagnosis. This program followed a structured approach with progressions based on set criteria for function and pain.<\/span>\r\n\r\nRest before physiotherapy<\/strong>\r\n\r\nThe participants in this group rested until their low back pain resolved for at least two consecutive days, and when this was the case, they initiated physiotherapy within seven days of pain resolution. They followed the same physiotherapy program, except for the progression criteria. In this group, progressions were made in a time-based manner, since their pain had resided before they could start the physiotherapy.\u00a0<\/span>\r\n\r\nReturn to sport criteria<\/strong>\r\n\r\nAthletes, irrespective of the group they were randomized to, were cleared to return to sport and discharged from care after completing their PT protocol and meeting all three of the following criteria:<\/span>\r\n
    \r\n \t
  1. Pain-free repetitive motion to end-range in all cardinal lumbar directions.<\/span><\/li>\r\n \t
  2. Completion of two weeks of return-to-sport activity in PT without pain.<\/span><\/li>\r\n \t
  3. No reported pain or disability (0% score on the Micheli Functional Scale (MFS))<\/span><\/li>\r\n<\/ol>\r\n[caption id=\"attachment_27299\" align=\"alignnone\" width=\"1320\"]\"active From: Selhorst et al., Br J Sports Med. 2026[\/caption]\r\n\r\n \r\n\r\nThe primary outcome was the Micheli Functional Scale (MFS), which is a 0-100 questionnaire that assesses pain and function in adolescents. The authors set the minimally clinically important difference (MCID) at 20 points, but had no reference.\u00a0<\/span>\r\n\r\nSecondary outcomes included:<\/span>\r\n