A multicenter randomized trial published in the British Journal of Sports Medicine compared two strategies for active lumbar spondylolysis in adolescent athletes: starting physical therapy within 7 days of diagnosis versus observing a period of rest until symptom resolution before initiating rehabilitation. [1]
64 athletes between 10 and 19 years old were included.
One-Month Results
The group that started physical therapy immediately showed greater improvement in function and pain on the Micheli Functional Scale. The mean difference was 21.3 points in favor of early rehabilitation. [1]
Return to Sport
Adolescents in the immediate physical therapy group returned to sport approximately 38 days earlier than those who initially observed a period of rest. [1]
Recurrences
At 12 months, recurrences of back pain were reported in 3% of the early-treated group and 29% of the group that started physical therapy later. [1]
This is likely the most relevant aspect of the study, as it suggests that a faster recovery does not necessarily come with a higher risk of new symptoms.
How Early Physical Therapy Was Managed
In both groups, sports participation was stopped until the study's return-to-sport criteria were met. In the early physiotherapy group, exercises began within one week of diagnosis and progressed according to pain and function. Starting rehabilitation earlier did not mean continuing sports training or competition. [1]
The goal was to progressively regain control, strength, and tolerance even to the extension and rotation movements required by many sports, instead of waiting for a complete absence of symptoms before starting any exercise.
Limitations
The sample is relatively small and concerns a specific population of adolescent athletes with active spondylolysis. The results cannot be automatically transferred to other causes of low back pain or non-comparable injuries. [1]
For this group, however, the trial provides direct evidence in favor of early and progressive rehabilitation compared to an initial period of watchful waiting alone.
Disclaimer: informational content, does not replace an individual clinical evaluation.
Essential Bibliography
[1] Selhorst M, et al. Immediate physical therapy is beneficial for adolescent athletes with active lumbar spondylolysis: a multicentre randomised trial. Br J Sports Med. 2026;60(2):125-132. doi:10.1136/bjsports-2025-110606. PMID: 41402030.
[2] Selhorst M, et al. Rehabilitation Considerations for Spondylolysis in the Youth Athlete. Int J Sports Phys Ther. 2020. PMID: 32269862.
[3] Overley SC, et al. Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis. Global Spine J. 2018. PMID: 29662750.
