Immediate physical therapy is beneficial for adolescent athletes with active lumbar spondylolysis: a multicentre randomised trial.

Adolescent athletes diagnosed with active lumbar spondylolysis, a stress injury of the lower spine, are often told to rest before starting rehabilitation. This trial asked whether starting physical therapy right away, rather than waiting until pain settles, changes recovery. Sixty-four young athletes were randomised to begin physical therapy within a week of diagnosis or to rest first and start therapy once symptoms resolved. Those who began therapy immediately showed significantly better pain and function scores at one month, returned to sport about 38 days sooner, and had fewer recurrences of low back pain over the following year (3% versus 29%).

No adverse events were reported. These are encouraging results, but the trial involved a relatively small number of participants across multiple centres, so the findings should be understood as an early, rather than definitive, picture of how timing of therapy affects recovery from this injury.

If your teenager is an athlete diagnosed with a stress fracture in the lower spine called spondylolysis, doctors have traditionally recommended resting before starting physical therapy. This study looked at whether starting therapy right away, instead of waiting, makes a difference. Researchers randomly assigned 64 young athletes to either begin physical therapy within a week of diagnosis or rest first and start therapy once their pain went away.

The group that started therapy immediately had less pain and better function after one month, got back to their sport about 38 days sooner, and had far fewer repeat episodes of low back pain over the next year (3% compared with 29%). No safety problems were reported in either group.

These results are encouraging, but this was a relatively small study, so it represents an early step in understanding how quickly therapy should start after this diagnosis rather than a final answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This trial addresses a practical question clinicians face when diagnosing active lumbar spondylolysis in adolescent athletes: should physical therapy begin immediately, or only after a period of rest and symptom resolution? In this multicentre randomised trial of 64 participants (immediate physical therapy n=30, rest-before-therapy n=34), the immediate group showed significantly greater improvement on the Micheli Functional Scale at one month (mean difference 21.3, 95% CI 13.9 to 28.7, p<0.001), returned to sport roughly 38 days sooner, and had a lower 12-month recurrence rate of low back pain (3% vs 29%, p=0.01). No adverse events were reported. These findings inform the timing conversation around early rehabilitation versus rest-based protocols for this diagnosis, suggesting that delaying therapy until symptoms settle is not clearly supported by this evidence.

The main limitation is the modest sample size across centres, meaning these results, while statistically significant across several outcomes, represent one trial rather than an established body of replicated evidence.