Immediate physical therapy improves recovery in adolescent lumbar spondylolysis: multicentre RCT (blogs.bmj.com)

• Immediate physical therapy led to faster functional improvement and earlier return to sport (38 days sooner) compared to rest-first approach.
• Bony healing rates on MRI were similar between groups, indicating early PT does not compromise healing.
• Low back pain recurrence at 12 months was only 3% with immediate PT vs 29% with rest-first; immediate PT also preserved multifidus muscle morphology.

"A multicentre RCT of 64 adolescent athletes with MRI-confirmed active lumbar spondylolysis compared immediate physical therapy (PT) within one week versus rest until pain resolution then PT. Immediate PT led to 20-point greater improvement on the Micheli Functional Scale at one month, return to sport 38 days sooner, and only 3% low back pain recurrence at 12 months vs 29% in the rest-first group. Bony healing rates on MRI were similar, and immediate PT prevented lumbar multifidus atrophy. The study challenges prolonged rest as necessary before rehabilitation."