Immediate versus delayed physical therapy for adolescent lumbar spondylolysis: functional progression program protocol (bjsm.bmj.com)

• Immediate PT (IFPP) uses pain-guided progression through 3 phases; rest-before-PT uses time-based progression after symptom resolution.
• Return-to-sport criteria include pain-free end-range motion in all lumbar directions, 2 weeks pain-free sports activity, and 0% on Micheli Functional Scale.
• Secondary outcomes show improvements in depressive symptoms, fear avoidance, and quality of life favoring immediate PT at early time points.

"This article presents the detailed protocol for a randomized trial comparing immediate physical therapy (Immediate Functional Progression Program, IFPP) versus rest before therapy for adolescent lumbar spondylolysis. The IFPP involves three phases: Phase I exercises in neutral spine, Phase II progression through functional range including extension/rotation, and Phase III return-to-sport with specific criteria (pain-free end-range motion, 2 weeks pain-free sports activity, 0% Micheli Functional Scale). The rest group starts therapy after pain resolution with time-based progression. The supplement includes treatment fidelity checklists and secondary outcome data showing improvements in depressive symptoms, fear avoidance, and quality of life."