Immediate physical therapy versus rest for adolescent lumbar spondylolysis: multicentre RCT results (bjsm.bmj.com)

• Immediate PT led to significantly better pain and function at 1 month (MFS difference 21.3 points).
• Immediate PT group returned to sport 38 days sooner and had 3% recurrence rate vs 29% in rest group.
• No difference in bone healing on MRI, but immediate PT prevented multifidus atrophy.

"This multicentre RCT randomised 64 adolescent athletes (median age 14.2) with active lumbar spondylolysis to immediate physical therapy (PT) or rest before PT. The immediate PT group started PT within 7 days; the rest group started after symptom resolution. At 1 month, the immediate PT group had significantly better pain and function (Micheli Functional Scale difference 21.3 points, p<0.001). They returned to sport 38 days sooner (median 74 vs 112 days) and had fewer low back pain recurrences over 12 months (3% vs 29%, p=0.01). No adverse events occurred. MRI healing rates did not differ, but multifidus atrophy was less in the immediate PT group."