Murray Mary Kate, Maxwell Jessica
Northeastern University, Department of Physical Therapy, Movement and Rehabilitation Sciences, Boston, MA, USA.
Int J Sports Phys Ther. 2020 Dec;15(6):1196-1210. doi: 10.26603/ijspt20201196.
Spondylolysis is an anatomical defect or fracture of the pars interarticularis and encompasses almost half of all cases of low back pain in adolescent athletes. Most athletes return to sport with conservative treatment, but it is possible that consideration of sport demands may further improve rate of successful return. When surgery is performed, complication rate is high, so all conservative measures should be explored before considering surgical intervention. The purpose of this case report is to present a program where demands of sport were considered and allowed successful return to sport for a subject with recalcitrant symptomatic spondylolysis that had failed to respond to prior treatment.
An 18-year-old lacrosse player with a history of recalcitrant symptomatic spondylolysis that failed three courses of conservative treatment and had been unsuccessful in returning to sport. A multi-phase program with a focus on multi-planar and full kinetic chain activities that addressed the nature of the sport demands is described, along with improvements in pain level, strength, range of motion, and subjective outcome scores.
The subject was able to successfully return to sport after 10 weeks of physical therapy and complete the remaining few months of his lacrosse season without reinjury. Range of motion and strength testing was markedly improved upon discharge. The subject's Modified Oswestry Disability Index improved from 16% to 0% and his pain level did not rise above 2/10 with any sport activity upon return.
DISCUSSION/CONCLUSIONS: Although return to sport rates following spondylolysis in young athletes is high, this case report demonstrates that a consideration of sport demands may increase return to sport rates in athletes that do not respond to standard care and prevent surgical intervention.
Level 4, single case report.
椎弓峡部裂是关节突间部的解剖学缺损或骨折，约占青少年运动员下腰痛病例的一半。大多数运动员通过保守治疗可重返运动，但考虑运动需求可能会进一步提高成功重返运动的比例。手术治疗时并发症发生率较高，因此在考虑手术干预之前应探索所有保守措施。本病例报告的目的是介绍一个针对一名患有顽固性症状性椎弓峡部裂且对先前治疗无反应的患者的计划，该计划考虑了运动需求并使其成功重返运动。
一名18岁的长曲棍球运动员，有顽固性症状性椎弓峡部裂病史，经过三个疗程的保守治疗均失败，未能成功重返运动。描述了一个多阶段计划，该计划侧重于多平面和全动力链活动，以满足运动需求的特点，同时还介绍了疼痛程度、力量、活动范围和主观结果评分的改善情况。
该患者在接受10周物理治疗后成功重返运动，并完成了长曲棍球赛季剩余的几个月，未再次受伤。出院时活动范围和力量测试有明显改善。该患者的改良奥斯维斯特里功能障碍指数从16%提高到0%，重返运动后任何体育活动时其疼痛程度均未超过2/10。
讨论/结论：虽然年轻运动员椎弓峡部裂后重返运动的比例较高，但本病例报告表明，考虑运动需求可能会提高对标准治疗无反应的运动员的重返运动比例，并避免手术干预。
4级，单病例报告。
