Selhorst Mitchell, Rodenberg Richard, Padgett Nick, Fischer Anastasia, Ravindran Reno, MacDonald James
Nationwide Children's Hospital.
Int J Sports Phys Ther. 2021 Feb 1;16(1):227-235. doi: 10.26603/001c.18715.
Half of adolescent athletes report low back pain (LBP) and there is a significant risk of vertebral injury in this population. The current model of care for adolescent athletes with LBP is to first confirm a medical diagnosis of spondylolysis which frequently requires advanced imaging. However, routine use of advanced imaging increases cost, delays treatment, and can expose the athlete to radiation.
The purpose of this pilot study was to assess the viability of a physical therapist guided functional progression program to manage low back pain (LBP) in adolescent athletes.
Non-randomized, controlled clinical trial.
Sixteen adolescents (15 ± 1.8 years, 50% female) with extension-based LBP were assigned to the biomedical model or physical therapy first model. The biomedical model sought to determine a spondylolysis diagnosis to guide treatment. In the physical therapy first model, patients began early therapeutic exercise and their ability to functionally progress determined the course of care. Dependent variables were change in Micheli Function Score, use of imagining, days out of sport, and ability to return to sport. Adverse events were monitored in order to assess safety. Descriptive statistics were completed to assess the viability of the alternative model.
Both models had similar improvements in pain and function. The physical therapy first model reduced use of advanced imaging by 88% compared to the biomedical model. Patients in the biomedical model who did not sustain a vertebral injury returned to sport sooner than the physical therapy first model (3.4 days versus 51 days), while those with a vertebral injury took longer in the current model (131 days versus 71 days). All of the patients in the physical therapy first model and 88% of patients in the current model made a full return to sport. Two adverse events occurred in the biomedical model, and none were noted in the physical therapy first model.
This pilot study demonstrated that the physical therapist guided functional progression program may be a viable method for treating young athletes with LBP and further research is warranted.
3b.
半数青少年运动员报告有腰痛（LBP），且该人群存在椎体损伤的重大风险。目前针对患有LBP的青少年运动员的护理模式是首先确认椎弓根峡部裂的医学诊断，这通常需要先进的影像学检查。然而，常规使用先进的影像学检查会增加成本、延迟治疗，并可能使运动员暴露于辐射中。
本初步研究的目的是评估由物理治疗师指导的功能进阶计划用于管理青少年运动员腰痛（LBP）的可行性。
非随机对照临床试验。
16名患有伸展型LBP的青少年（15±1.8岁，50%为女性）被分配到生物医学模式组或物理治疗优先模式组。生物医学模式旨在确定椎弓根峡部裂诊断以指导治疗。在物理治疗优先模式中，患者开始早期治疗性锻炼，其功能进阶能力决定护理过程。因变量包括米凯利功能评分的变化、影像学检查的使用、停赛天数以及恢复运动的能力。监测不良事件以评估安全性。完成描述性统计以评估替代模式的可行性。
两种模式在疼痛和功能方面均有相似改善。与生物医学模式相比，物理治疗优先模式将先进影像学检查的使用减少了88%。生物医学模式中未发生椎体损伤的患者比物理治疗优先模式的患者更早恢复运动（3.4天对51天），而发生椎体损伤的患者在当前模式中恢复运动所需时间更长（131天对71天）。物理治疗优先模式中的所有患者以及当前模式中88%的患者完全恢复了运动。生物医学模式中发生了两起不良事件，物理治疗优先模式中未发现不良事件。
本初步研究表明，由物理治疗师指导的功能进阶计划可能是治疗患有LBP的年轻运动员的一种可行方法，值得进一步研究。
3b。
