MDNews - Greater Kansas

+++++++++++++++++++++++++ + + +++++++++++++++++++++++++ PHYSICAL THERAPY +++ +++ Physical Therapy and By Cody Barnett, P.T. back pain. These conditions are even more pervasive in young athletes who partici- pate in high-risk, repetitive sports such as diving, gymnastics, football and rowing, with as many as 47% of these athletes affected by low back pain. The good news, however, is that such conditions can often be treated successfully using immobiliza- tion and strengthening exercises. Spondylolysis is a defect of the pars S interarticularis, but does not involve displacement of the vertebral body. Spondylolisthesis involves a forward translation of one vertebra in comparison to the next; this condition is most often seen in the fifth lumbar vertebra. Certain forms of the condition are more serious than others. For example, dysplastic spondylolisthesis may cause L5 nerve root radiculopathy and bowel and bladder dysfunction resulting from sacral nerve root compression. Children with this particular form are also more likely to develop neurological injury and progressive deformity. Stress fracture spondylolysis: These patients demonstrate fracture as the result of participation in sports. For this group, outcomes are typically excellent. A period of full-time immobilization and activity restriction are necessary. This is followed by physical therapy with emphasis on trunk and core strengthening when the patient demonstrates symptom-free 8 | Greater Kansas MD NEWS ■ MDNEWS.COM PONDYLOLYSIS AND SPONDY- LOLISTHESIS commonly affect children and adolescents aged 6 years and older, causing low Nonsurgical Treatment of Back Pain in Children extension and rotation. A gradual rein- troduction of activity typically leads to an excellent outcome. Early diagnosis of the condition and referral for physical therapy treatment are likely to lead to better outcomes for the patient. Isthmic spondylolysis: The goals of treatment should be to reduce or eliminate pain and improve the strength of the spinal stabilizing musculature, not bony healing. (Note — this is the case because many spondylolysis fractures are asymptomatic.) Such goals can often be reached through activity restriction and physical therapy with specific exercise prescription (exercises targeting the multifidi and abdominal oblique muscles). Isthmic spondylolisthesis: Patients with less than 50% slip can expect an excellent outcome with immobilization, activity restriction and physical therapy treatment. Once asymptomatic, a full return to activity is recommended but may require some modifications. For example, the patient may need to avoid excessive lumbar extension or heavy squatting. Progression of the spondylo- listhesis is not typical (except with the dysplastic variety). High-grade spondylolisthesis: Studies have shown that early intervention leads to excellent outcomes without the use of surgery. In a study of long-term outcomes conducted by Harris and Weinstein on adolescents with greater than 51% anteriorly displaced spondylolisthesis: + 36% of non-surgica l pat ient s were asymptomatic. + 55% had only occasional back pain. + 45% had neurological symptoms. + None were incontinent. + At an 18-year follow-up, every one of the subjects was leading a normal, active life and had made only minor lifestyle adjustments for the condition. In summary, accurate diagnosis of the spondylolytic defect is necessary. Activity modification, bracing, physical therapy and a gradual return to all activities is possible in most cases. Cody Barnett, P.T., specializes in the treatment of orthopedic and musculo- skeletal injuries. He may be reached at www.BodyworxPhysicalTherapy.net or (316) 558-8808. ■

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