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Aims: The primary aim of this study was to develop a diagnostic cluster of common clinical findings that would assist in ruling out an active spondylolysis in adolescent athletes with low back pain (LBP)., Design: Retrospective case-series., Setting: Hospital-based sports medicine clinic., Patients: One thousand and twenty-five adolescent athletes with LBP (age 15.0 ± 1.8 years, 56% female) were reviewed. Active spondylolytic injuries were identified in 22% (n = 228) of these patients., Main Outcome Measure: presence or absence of active spondylolysis on advanced imaging., Results: Through logistic regression analysis, pain with extension (p < 0.001), difference between active and resting pain ≥3/10 (p < 0.001), and male sex (p = 0.002) were identified as significantly associated with active spondylolysis. The clinical cluster had a sensitivity of 88% (95% CI 83%-93%) to help rule out active spondylolysis. The negative likelihood ratio was 0.34 (95% CI 0.23-0.51) and the negative predictive value was 90% (95% CI 86%-93%). Diagnostic accuracy of the cluster was acceptable (area under the curve = 0.72 (95% CI 0.69, 0.76; p < 0.001)., Conclusion: This study found a cluster of three patient characteristics that may assist in ruling out active spondylolysis in adolescent athletes with LBP., Competing Interests: Declaration of competing interest None Declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP)., Design: Retrospective case series., Setting: Hospital-based sports medicine clinic., Patients: The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis., Assessment of Risk: Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females., Main Outcome Measure: Relative risk of diagnosis of spondylolysis injury., Results: The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis., Conclusions: The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.

Study Design Retrospective review with telephone follow-up. Background Acute spondylolytic injuries have a dramatic impact on the young athlete. Excellent short-term clinical outcomes have been observed, but not enough is known about long-term clinical outcomes. Objectives (1) To report long-term clinical outcomes for patients diagnosed with acute spondylolysis, and (2) to assess the prognostic ability of retrospective variables for long-term outcomes. Methods Patients from 2010 through 2013 were retrospectively reviewed to identify patients and to obtain demographic, baseline, and short-term outcomes. Long-term follow-up data were collected by telephone from patients diagnosed with acute spondylolysis to assess recurrence rate of low back pain, perceived outcome, pain, and functional ability. Patients were categorized as having a good or poor long-term outcome based on these measures. Logistic regression analysis was performed to assess the prognostic ability of the retrospective variables for long-term outcomes 3.4 years (range, 1.5-5.6 years) after treatment. Results One hundred twenty-one (71.6%) patients completed the follow-up questionnaire (48 female; mean age at baseline, 14.4 years). At follow-up, 81 (66.9%) patients were able to maintain their same or a higher level of sport. Recurrence of significant symptoms was reported by 55 (45.5%) patients, with 41 (33.9%) requiring medical treatment. The final logistic regression model revealed that female sex, adverse reaction during care, and multilevel injury were significant predictors of poor long-term outcome (R 2 = 0.22). Conclusion Although excellent short-term outcomes were noted, 42% of patients reported a poor outcome at long-term follow-up. Female sex, multilevel injury, and experiencing an adverse reaction during care were significant predictors of poor long-term clinical outcome for patients diagnosed with acute spondylolysis. Level of Evidence Prognosis, level 4. Registered January 15, 2015 at www.clinicaltrials.gov (NCT02332200). J Orthop Sports Phys Ther 2016;46(12):1029-1036. Epub 8 Nov 2016. doi:10.2519/jospt.2016.7028.

Female high school athletes are an at-risk population for the Female Athlete Triad--a syndrome including low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. School nurses can play an important role in reducing the health burden of this syndrome, by educating coaches and athletes, and by referring symptomatic student-athletes to appropriate community resources for evaluation and treatment. This study assessed knowledge, attitudes, communication, and referral behaviors of U.S. high school nurses about the Female Athlete Triad. Participants were a random sample of 370 U.S. high school nurses. The results indicated that only 19% of the nurses were able to identify the three components of the Triad and only 25% reported that they work proactively with coaches to help prevent health issues among their female athletes. Over 95% expressed interest in learning more about the Triad. Implications for educational program design are discussed.

Background and Purpose 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. Purpose 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. Study Design Non-randomized, controlled clinical trial. Methods 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. Results 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. Conclusion 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. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

The article offers information on the syndrome of menstrual dysfunction, relative energy deficiency, and low bone mineral density in women athletes. Topics discussed include an increased risk of musculoskeletal injuries in teenagers with menstrual dysfunction (MD), risk factors for amenorrhea, eating disorders, or osteoporosis, and physical examination for sports for MD screening among female high school and middle school athletes.

PURPOSE: Half of all adolescents report low back pain (LBP), with an even higher rate among athletes. Spondylolysis is the most common identifiable cause of LBP in adolescent athletes. Expert consensus recommends resting for up to 3 months before beginning rehabilitation. This recommendation may have negative consequences including 5-7 months out of sport, muscle atrophy, weight gain, and depression. The purpose of this pilot study was to assess the viability of using an immediate functional progression program to treat adolescent athletes with an active spondylolytic injury. METHODS: Adolescent athletes were referred to physical therapy (PT) without restrictive bracing immediately after diagnosis of the active spondylolysis. The PT program progressed participants based upon pain-free functional ability and the athletes returned to sport when they passed predetermined functional criteria. Clinical outcomes included time out of sport, Micheli Functional Scale (Function and Pain) and adverse reactions. Clinical outcomes were assessed at baseline, 1 month, 3 months and 6 months. MR imaging was performed at baseline and 3 months to confirm diagnosis and assess healing of lesion. Data Analysis: Descriptive statistics were calculated to assess viability of the program. RESULTS: Twelve participants (14.2 ± 2 years, 25% female) with active spondylolytic injuries completed the immediate functional progression program. Eleven participants (92%) were able to return to sport in a median time of 2.5 months (interquartile range 55 days, 85 days). All participants demonstrated marked improvements in pain and function (35.6 ± 22.1 on Micheli Functional Scale) by the end of the program. One participant (8%) had an adverse reaction during care with a significant recurrence of LBP and was unable to return to sport by 6 months. MR imaging demonstrated that only one participant had a progression of a lesion at 3 months. CONCLUSION: Athletes in the immediate functional progression program experienced similar clinical and imaging outcomes to previously published research and returned to sports two months sooner. Beginning PT immediately and progressing the young athlete based on functional ability appears to be a viable method for treating this population and warrants future research. [ABSTRACT FROM AUTHOR]