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To compare the skeletal, dental, and esthetic changes produced by three functional devices, Fränkel-2 appliance (FR-2), Twin Block (TB), and Occlus-o-Guide® (O-o-G®), for the treatment of Class II malocclusion. Methods: Sixty-five patients with Class II Division 1 malocclusion were divided into three groups and were analyzed through cephalometric analysis of skeletal, dental, and esthetic variables before and after treatment. The first group of 23 patients (F: 9, M: 14, mean age: 10.3 ± 1.08 years) was treated with FR-2, the second group of 18 patients (F: 8, M: 10, mean age 10.7 ± 1.05 years) was treated with TB, the third group (F: 11, M: 13, mean age: 9.05 ± 0.39 years) of 24 patients was treated with O-o-G®. The structural effects of the three devices were compared with a control group generated by the growth variations reported in the cephalometric atlas of Bhatia and Leighton. Esthetic analysis was performed comparing the results of the patients treated with a control group of 20 subjects with mandibular retrognathia and Class II Division 1 malocclusion, not subjected to therapy. Results: The three devices resulted in a significant increase in mandibular length, with higher results obtained for FR-2 and TB. A statistically significant increase in the IMPA angle was found for the O-o-G® group, and a notable reduction of both overjet and overbite was detected in all three groups of treated patients. The esthetic evaluation showed overall more significant results in the TB group, especially with regard to the reduction of facial convexity. The retrusion of the upper lip was on average more significant in the O-o-G® group, followed by that in the TB. Conclusion: All three devices have proven to be effective overall in resolving skeletal changes and improving facial esthetics.

BackgroundTo apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). ObjectivesTo compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. DesignSystematic review and meta-analysis. MethodLiterature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. ResultsThree studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -2.78 [-2.78−0.02] and -1.01 [-1.92−-0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46−-0.07] at the intermediate for three studies and MD [95% CIs] was -0.84 [-11.47−-5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14−-0.88] and -3.56 [-6.43−-0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. ConclusionsThree studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future.PROSPERO registration number CRD42020158182

Summary Objective The objective of this study was to analyse the soft tissue changes produced by the functional treatment of mandibular advancement in growing Class II patients. Materials The treated group consisted of 25 Caucasian patients (12 females and 13 males) with dento-skeletal Class II malocclusion treated with functional therapy (Activator). All patients were evaluated before treatment (T1; mean age, 9.9 years), at the end of functional treatment phase (T2; mean age, 11.9 years), and at a post-pubertal follow-up observation (T3; mean age, 18.5 years). The treated group was compared with a matched control group of 25 untreated subjects (13 females, 12 males) with untreated Class II division 1 malocclusion. Statistical comparisons between the two groups were performed with independent samples t-tests (P < 0.05). Results Significant improvements were found during the long-term interval for mandibular sulcus (9.9°) and the profile facial angle (9.8°) in the treated group. No significant effects were found in terms of lower face percentage between the two groups. Conclusion Removable functional appliances induced positive effects on the soft tissue profile in Class II growing subjects with good stability in the long-term.

The nonsuppurative osteomyelitis of the mandible is a rare condition that can occur in children due to low-grade inflammatory processes, dental cavities, periodontal lesions as well as the eruption process of the teeth. We submit a case report involving the orthodontic management of a 9-year-old female patient who presented in our service in the mixed dentition period with diagnosed Garre’s sclerosing osteomyelitis of the entire mandibular body. After a full work-up, the following symptoms and signs were noted: bilateral temporomandibular joint (TMJ) pain, loss of the leeway space, anterior open bite, distalization of the secondary maxillary right canine, nail biting and tongue thrust. Our orthodontic objectives were to relieve the TMJ pain, limit the eruption process of the teeth and to diminish the evolution of the osteomyelitis, reduce the growth of the inferior lower third of the face and to prevent further invasive treatment of the patient. In the first phase of treatment, we established a centric relationship using an orthopedic appliance (occlusal splint) and physiotherapy to deprogram the muscles and the TMJ. Throughout the second phase of treatment, we used orthopedic appliances to inhibit the overeruption of the secondary molars. After another year of treatment, the osteomyelitis lesions were under control with the permanent teeth in final position, good facial esthetic and as a functional result, no root resorption. We can conclude that by using low physiological forces to direct and control the growth pattern, good results could be obtained in stabilizing and controlling the sclerosing osteomyelitis of the mandible.

This study was aimed at proposing a three-dimensional (3D) evaluation method for the soft tissue effects of Twin Block (TB) functional appliance therapy by using cone beam computed tomography (CBCT) images. In this retrospective study, a total of 60 pre- and posttreatment (T0 and T1) CBCT images of Class II patients with mandibular retrognathia treated with a TB appliance were used. Volumetric and linear soft tissue changes were evaluated quantitatively with 3D measurements and qualitatively with color mapping visual. Linear (NV-A and NV-Pog) and angular (SNA, SNB, and ANB) skeletal changes were also measured on 3D images. The Wilcoxon signed-rank test was used to compare statistical differences, and the scores of male and female participant differences were observed with the Mann–Whitney U test. In this study, a decrease was observed in SNA ( p < 0.05 ), ANB ( p < 0.01 ), and NV-Pog ( p < 0.05 ) while an increase in SNB ( p < 0.01 ) was found. However, decrease in NV-A distance was not statistically significant ( p > 0.05 ). As a result of the evaluation of soft tissue changes, while the anterior reposition of the lower lip, soft tissue pogonion, and soft tissue gnathion was found to be significant ( p < 0.01 , p < 0.01 , and p < 0.05 , respectively), the upper lip and subnasale repositions were not statistically significant ( p > 0.05 ). 3D soft tissue changes after TB therapy can be evaluated quantitatively and qualitatively by using CBCT images. Anterior repositioning of the mandible with functional therapy also provides improvement in soft tissue profile, especially in the lower facial region.

The aim of this study was to evaluate three-dimensional (3D) effects of Twin-block functional appliance (TB) on the pharyngeal airway by using cone beam computed tomography (CBCT). A total of 30 patients (14 females, 16 males; mean age 12.50 ± 1.23 and 12.83 ± 1.17 years, respectively) with skeletal Class II malocclusion were included in this study and were treated with TB. On the pretreatment (T1) and posttreatment (T2) CBCT scans, volumetric changes in the pharyngeal airway; SNA, SNB, and ANB angles; and bilateral effective mandibular (Co-Gn) and midfacial length (Co-A) were also evaluated. The statistical differences were accessed by Wilcoxon signed-rank tests, and Mann-Whitney U tests were used to analyze the scores of male and female subjects. In this study, an increase was observed in SNB and Co-Gn ( p < 0.01 ) while a decrease in ANB and SNA ( p < 0.01 and p < 0.05 , respectively) was found. However, increase in midfacial length was not statistically significant ( p > 0.05 ). In the evaluation of volumetric pharyngeal airway changes, statistically significant increases ( p < 0.01 ) in the upper and lower division and total airway volume were determined. Gender differences were insignificant for all measurements ( p > 0.05 ). Volumetric changes in the pharyngeal airway after functional therapy can be successfully evaluated by CBCT images. The anterior repositioning of the mandible by TB increases the mandibular length and pharyngeal airway volume in patients with retrognathic mandible.

Objective The aim of this study was to investigate physiotherapists’ validating and invalidating communication, before and after brief Cognitive Functional Therapy (CFT) training that included a session on validation skills. Associations between validation/invalidation and the characteristics of the interviews and physiotherapists were also explored. Methods Eighteen physiotherapists treating patients with low back pain participated in the study. The study had a within-group design in which validation and invalidation for physiotherapists were rated before and after training using a reliable observational scale. We also collected data on interview length and physiotherapists’ and patients’ speech percentages. Results The physiotherapists’ validating responses increased and invalidating responses decreased from pre- to post-training. The within-group effect size was large for validating responses and medium for invalidating responses. The interview length increased from pre- to post-training (large effect size). However, the reason for this was related to factors other than validation and invalidation. The results indicate that increased validation is associated with an increase in physiotherapists’ speech percentage. Conclusions The results of this study show changes invalidating and invalidating communication among physiotherapists from pre- to post-CFT training. The study also found associations between specific interview characteristics and validating communication. Future studies with larger samples and control groups are needed. peerReviewed

To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT).As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions.The analysis revealed four descriptive categories: "hung out to dry," "stuck," "making sense and taking control," and "holistic approach to care and living," that varied based on six themes.Although the participants accepted this approach to care well, there was significant variation in patients' conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.Implications for rehabilitationThe participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don't feel abandoned by the system.Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.

Objective Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention. Methods In this case series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase (phase A; no intervention), outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, participants received an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12, and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (numerical pain rating scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes. Results Days of absenteeism due to LBP were significantly reduced in the first and second calendar years after the CFT intervention but not the third and fourth. Disability was significantly reduced immediately after (−4.4; 95% CI = −6.5 to −2.2) and at 3 months (−4.3; 95% CI = −6.6 to −2.0), 9 months (−6.0; 95% CI = −8.1 to −3.9), and 12 months (−4.9; 95% CI = −7.0 to −2.8) after the intervention. Pain was significantly reduced immediately after (−1.2; 95% CI = −1.7 to −0.8) and at 3 months (−1.5; 95% CI = −2.0 to −0.9), 9 months (−1.1; 95% CI = −1.9 to −0.3), and 12 months (−0.9; 95% CI = −1.5 to −0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-up assessments. Conclusions This case series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until the 1-year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among nurses is recommended.

Os serviços de saúde, como as atividades terapêuticas grupais, podem proporcionar uma modificação na rotina hospitalar com experiências positivas de acolhimento, bem-estar, socialização e interação com os profissionais de saúde. Assim, este artigo relata a experiência de uma equipe interdisciplinar na implantação e condução de um grupo de terapia funcional (GTF) em ambiente hospitalar, como estratégia de humanização das práticas assistenciais. Participaram 371 usuários, 52% (193) do sexo feminino. O GTF ocorreu 01 vez por semana em um ambiente acolhedor, com atividades lúdicas, dinâmicas de grupo, exercícios físicos, alongamentos e rodas de conversa. Observou-se adesão dos usuários, significando o GTF um momento de socialização e interação com os profissionais de saúde. O GTF foi reconhecido como parte das ações de humanização pelo Grupo de Trabalho de Humanização Hospitalar. O GTF proporcionou um novo modo de cuidar/reabilitar, sendo os profissionais agentes ativos neste processo de mudança da assistência à saúde.

Sokołowski Marek, Brzozowska Malina, Posłuszny Bartosz. Should the identified correlations between the spine, pelvis and feet be considered in the functional therapy of postural static disorders? Journal of Education, Health and Sport. 2019;9(2):65-78. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.2558160 http://ojs.ukw.edu.pl/index.php/johs/article/view/6565 https://pbn.nauka.gov.pl/sedno-webapp/works/902883 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eissn 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 16.01.2019. Revised: 30.01.2019. Accepted: 06.02.2019. Should the identified correlations between the spine, pelvis and feet be considered in the functional therapy of postural static disorders? Marek Sokołowski1, Malina Brzozowska2, Bartosz Posłuszny3 1AWF, ul Królowej Jadwigi, Poznań 2Kręg-Clinik, ul. Strzeszyńska, Poznań 3Gabinet Morbus, Gniezno Key words: lower limbs, pelvis, spine, functional correction and compensation Abstract The human locomotor system is a complex kinematic system whose elements remain in uninterrupted mutual subtle relations. Any changes in the position or function within the spine-pelvis complex or in lower limbs trigger mutual reactions. Therefore, one should believe that the concept of tensegration and the integrity of myofascial tapes, assuming that the normal function of the musculoskeletal system depends on the correct deployment of tension between specific elements of the system, is currently the only concept that meets the needs of the comprehensive therapy of postural mistakes and defects. Summary The mentioned clinical observations confirm the correlations between the spine, pelvis and feet determined by Mrozkowiak et al. [21-28]. The authors of the study showed relationships between particular elements of the body posture. Despite extensive research material, one should not unquestioningly implement the findings referred to herein into the correction and compensation procedure as this is the first step on the way to the scientific demonstration of the correlations between such distant posture elements. Yet, failing to take into account the displayed frequency of significant correlations may lead to erroneous programming of the repair process of postural static disorders. That is why, one should be aware of the fact that modelling the foot arching with physical effort may also influence the correction of sagittal curvatures of the spine to some extent and vice-versa, the correction of axial curvatures affects the functional condition of feet.

Objective: This randomized controlled trial examined the efficacy of adding a fasting‐mimicking diet to a structured psychotherapy protocol for treating depression.Design: Of 20 patients with depression, 10 were randomly assigned to psychotherapy and dieting (i.e., experimental group) and the other 10 to psychotherapy only (i.e., control group). Patients in both groups received20 individual sessions of functional therapy along with nutrition consultation. Patients in the control group were instructed to maintain their usual daily diets. Results: Both treatments were effective in reducing depression as well as increasing self‐esteem and quality of life. The experimental group showed improved self‐esteem and psychological quality of life as well as a reduction in their mean body mass index, in comparison to the control group. Conclusions: The study revealed initial evidence of the efficacy of combining psychotherapy with a fasting‐mimicking diet to treat depression and its correlates

Background: The aim of the study included interdisciplinary efficiency in treatment children with class II Angle malocclusions in association withosteopathy problems. Material and methods: there were examined 30 patients of the 6- 12 years old with class II Angle malocclusion in association with osteopathy problems.The patients were divided into two groups, the main group consists of children, who have complex treatment, and in the control group they have justorthodontic treatment. Results: The results show that patients with complex treatment have potentially positive contributions in anthropometric changes as well as in facialappearance and postural problems. The orthodontic treatment of patients, from the control group, was 1.5 times longer than in the main group. Socomplex treatment of patients combined with postural problems is much shorter and have a positive influence on musculoskeletal disorders than in thecontrol group. Conclusions: Efficient complex treatment of children with malocclusion and osteopathic problems influences the duration of orthodontic treatment ofclass II malocclusion conditioned by distal position of mandible.

Aim To demonstrate the effectiveness of early weight bearing with no immobilisation (functional therapy) applied to fractures of the fifth metatarsal. Materials and method A retrospective case and control observational study was performed among 382 fractures on the fifth metatarsal comparing functional, conservative-orthopaedic and surgical treatments. Fractures were classified according to the settlement on the distal, diaphyseal or proximal part of the bone, the recommended therapy and the treatment performed. Influence of age, profession and characteristics of the injury were considered and results were measured using the parameters incapacity for work and number and intensity of complications. Discussion Fractures of the fifth metatarsal are the most common injuries of the foot. Whether conservative or surgical treatment is recommended depends on the sort of fracture, the trend nowadays is to use non-invasive methods. Conclusions Functional treatment for metatarsal fractures provides earlier healing and fewer adverse effects than conventional therapies, and becomes first choice for non-displaced fractures and most displaced fractures of the fifth metatarsal.

Introduction A Class II malocclusion is a common orthodontic problem that may affect social acceptance and the self-esteem of the patient. The aim of the present study was to evaluate the effect of functional appliance therapy on the oral health-related quality of life (OHRQOL) of patients presenting with a skeletal Class II malocclusion due to mandibular deficiency. Methods Forty-nine patients (11 to 14 years old) with a Class II malocclusion due to mandibular deficiency were included as the experimental group. A control group of 49 subjects was selected from school children without malocclusion. The Child Oral Impact on Daily Performance (Child-OIDP) index was administered, repeated and differences were evaluated following functional therapy using the Clark Twin Block appliance. Results At baseline, the most common oral impact on daily performance in the experimental group was emotional stability (35 patients, 71.4%) and smiling without shame (34 patients, 69.4%), which respectively decreased to 12.2% (six cases) and 20.4% (10 cases) after functional therapy. The mean (±SD) of the Child-OIDP Overall Impact score in the experimental group at baseline was 25.94 (±17.84), which significantly decreased to 2.77 (±2.09) after therapy (p < 0.001). Conclusion Functional therapy using the Clark Twin Block appliance had a significant effect in improving OHRQOL of children presenting with mandibular deficiency.

Aim: To assess improvement of soft tissue profile and upper airway dimensions in skeletal Class II adolescent patients treated with Forsus Fatigue Resistant Device (FRD). Material and Methods: This prospective observational study was planned with a sample size of 15 subjects (5 male & 10 female) diagnosed with mandibular hypoplasia as a cause of Class II malocclusion, requiring fixed functional therapy, with the inclusion criteria of age of 16-25 yrs with the ANB value range of 4°+2° with a non-extraction treatment plan. Pre-functional records were recorded once the leveling and alignment phase was complete and Forsus FRD attachments were placed. Treatment continued till the desired objectives were achieved. Post functional records were made at the end of functional therapy, after removal of Forsus FRD. Along with soft tissue analysis on lateral cephalogram, Acoustic Pharyngometry (AP) was recorded for each patient (Eccovision®” (sleep group solutions Florida, US) for airway changes before and after Forsus FRD. Results: Post functional treatment indicated statistically significant changes in nasolabial angle, upper lip position, upper lip strain, H angle and mento-labial sulcus. On evaluation of upper airway dimensions of the subjects by pharyngometry , there were statistically significant changes in mean upper airway volume and area. Conclusion: Study concluded that Forsus FRD is an effective method for correction of skeletal Class II malocclusion among adolescent patients, enhancing marked improvement in soft tissue profile of the patients, along with significant increase in volume and area of hypopharyngeal and oropharyngeal spaces, thus improving the upper airway patency.

Liposuction is one of the most common procedures undertaken in plastic surgery with a steadily increasing trend over the years. Although usually performed as an aesthetic procedure for body contouring, it can also be utilized in specific patient groups for disease symptom reduction. One such disease entity is lipedema. The goal of this video to present the authors’ technique in the surgical treatment of lipedema, and to offer the viewer a better understanding of the differences between an aesthetic liposuction and a functional liposuction as performed on a lipedema patient. Between July 2009 and July 2019, 106 lipedema patients have been treated in the authors’ specialized lipedema clinic, with a total of 298 liposuction procedures and a median follow-up of 20 months. The mean amount of lipoaspirate was 6354.73 ml (± 2796.72 ml). The patients reported a significant reduction in lipedema-associated complaints and improvement in quality of life. The need for conservative therapy was significantly reduced. No serious complications were reported. The authors also present before and after photographs of three patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Articular cartilage defects remain a clinical challenge. Articular cartilage defects progress to osteoarthritis, which negatively (e.g., remarkable pain, decreased mobility, distress) affects millions of people worldwide and is associated with excessive healthcare costs. Surgical procedures and cell-based therapies have failed to deliver a functional therapy. To this end, tissue engineering therapies provide a promise to deliver a functional cartilage substitute. Among the various scaffold fabrication technologies available, electrospinning is continuously gaining pace, as it can produce nano- to micro- fibrous scaffolds that imitate architectural features of native extracellular matrix supramolecular assemblies and can deliver variable cell populations and bioactive molecules. Herein, we comprehensively review advancements and shortfalls of various electrospun scaffolds in cartilage engineering.

Aim: To review definitions and elements of interventions in studies, which used the word "functional" to describe their intervention for children with cerebral palsy (CP), and to determine whether definitions and elements are similar to criteria of functional therapy described in the Dutch Guidelines. Methods: Systematic review of intervention studies, which used the word "functional" to describe interventions for children with CP. We described criteria of functional therapy that were used to describe the intervention, and whether criteria were described similarly to the descriptions used in the Dutch Guidelines. Results: Of the 27 included studies, criteria "based on the activities/participation level of the ICF-CY", "goal-directed" and "context-specific" were referred to the most (40-59.3%). Descriptions of these criteria were less comparable to the suggested definition (43.8-69.2%). The remaining three criteria ("active involvement", "task-specific", and "focused on functionality instead of normality") were referred to less frequently (18.5-33.3%). The descriptions reported for these criteria were, however, the most comparable with the suggested definitions (80-100%). Conclusions: The included studies, in general have not used criteria of functional therapy. Future studies have to describe the elements of interventions in detail. Moreover, it is important to reach consensus on the definition and elements of functional therapy.

Adolescent low back pain has received limited research attention despite its potentially considerable impact on quality of life. The role of diagnostic triage to identify serious or specific pathology and/or order relevant investigations is considered. An overview of contemporary pain mechanisms is provided, with specific reference to the wide range of risk factors for persistent low back pain. Education and exercise framed within a biopsychosocial framework are the cornerstones of treatment. There is a lack of data on more comprehensive personalized treatment approaches among adolescents. One such approach – Cognitive Functional Therapy – which has shown promise in adults and active adolescents with low back pain, is described and illustrated using a case study. The most promising avenues, in practice and research, may be those that view adolescent low back pain as less of a local structural spinal issue and more of an indication of the general health of the adolescent.