John Winslow is a assistant professor in the physical therapy program at Ithaca College, Ithaca, NY. He is a board certified orthopaedic specialist and athletic trainer. His clinical expertise is in the area of spine rehabilitation, particularly with athletes. He developed the first APTA credentialed orthopaedic physical therapy residency in NY state and continues to teach in the program. Currently he is working on predicting return to sport using radiographic assessment of lumbar facet distance and fatty infiltrate of the lumbar multifidi in athletes with extension back pain. He has developed a treatment algorithm for extension back pain that includes specific core stabilization exercises or facet injections.
Study Design: Case Series
Background: Managing adolescent athletes with extension back pain can be very challenging, particularly when imaging is negative for a stress reaction or spondylolysis and the patient is not responding to activity modification, bracing, stretching, or strengthening exercises.
Case Description: Three high school athletes with extension back pain were treated with specific core stabilization exercises or facet injections based on imaging and physical examination findings.
Outcomes: Clinically significant improvements were seen in pain and function in each case. All three athletes were able to return to their sport without restrictions.
Discussion: When an adolescent athlete presents with a primary compliant low back pain with extension, spondylolysis should be suspected. If imaging is negative, facet inflammation or impaired segmental neuromuscular control should be considered. Interfacet spacing and fatty infiltrate of the lumbar multifidi can assist the clinician in developing a treatment plan that includes specific core stabilization exercises or facet injections. These factors may also be helpful in giving a prognosis for return to play.