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CLINICAL BOTTOM LINE

Commentary on “Spinal Stabilization Exercise Effectiveness for Low Back Pain in Adolescent Idiopathic
Scoliosis: A Randomized Trial”

“How should I apply this information?”

In this study, a weekly physical therapy (PT) intervention group experienced significantly greater reduction of
pain and an improvement in patient-selected functional outcomes than an unsupervised group.
Although the use of technology, such as a DVD, is common for adolescents, using technology to provide
intervention may not be an adequate substitute for weekly contact with PT. This study provides support for
weekly PT intervention and for the role that spinal stabilization training may play in reducing low back pain in
adolescents with adolescent idiopathic scoliosis. A prevention-oriented health care system could use the results of
this study to support the development and implementation of PT programs for this patient population. The study
provides a beginning point for future research to explore spinal stabilization training for adolescents with low
back pain and the use of the Global Rating of Change, Patient Specific Functional Scale, and Revised Oswestry in
studies with adolescent subjects.
“What should I be mindful about when applying this information?”
The majority of the prescribed exercises focused on neuromuscular activation and/or hold of transverse abdo-
minis and lumbar multifidus, but change was not directly assessed for these muscle groups. The Prone Double-leg
Test is more specific to multijoint spinal extensors.
From a clinical perspective, using the Prone Double-leg Test as a test of muscular endurance should be
considered with caution. Lack of improvement may be due to factors other than endurance of the spinal extensors.
Structures that may be adversely affected during this test include spinal nerve roots due to compression during
closure of the intervertebral foramen; facet joints due to irritation from compression or hypomobility; and the
disc due to compression. Selecting an outcome measure for muscle performance requires consideration of several
factors, including (1) what one wishes to measure, for example, activation, strength, or endurance; (2) whether the
outcome measure is appropriate to assess the focus of training such as strength or endurance; and (3) how the test
may affect regional structures. Each factor has the potential to affect outcomes in a positive or negative direction.

Melodie Kondratek, PT, DScPT, OMPT

Physical Therapy Program
Oakland University
Rochester, Michigan
Dhana Ponners, PT, DPT, OMPT
The Training Room
Troy, Michigan
The authors declare no conflicts of interest.
DOI: 10.1097/PEP.0000000000000189

402 Zapata et al Pediatric Physical Therapy

Copyright © 2015 Wolters Kluwer Health, Inc. and the Section on Pediatrics of the American Physical Therapy Association.
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