Application of Regional Interdependence in Treating an Adolescent Athlete with Low Back Pain: A Case Report

Sep 25, 2026

Background: Descriptions of treatment for adolescent athletes with non-specific low back pain are rarely cited, though physical therapy is commonly recommended. Case Description: An 18-year-old high school athlete presented with low back pain, receiving local lumbar spine treatment plus a global focus on improving anterior and rotational hip mobility. Outcomes: Across 7 visits, Oswestry Disability Index improved from 16% to 0%. Discussion: Regional interdependence reasoning tied hip deficits to altered lumbar mechanics and symptom provocation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Adolescent low back pain and classification limits

Regional interdependence concepts and supporting literature

Rationale for applying regional interdependence in baseball

Application of Regional Interdependence in Treating an Adolescent Athlete with Low Back Pain: A Case Report Ari Kaplan, PT, DPT, SCS, CSCS, CertMDT Association of Clinical Excellence, Wilmington, DE ATI Physical 􀀞erapy, Bear, DE ABSTRACT Background: Descriptions of treatment of adolescent athletes with non-speciﬁc low back pain is sparsely cited in the literature. However, physical therapy is often recommended. Case Description: e patient was an 18-year-old high school athlete with low back pain. Interventions consisted of direct treatment (local) at the lumbar spine, and also a focus on improving anterior and rotational hip mobility (global approach) . Outcomes: e patient was treated for a total of 7 visits with an Oswestry Disability Index improvement from 16% to 0% . Discussion: is case report describes the clinical reasoning and interventions of a regional interdependence approach in an athlete where hip deﬁcits were found and were believed to be resulting in altered lumbar mechanics. e resolution of symptoms and full return to activity in a limited number of treatments may suggest the hip to be a contributor of symptom provocation in teenage athletes. KeyWords: physical therapy, lumbar pain INTRODUCTION Low back pain is the cause for seeking treatment in nearly 50% of all patients presenting to outpatient physical therapy.1,2 is does not preclude adolescents, who show a prevalence that is exceedingly high. Estimates cite an eﬀect as great as 70% to 80% of this population by age 20.3 Recently, clinical prediction rules and treatment-based classiﬁcations have been developed to improve the care of patients with back pain.4-8 ey aim to treat a patient through symptom presentation as opposed to focusing on the anatomical diagnosis. While classifying patients has shown improvements in low back pain care,9 Stanton et al8 have shown that 50% of individuals will not clearly ﬁt into a classiﬁcation and half of that 50%(25%) will not ﬁt into any category, resulting in diﬃculty deciding on the proper treatment. Additionally, past studies have excluded patients under the age of 18 and have not examined athletes as a speciﬁc population. e treatment categories also only focus on a speciﬁc intervention delivered to the lumbar spine: manipulation, directional preference exercises, stabilization exercises, and traction.6 ere is a dearth of literature on back pain in the adolescent athlete, with much of this limited focus solely on spondylogenic lesions. Spondylogenic lesions can be illusive in their detection as special testing shows sensitivity and speciﬁcity that is poor and therefore often requires advanced imaging, such as magnetic resonance imaging. 10,11 As insurance companies deny greater proportions of advanced imaging, immediately searching for these issues may no longer be an option. Additionally, Fredrickson et al12 found that 6% of adults showed a spondylogenic lesion, without associated pain in the past. is maybe that some of these lesions may not be the source of an athlete’s pain. Clinicians have recently been considering applying the concept of regional interdependence, where one area of the body inﬂuences another area.13 For example, much research has examined the hip’s inﬂuence on the patellofemoral joint in anterior knee pain, noting that poorly controlled gluteal muscles correlate with patellofemoral pain.14 Research is beginning to emerge on the eﬀects of treating multiple areas of the body for a diagnosis of lumbar spinal stenosis and showing it to be superior to conventional treatments directed solely at the lumbar spine.15-17 In golf, there is research supporting the inﬂuence of other regions of the body on lumbar spine injury. Kim et al18 found that a loss of hip rotation in the lead limb correlates with low back pain in professional golfers. ey stated that the kinetic energy normally dissipated during the follow-through was transferred from the lead hip to the lumbar spine, resulting in c

FAQs

What was the patient’s age and athletic background in the case report?

The case involved an 18-year-old high school athlete who played hockey and baseball.

What interventions were used in the regional interdependence approach?

Treatment combined local direct work at the lumbar spine with global efforts to improve anterior and rotational hip mobility.

What outcome measures and results were reported after treatment?

The patient received 7 visits, and the Oswestry Disability Index improved from 16% to 0%, with symptom resolution and full return to activity.

Sep 25, 2026

Uploaded by Taylor Morgan