Utilization of Imaging in Young Athletes with Low Back Pain.

Only 397 of 2,185 invited physicians answered (18%). The authors acknowledge that those who responded may hold stronger views or have more experience with this population than those who did not, so these figures may not describe sports medicine physicians as a whole. Everything is self-reported. No one checked what these physicians actually order, and no patient outcomes were measured, so the survey cannot show whether any of these imaging choices help or harm a young athlete. The subgroup comparisons were exploratory, involved many statistical tests and were not adjusted for multiple comparisons. The authors themselves present the p-values as possible patterns rather than firm conclusions. Respondents were members of a single national sports medicine organization, and the views of physical therapists, athletic trainers and other clinicians who also assess these athletes were not captured. The conclusion that radiographs may be overused rests on applying adult low back pain guidelines to children and adolescents, because no pediatric-specific imaging guidelines exist.

The authors declare no financial affiliation with, or involvement in, any commercial organization with a direct financial interest in anything covered by the manuscript, and no conflict of interest related to its content. No funding source is named in the text supplied.

Do not read this as proof that X-rays or scans are unnecessary or harmful for young athletes with back pain. The study asked physicians what they do and reports their answers; it measured no patient outcomes and cannot show whether imaging helps or hurts. The comparison suggesting less imaging with a physical-therapy-first approach came from a pilot of 16 athletes, far too few to act on as evidence.