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Perfect 10.0 Physical Therapy, PLC

Perfect 10.0 Physical Therapy, PLC Perfect 10.0 PT is a mobile cash based physical therapy clinic that specializes in the one on one ca

Operating as usual

01/24/2023
Out of the Cast...Now What?

𝐎𝐮𝐭 𝐨𝐟 𝐭𝐡𝐞 cast and into a boot (or brace)? 𝐍𝐨𝐰 𝐰𝐡𝐚𝐭?

Some people are in a boot or brace right out of a cast for a lengthy amount of time, which can cause decreased proprioceptive awareness and cause muscle atrophy as well as joint stiffness. Once they’re out of the boot or brace and sometimes even while they are still in the boot, my goals are to improve all of the above through different exercises.

I think this is a mismanaged area of orthopedics as many people may never end up doing rehab after lengthy bouts in a boot, brace or cast. In my opinion, this puts them at risk for another injury by returning to a high impact sport like cheering, gymnastics or dancing too soon.

Here are a few exercises we did after a few weeks of being out of the boot.
1. Tandem balance on foam, Single Limb Stance on airex and on a trampoline with dumbbell swing
2. Balance board
3. Heel raises
4. Kettlebell squats

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01/23/2023
Ankle Stability Challenge

Ankle Stability Challenge!

I am always looking for fun and new ways to challenge my patient's ankle stability, since we all remember that the ankle is the most common injury in gymnasts, dancers and cheerleaders. This exercise targets many aspects of the ankle's stability and mobility, and not to mention is really fun with a gym buddy!

Mainly we are focusing on ankle and hip stability in a D1/D2 pattern as well as hitting up my favorite sagittal and transverse planes all while on these girl's favorite and most challenging apparatus: beam.

Try different directions, standing on one leg, throwing outside your partner's base of support, perform in releve, coupe, tandem stance, double limb, single limb, passe... the varieties are endless and it's all about what you are trying to get out of the exercise. For these two it was ankle stability in releve and "saving big wobbles on beam" during their routines.

Give it a try and let us know how it goes!! Post a video and tag us in it!

01/19/2023
Shin Splint Rehab Exercises

Shin Splint Rehab Exercises

Shin splints is when pain commonly occurs along the inner/medial side of the tibia (large lower leg bone). This is an overuse injury that commonly occurs in gymnasts, dancers, and cheerleaders, to either drastic changes in training intensity or change in training routine. Muscles primarily affected are the Tibialis Anterior (TA) (front shin muscle) and Tibialis Posterior (TP) (back shin muscle). The TA muscle performs dorsiflexion and inversion (up and in), and the TP performs plantarflexion and inversion (down and in).

The following exercises are to reduce shin pain in preparation for running or higher level training/impact:

️Kneeling Stretch – make sure to have toes pointed to stretch the front of the shin (TA)
️Calf Eccentrics – push-up with 2 legs and lower slowly with the affected side
️Ankle Weight Dorsiflexion - make sure to perform full range of motion
️Slantboard Heel Raise – calf strengthening with an increased focus on the TP muscle
Single Leg RDLs with dumbbell Passes – working on ankle stability and hip control

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01/18/2023
Osgood Schlatter's Rehab

Osgood Schlatter’s Rehab

In the clinic, I see many athletes with Osgood Schlatter’s. This injury is known as an apophysitis at the tibial tuberosity, which is basically an irritation to the bone/growth plate due to high loads of activity (either a lot of repetition of tumbling, running and jumping or occasionally a tough fall/trauma to that area).

When treating this injury, it’s important to focus on mobility and strength. There are many exercises that we can use to treat this injury throughout the different phases of rehab, however here are a few examples:

1. Quadriceps Stretch/foam rolling
2. Bretzel Mobilization
3. Sartorius Stretch
4. Reverse Nordic
5. 3 Way Squat Tap
6. Single Leg Squat to Beam

Please remember that if you or your athlete are experiencing pain, seeing a medical professional is important. The quicker you get seen after an injury starts, the quicker the injury will heal. This post is only a glimpse of how we treat Osgood Schlatter’s at our clinic, and should be used for educational purposes only.

01/16/2023
Chronic vs Acute Pain Management

Chronic vs Acute Pain Management

We interpret pain subjectively, however there are biochemical processes that take place in our body that separate pain into acute vs chronic phases.

Acute pain happens at an initial point of time/event, usually from trauma ie. sprained ankle, dislocated shoulder, broken arm etc. The inflammatory phase lasts about 3 days and then slowly begins to "calm down" so to speak.

Chronic pain is a different bear. If pain lasts longer than 2 weeks it’s considered chronic. You can also have acute flare ups with a chronic injury. This kind of pain builds over time, doesn't seem to go away, and can be nagging.

So how do you manage chronic vs acute pain?

Disclaimer: This is not medical advice. It’s always best to get checked out by a physician who can do a thorough exam and determine if these recommendations are appropriate for you specifically!

Acute Pain, we follow RICE:
1. REST
2. ICE
3. COMPRESSION
4. ELEVATION
We want the swelling down and want to begin gentle motion as soon as possible. NSAIDs can also be helpful with controlling inflammation in this phase. Commonly, after 2 weeks we should have very little pain. However, if pain persists then we are now looking at chronic pain.

Chronic pain is something that you should have assessed by a medical provider, especially if it is affecting activities of daily living. However, here are some ideas to help:
1. Deloading/impact modification (limit high impact activities for 1-2 weeks)
2. Foam Rolling or Lacrosse ball work, roll out the muscles around or on the area you have pain
3. Stretching, performing gentle stretches 2-3x a day to the muscle group causing pain
4. Heat, (or ice- If there is swelling or warmth to touch), applying a hot pack for 15-20 min can be very helpful with pain control
5. Eccentric loading of the muscle group in pain.
6. NSAIDs can also be helpful in this phase as well, but should only be needed for about a week.

01/12/2023

Lunge Jumps Without Arm Use

This drill is great coupled with single leg squat jumps without arm swing. Doing this jump from a lunge position can also be really challenging. Make sure to start slow and small for safety (like onto a panel mat or start from a standing lunge), then progress up over a few weeks. ⠀

This drill is perfect for single leg jumps, leaps, push off for round offs, or just a great plyo power training drill for the lower extremity.

If you want to learn more Check out: perfect10pt.org⠀

01/11/2023

Lower Body PLYOMETRICS for Gymnastics

Here are a few plyometrics progressions I use with gymnasts specifically, but really, these could be applied to other athletes recovering from lower body injuries that need to work on jumping and landing mechanics for their sport

Videos are in no particular order

Gymnastics, unlike most sports, is performed without shoes, therefore in rehab it’s important to train these athletes not to rely on shoes for ankle stability.
Gymnasts, like most jumping athletes, typically injure themselves during the takeoff (jumping up portion) or the landing (coming down portion) of skills, some recent research shows specifically in back-tumbling the achilles is mostly likely to rupture/be affected. Therefore, it’s crucial to train both jumping and landing mechanics to improve loading patterns and reduce risk of re-injury.
Gymnasts perform jumps and skills a variety of ways and we must incorporate all 3 ways of jumping and all 3 planes of movement in our plyometric rehab protocol, and make sure we incorporate a good amount of both single leg and double leg exercises:
1. Non-countermovement
2. Countermovement
3. Rebounding

1. Linear
2. Lateral
3. Multidirectional/Rotational

Shoutout to for letting me document her rehab to help so many others!

01/11/2023
Chronic vs Acute Pain Management

Chronic vs Acute Pain Management

We interpret pain subjectively, however there are biochemical processes that take place in our body that separate pain into acute vs chronic phases.

Acute pain happens at an initial point of time/event, usually from trauma ie. sprained ankle, dislocated shoulder, broken arm etc. The inflammatory phase lasts about 3 days and then slowly begins to "calm down" so to speak.

Chronic pain is a different bear. If pain lasts longer than 2 weeks it’s considered chronic. You can also have acute flare ups with a chronic injury. This kind of pain builds over time, doesn't seem to go away, and can be nagging.

So how do you manage chronic vs acute pain?

Disclaimer: This is not medical advice. It’s always best to get checked out by a physician who can do a thorough exam and determine if these recommendations are appropriate for you specifically!

Acute Pain, we follow RICE:
1. REST
2. ICE
3. COMPRESSION
4. ELEVATION
We want the swelling down and want to begin gentle motion as soon as possible. NSAIDs can also be helpful with controlling inflammation in this phase. Commonly, after 2 weeks we should have very little pain. However, if pain persists then we are now looking at chronic pain.

Chronic pain is something that you should have assessed by a medical provider, especially if it is affecting activities of daily living. However, here are some ideas to help:
1. Deloading/impact modification (limit high impact activities for 1-2 weeks)
2. Foam Rolling or Lacrosse ball work, roll out the muscles around or on the area you have pain
3. Stretching, performing gentle stretches 2-3x a day to the muscle group causing pain
4. Heat, (or ice- If there is swelling or warmth to touch), applying a hot pack for 15-20 min can be very helpful with pain control
5. Eccentric loading of the muscle group in pain.
6. NSAIDs can also be helpful in this phase as well, but should only be needed for about a week.

01/10/2023
01/09/2023

When is it appropriate to send a patient for an ankle x-ray?

Here is the research provided for the Ottawa Ankle screening test for ankle fractures post inversion trauma aka ankle sprain

EX*****ON:
1. Palpate for tenderness on the posterior edge of the medial and lateral malleoli from the distal tip up 6 cm
2. Palpate for tenderness or pain at the navicular bone and 5th metatarsal
3. Ask the patient to walk 4 consecutive steps (limping is permitted)

Positive Outcome: Tenderness on any of the first two points (step 1 and 2) or if the patient is unable to walk four consecutive steps. In that case refer for radiography - If any one of the 3 tests is positive there's a 25-50% chance there's an x-ray needed, but if none are positive there's close to 100% chance there is no fracture.
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Comment your thoughts below-was this helpful?

01/07/2023

✨It’s 2️⃣0️⃣2️⃣3️⃣✨

Did you make New Year Goals? As we close out the first full week of the New Year, setting goals for your health, school, life, and sport is SO important to help create new or better habits. Goals help to keep you focused, motivate, and improve your overall success!

Remember it takes 60 days of a good repetitive action (habit) to really make it stick. I know it can be intimidating to set goals, but have you tried SMART goals?

Specific. Measurable. Achievable. Relevant. Timely. What does this look like and how do I set them?

Specific: Use numbers. Don’t give a general goal of “I want to exercise more”, “I want to eat better”, "I want to lose weight" or “I want to move up a level or go on pointe” Instead, how quickly do you want to run the mile? How many servings of veggies will you eat daily? What specific skill on what apparatus do you need to achieve in order to move up?
Measurable: Can you measure your success? Can you perform this skill perfectly with a stuck landing 8/10 times? Can you check off the habits you need to set to eat healthier?
Achievable: Is it a realistic goal? Is it possible to achieve this skill in one month when you haven't begun drilling the skill or you're unable to stick to the prior progressive skill? Is it realistic and SAFE to lose 10lbs in 2 weeks?
Relevant: Why are you setting the goal that you are setting? Is there a reason you want to move up levels? Why are you wanting to eat more veggies? If your answer is: my goal is to eat more veggies because my energy is low and I feel tired all the time and I was encouraged by my doctor to have a better diet to help with my fatigue, energy and overall health than great! That’s a relevant goal!
Timely: WHEN will you accomplish this goal by? Will it take 6 months? A full year? Set a time when you want to accomplish this goal, so you hold yourself accountable to your goals!

What are your goals for 2023? Drop them in the comments below! #2023

01/05/2023

Shoulder Mobility and Flexibility Work for the New Year

With the holidays over and New Years Resolutions in play week here it’s important not lose your shoulder mobility and flexibility! Here are a couple easy to do exercises to keep those shoulders healthy and flexible as you meet those New Year's Resolutions!

Shoulder Mobility Exercises:
1. Lat lacrosse ball rolling 2-3 minutes each side
2. Underhand grip lat mobilization with a PVC pipe 2x30 sec (sit back on heels-hollow upper body)
3. Tucked wall handstand 3x30 sec hold
4. Overhead circles 2x10
6. Eccentric pull ups 5x5sec
6. Repeat 3 times

Look at that 15 degree shoulder range improvement! It may seem like a small change visually, but in skills it can make the difference in hitting your kip cast handstand, back HS step out on beam or even your yurchenko on vault! Shoulder mobility and flexibility is vital in achieving full “open shoulder” skills like the ones mentioned above.

Try a few of these and let me know how it goes! They are harder than they look!

Want a full shoulder mobility and flexibility workout? DM me or sign up for a full evaluation. Link in bio

01/04/2023

Injury PREVENTION Exercises

Can you actually prevent injuries though?

Maybe you can...maybe you can’t.

Let me explain.

Sometimes, freak accidents/injuries happen, which are the result of direct contact from another person, object, etc.
These injuries are pretty difficult to prepare for, as you don’t usually see them coming... they aren’t really preventable.

Now, let’s talk about the potentially preventable kind.

Keep following:
Bob is a gymnast. His tumbling pass is a round off backhandspring, therefore the internal load/tissue capacity of Bob's overall body loading is 13x his body weight.

Bob moved up two levels in one season, and one of the floor requirements is to perform a roundoff backhandspring full several times throughout the day, which is now 15x his body weight (due to difficulty and force of the pass) with double the amount of passes. Do you think Bob may end up hurting himself?

YES.

Why? The external load (x15 his body weight) required to perform the task is way larger than the current internal capacity of his body's capacity (13x), which means he is susceptible to tissue related injuries such as muscle strains, tendinopathies, ruptures, etc.

Is it preventable? YES! In instances like this, if we increase the internal capacity of the tissue, we can reduce the potential risk for an injury. This is why strength training is SOOO IMPORTANT!

Now, most people do a fair amount of strengthening for their larger muscles? How about those smaller muscles? Unilateral work? Mobility work? Stability work?

Here’s an example of some strengthening exercises:
1. Copenhagen Body Lifts with Reverse Flyes
2. Prone I Y T W Lifts + Angels
3. Weighted Hip Abduction Lifts
4. Front Leg Elevated Deep Forward Lunge

Interested in developing a strength training program designed for YOU!? Shoot me a DM, email or text.

01/03/2023

Shoulder Mobility and Flexibility Work for the New Year

With the holidays over and New Years Resolutions in play week here it’s important not lose your shoulder mobility and flexibility! Here are a couple easy to do exercises to keep those shoulders healthy and flexible as you meet those New Year's Resolutions!

Shoulder Mobility Exercises:
1. Lat lacrosse ball rolling 2-3 minutes each side
2. Underhand grip lat mobilization with a PVC pipe 2x30 sec (sit back on heels-hollow upper body)
3. Tucked wall handstand 3x30 sec hold
4. Overhead circles 2x10
6. Eccentric pull ups 5x5sec
6. Repeat 3 times

Look at that 15 degree shoulder range improvement! It may seem like a small change visually, but in skills it can make the difference in hitting your kip cast handstand, back HS step out on beam or even your yurchenko on vault! Shoulder mobility and flexibility is vital in achieving full “open shoulder” skills like the ones mentioned above.

Try a few of these and let me know how it goes! They are harder than they look!

Want a full shoulder mobility and flexibility workout? DM me or sign up for a full evaluation. Link in bio

Let's start 2023 off right with some Proper Core Training.This is one of my TOP 5 return to sport “must dos”Core stabili...
01/02/2023

Let's start 2023 off right with some Proper Core Training.
This is one of my TOP 5 return to sport “must dos”

Core stability and strength are 2 separate concepts that get interchanged often in the gymnastics world. That’s why I love isolating these two concepts and educating my gymnasts, dancers or cheerleaders either before or after practice about proper spine alignment, diaphragmatic breathing (belly breathing ) core/pelvic floor anatomy and proper core STABILITY in isolation!

If core stability is left unchecked, gymnasts often end up with low back pain, inconsistency with skills across events, and repeat lower extremity injuries. But when proper core stability is put into action the power and skills become natural and automatic! *see video*

The main core stabilizer is the transverse abdominus (TrA)! Fun fact: Nobody can have mobility/movement BEFORE stability. The gymnasts pictured above are working on TrA isolation in neutral spine. Do you know how to isolate and activate your core stabilizers?

Want to learn?

Link in bio for a free consult or full evaluation!

01/01/2023

Wishing all of our patients and followers a very safe and Happy New Year! Cheers to 2023!

-From the entire Perfect 10.0 PT Staff

12/31/2022

Advanced floor progression for pirouettes!
Stronger Core
Stronger Glutes
Improved Placement

12/29/2022

What's the best way to start with gymnasts lifting weights?
First, learn the basics of lifting movement patterns. For the lower body, it's squatting, hinging, single leg, split pelvis, and accessory work (generally).

Next, learn the proper technique for these things either from a strength coach or by taking courses.

Then, understand the basic set and rep ranges for strength, which is usually 3-4 sets of 8-12.

From there, watch body weight only movements and make sure form is perfect. Adjust as needed.

Once that shows proficiency, add small amounts of load, say 5-10lbs to start, and load the exercises for a few weeks pending that form and quality doesn't slip, and that athletes don't have too much soreness after.

Week by week, slowly increase load by 5-10% over 6 weeks. Then, look back and re-evaluate how things went to adjust for the next cycle!

Hope this helps as a starting point :)

12/28/2022

Did you know that we offer functional dry needling only services?

Intramuscular Functional Dry Needling (IDN) uses a filiform needle as an application to target specific tissues responsible for driving neuromuscular dysfunction, to help reduce pain, improve function, improve flexibility, and increase blood flow and promote overall healing.

Contact Dr. Ezara Greene at [email protected] for additional information!

12/27/2022

Knee Strengthening

Strengthening the muscles that support your knee will reduce stress on your knee joint. Strong muscles in the front of your thigh (quadriceps) and back of your thigh (hamstrings) help your knee joint absorb shock. The less strain on your knee, the better the chances are for pain relief and preventing further injury. Dance, cheer and tumble smarter, not harder.

12/26/2022

Check out this Hip Flexor Strengthening exercises!

Hip flexor strengthening is often overlooked as a targeted exercise for dancers. Sure, dancers use their hip flexors ALL of the time, but are you training them to be strong enough to endure the range of motion and repetitiveness of use?

Here are some of my favorite ways to get to those hip flexors, especially above 90 degrees. These can all be done in parallel and turned-out positions. If you're a constant stretcher, try switching it up to strengthening instead! Side note: I don't routinely recommend standing battements and kicks with ankle weights for young dancers as a primary means of strengthening the hips (topic for another day). Of course, it's always a good idea to seek personalized evaluation and recommendations from a dance medicine specialist for your unique situation. Dancers should not push into hip pain or pinching in the front of the hip without seeking further evaluation.

Disclosure: These dance tips and exercises do not substitute for diagnosing, examining, or in determining the effect of any specific exercise on a medical condition. Contact us for an assessment of your specific injury or medical condition. When participating in any exercise or exercise program, there is the possibility of physical injury. If you engage any dance tips and/or exercise, you agree that you do so at your own risk, you assume all risk of injury to yourself, and agree to release and discharge Perfect 10.0 Physical Therapy, PLC from any and all claims or causes of action, known or unknown, arising out of Perfect 10.0 Physical Therapy negligence.

Wishing all of our patients and followers a very happy and safe Christmas Day!-From our entire Perfect 10.0 PT Staff
12/25/2022

Wishing all of our patients and followers a very happy and safe Christmas Day!

-From our entire Perfect 10.0 PT Staff

12/24/2022

Do you know how a PT can help you?

Here are 5 reasons why Perfect 10.0 PT believes EVERY Artistic Athlete should have a PT on speed dial….☎️

1. Help get you back on your feet, quickly AND safely, after an injury
2. Strength and conditioning— perfect for injury prevention!
3. Performance coaching to help take your technique to the next level
4. Education…. Knowledge is power and every dancer should have a basic understanding of how your body works and ways to keep healthy!

How has a PT helped you?? Tell us all your success stories in the comments!

12/23/2022

This is a MUST do for developing foot extension and take off technique.
Start with tendue ( slide the foot forward using turn out) , start with using only toes to push of the floor, curl toes and lengthen your ankle every time! then add full foot and plie. It's a peeling action- toe to heel and heel to toe. Repeat front side and back .
Will try to post the full sequence soon.

I had the opportunity to be interviewed for a podcast called “Flippin’ Out” (run by a super star level 10 Junior Olympic...
12/23/2022

I had the opportunity to be interviewed for a podcast called “Flippin’ Out” (run by a super star level 10 Junior Olympic gymnast) on the topic of Longevity and Injury Prevention in the sport of Gymnastics!
Give it a listen and let me know your thoughts below!

12/22/2022

Focus on the step in front of you, not the whole staircase. ✨

📞 571-252-9131
📧[email protected]

12/21/2022

Trust, Quality Care and Guaranteed Results!

Identify • Plan • Restore • Maintain
Just stick to the method and we’ll ensure that your goals are met!

Cheers to another successful journey and improved strength AND skills working with Dr. Ezara! ️

P.S. March's schedule is now open!

12/20/2022

How long should you stretch for to improve range of motion?

Taken from a 2018 systematic review, theis slideshow will give you some great details on time holding, frequency, types of stretching, and other pieces that are most helpful

1. Which type of stretching increases range of motion the most?

Static stretching seems to take the lead, but PNF, active, and dynamic stretching aren't far behind.

2. How long should you spend stretching per week to increase range of motion?

Generally, 5 minutes per muscle group seems to be best.

3. How long should you hold a stretch to increase range of motion?

60 sec seems to be a sweet spot, with 120 sec+ not showing that much more benefit

4. How many days a week should you stretch to increase range of motion?

5-6 days per week tended to be most effective.

Source:
The Relation Between Stretching Typology and Stretching Duration: The Effects on Range of Motion - Thomas et al 2018.

12/19/2022

Is Shoulders Flexibility linked to Low Back Pain in Gymnastics?

Lack of shoulder flexibility is a very real and common problem in gymnastics.

Without adequate shoulder flexibility, most gymnasts will rely on their lower back flexibility to do skills such as back walkovers, back handsprings, front handsprings, etc.

Over time, the extra stress to the low back may (and usually does) result in low back pain…or even worse things like spondys or stress fractures

If sufficient shoulder flexibility is developed early in a gymnast’s career before they are doing any skills that stress the lower back, gymnasts may be able to go their entire career without any low back pain! Also, gymnasts with sufficient shoulder flexibility tend to learn several skills faster and will have less deductions during those skills.

But it’s never too late to work on that overhead position and learn how to own that open shoulder angle

Here’s some ideas to improve shoulder flexibility which will help handstands, skills and reduce the risk of low back pain:

1. Soft tissue mobilization (both lat and teres major shown)
2. Kneeling stick mobilization
3. Child pose lift offs
3. Prone Shoulder Circles
5. Hollow Body Pullovers
6. Eccentric Pull-ups
7. Z Press
8. Ground to Wall Walks
9. Tucked Wall Handstand Drill

Make sure to tag a gymnast, parent or coach that could benefit from this post!

Happy Holiday GIVEAWAY TIMEAt Perfect 10.0 PT we are SO very thankful to all our amazing patients, friends and followers...
12/19/2022

Happy Holiday GIVEAWAY TIME

At Perfect 10.0 PT we are SO very thankful to all our amazing patients, friends and followers, we are doing a Happy Holiday Give Away!!!

Including:

🎁One FREE Evaluation of your choosing!

💚Price value of $275-$350 depending on the type of Evaluation

❤️ YOU get to pick!!!

Giveaway ends Friday 12/23! We will announce a winner that night on stories and there will be NO other accounts reaching out to you!

HOW TO ENTER:

1. Like & SAVE this post! ⠀

2. Follow (We will check!)

3. Leave us a Google Review

Side note: This is our ONLY Instagram account. We will not contact you from another account asking for your personal information, this is a FREE GIVEAWAY!

USA ONLY! ⠀
This giveaway is not endorsed or sponsored by Instagram!

12/17/2022

Back Injury Timeline for Healing

While there is no exact way to know for how long back pain will take to heal, after treating many gymnasts, dancers and cheerleaders for extension based back pain I have a decent idea on how long things tend to take.

Each phase (acute/subacute, intermediate, advanced/S&C, return to sport) has its own focus, but they tend to each fall into the 4-6 week mark depending on the severity.

That said, different injuries tend to resolve quicker or slower, depending on how long a gymnast may continue to train in pain before they go get looked at or diagnosed.

Here are some helpful timelines:

Stress Reaction: 2-3 weeks each, 8-12 weeks total

Spondylolysis: 4-6 weeks each, 16-24 weeks total

Facet syndrome: 1-2 weeks each, 4-8 weeks total

Spondylolethesis: min 6+ weeks each, ? Weeks total

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