by Colin Farrell
What is Spondylolysis?
Spondylolysis is a fracture of small portion of your vertebrae called the pars interarticularis. It most frequently occurs in the lumbar spine or otherwise known as your low back. Basically, all these fancy words means that you fractured a small section of a vertebrae which can leads to low back pain. The pars interarticularis happens to be the weakest section of your vertebrae. A pars fracture is typically sustained by repetitive motions that involve loading your low back, twisting, and/or extending. Over time, repetitive twisting and extension of the low back leads to overuse and eventually a stress fracture.
*It’s estimated as high as 50% of child athletes who present with low back pain are positive for a pars fracture or defect.
Who does this affect?
A pars fracture most frequently occurs in adolescents and especially those who are athletes. High risk sports include but are not limited to football, wresting, volleyball, gymnastics, and dancing.
What are the signs and symptoms of a pars fracture?
- *low back pain* usually insidious or slowly appears/progresses
- Pain is often worse with activity or participating in sport – especially with twisting and/or extension of the low back
- Can feel radiating pain down into your thigh and buttocks (this is uncommon)
- Many pars fractures go unnoticed! Estimated as nearly 80% of cases…
How is a pars fracture diagnosed?
- Comprehensive patient history and physical examination performed by a clinician such as a physician or a physical therapist
- Evaluating patient signs and symptoms
- Imaging studies such as X-Ray followed by a CT scan or MRI can confirm a fracture
What are the treatment options?
- Medical management – Steroid shots to reduce inflammation, Medications like ibuprofen
- Surgical management (RARE): only if conservative management fails or if your condition progresses to spondylolisthesis (the pars fracture allows two connecting vertabrae to “slip” on one another)
- Conservative management/ physical therapy
Physical therapy treatment would include …
- Pain/inflammation management
- Patient education including activity modification
- Exercises to strengthen paraspinal muscles, as well as stabilization exercises to strengthen core/abdonimals, all of which support your spine
- Stretching tight muscles like hamstrings/glutes
- Activity/sport specific exercises to return to sport or prior level of function
References
- Professional CC medical. What is spondylolysis? Cleveland Clinic. Accessed July 23, 2023. https://my.clevelandclinic.org/health/diseases/10303-spondylolysis.
- Mansfield JT, Wroten M. Pars interarticularis defect. 2019.
- Physiopedia. Accessed July 23, 2023. https://www.physio-pedia.com/Spondylolysis.
- GUIDE: Physical therapy guide to spondylolysis and spondylolisthesis. Choose PT. August 17, 2020. Accessed July 23, 2023. https://www.choosept.com/guide/physical-therapy-guide-spondylolysis.
