1. a congenital abnormality (present at birth) called an ‘attenuated pars’, or
2. a stress fracture.

The main vertebrae affected are L5 (85 – 95%), and L4 (5 – 15%), but rarely higher lumbar vertebrae. It can be diagnosed by plain X-ray, CT or MRI. 50 – 81% of people with spondylolysis end up with the bilateral fractures of the pars interarticularis, resulting in forward slippage (spondylolisthesis) of the vertebra.

Most pars defects are asymptomatic, but some present as lower back pain. Typically, when the patient stands on one leg and leans backwards, pain results. When the defect is on one side only, standing on the opposite leg elicits the pain (Syrmou 2010). Pain typically gets worse with sport, and better with rest (Harris nd).

About 6% of the general population have a pars defect (Syrmou 2010). However, the injury is more common in adolescents participating in high risk sports (gymnastics, diving, weight lifting, wrestling, rowing, figure skating, dancing, volleyball, soccer, tennis). Up to 30.4% experience lower back pain (Malanga 2015), often  due to a pars defect (McTimoney & Micheli 2003).

Healing of pars defects can occur but is more likely in early-stage cases. No optimal treatment plan exists in the literature. Pain relief medications may be used but nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they slow down bone growth and healing (Syrmou 2010). Some authors (Harris nd) state that ‘only rest’ can heal a pars defect, with acupuncture and massage having no benefit. This is incorrect.

Rest is vital, however stiff lower back muscles increase the forces on vertebrae to which they are attached, and so the likelihood of re-injury. Inflammation reduces the ability of tissue to heal. Muscle elongation therapy uses both dry needling techniques and specific muscle elongation techniques to address both these issues, and along with rest, this helps many cases of long standing back pain associated with pars-defects to become pain free and heal.

If you have unresolved pars-defect related back pain, why not come talk to us at BHW – see our ad for contact details.

References:

1.      Syrmou E etal, 2010, ‘Spondylosis: A review and reappraisal’, Hippokratia, vol 14 no1, pp17–21

2.      Harris SS, nd, ‘Pars Stress Fractures of the Lumbar Spine’,  Palo Alto Medical Foundation, Palo Alto, CA, viewed 24 January 2016, <http://www.pamf.org/sports/harriss/parsstressfractures.pdf>

3.      Malanga GA (Ed) 2015, ‘Pars Interarticularis Injury’, Medscape, WebMD, New York, NY, viewed 24 January 2016, <http://emedicine.medscape.com/article/95848-overview#a6>

4.      Olsen TL et al, 1992, ‘The epidemiology of low back pain in an adolescent population’, Am J Public Health, vol  82 no4, pp606-8, viewed 24 January 2016, <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694113/ >

5.      McTimoney CA¹, Micheli LJ, 2003, ‘Current evaluation and management of spondylolysis and spondylolisthesis’, Curr Sports Med Rep,  vol 2 no1, pp41-6, viewed 24 January 2016, <http://www.ncbi.nlm.nih.gov/pubmed/12831675>