Stress Fracture of the Pars Interarticularis / Lumbar Spondylolysis
A lumbar spondylolysis is a term used to describe a lesion to the posterior vertebral arch in the region of the pars interarticularis, confirmed only with radiology.
- Rest: This involves avoiding aggravating activities that place high degrees of stress on the lower back. Rest in this case does not include rest from all activities. The most important aspect of this is to cease sporting activities that place high loads on the posterior vertebral arch such as contact sports, running and jumping. It is also important to avoid repetitive end range positions, particularly hyperextension / rotation and side flexion of the spine.
Professional Medical Treatments
- NSAIDs (or Nonsteroidal Anti-Inflammatory Drugs) can often help reduce swelling and back pain. Consult GP to ensure appropriate use.
- Physiotherapy treatments can often help with symptomatic relief, especially if muscular issues are involved
- In extreme cases, surgery may be recommended. This is usually in the case of high grade slippages that may be progressively worsening or cases where conservative management has failed. Most commonly, surgery will involve a spinal fusion which essentially fuses affected vertebrae together to allow them to heal into a single solid bone.
Physical Therapy Exercises
- Strengthening exercises that address lumbopelvic stability, improve lower limb mechanics and strength as well as increasing flexibility are important to rehabilitate. Strengthening should be through a progressive offloading and then reloading rehabilitation program which should be guided by your physiotherapist. The offloading period combined with the protected reloading period as well as the return to sport period will usually take approximately 3 – 4 months.
- Poor endurance of the lumbar extensor muscles has been linked to development of lumbar bone stress injuries
- Maintaining good control through lumbar spine, pelvis and hip muscles is key in these cases
- Ensuring that load in sport is gradually introduced