Spondylolysis (spon-dee-low-lye-sis) and spondylolisthesis (spon-dee-low-lis-thee-sis) are common causes of low back pain in children and adolescents. These injuries are also sometimes known as pars stress fractures, pars defects or pars fractures.
Spondylolysis and spondylolisthesis affect the pars interarticularis of the vertebrae, the bridge between the upper joint of the vertebrae and the lower joint of the vertebrae.
Injuries to this area range from tiny, nearly invisible cracks called “stress fractures” to complete fractures called a spondylolysis, also known as a pars defect or pars fracture. Bilateral complete fractures can lead to spondylolisthesis, which is when one of the vertebrae slides forward more than it should.
These pars defects are most common at the lower lumbar spine. They can have a genetic aspect, but are often related to overload or an acute trauma. Most commonly, this injury is more painful into extension, so this happens more frequently in sports like gymnastics.
Often, spondylolysis or spondylolisthesis presents with insidious onset lower back pain, sometimes after an increase in loading or training volume. The pain often gets worse if the sport or activity is continued. The pain is often worse when leaning backwards into extension, and relieves towards flexion. Because this is a common injury in adolescents and can have poor outcomes if not treated, this is something that we have to keep in mind when assessing a younger athlete with lower back pain.
The treatment consists out of restricting the activity levels to a painfree level. This is necessary for the (stress) fracture to heal. If there is no improvement with rest for a few weeks, then bracing is another option. If there is improvement with rest, this may be necessary for up to 3 months for the fracture to fully heal, before initiating sporting activities again. Our physiotherapists can also address any factors, which may have caused excess stress in this region, such as abnormally tight muscles or poor movement patterns, and improve strength and endurance around the trunk to prevent any recurrence. Generally this type of injury heals really well without surgery, but surgery can be a last resort if it is a severe case where there might be a large degree of slip of the vertebrae or there is no improvement with rest.
If you suspect your child might have a pars injury, please get in touch and book an appointment with one of our highly skilled physiotherapists