Spondylolysis, pars interarticularis...are these names of dinosaurs or something to look out for in adolescent low back pain?
- 3 days ago
- 4 min read
If your adolescent child is experiencing persistent lower back pain, especially during or after sports, it could be more than just a strain. Pars defects are common in active teens and can significantly impact their ability to participate in sports. Understanding this condition, how it occurs, and what you can do to support your child’s recovery is crucial.
A pars defect, also known as spondylolysis, can be a congenital defect (something you are born with) or a small stress fracture in a part of the spinal vertebrae called the pars interarticularis.
Pars defects can occur on one side of the vertebrae (unilateral) or both sides (bilateral) and 80-95% of pars defects occur in the L5 vertebrae in the lower back. They affect 6-8% of the general population, however it is important to know that many cases of pars defects are not painful and do not affect the stability or movement of the spine. This is especially true if the defect is small or stable. Congenital cases are usually discovered incidentally during imaging for another reason, such as checking for unrelated injuries.
Pars defects may otherwise arise from repetitive stress on the lower back, especially in sports that involve a lot of bending backward (extension) or twisting/rotation, and in particular a combination of extension and rotation. If your child has a symptomatic pars defect, they may complain of lower back pain that gets worse with activity, notably with movements that involve bending backward, and the pain is usually centered in one spot on the lower back (if a one-sided injury).
Specific sporting risk factors include overuse, especially in sports like gymnastics, cricket, diving, and tennis. Poor technique with specific sporting movements, such as fast bowling in cricket, is a common contributing factor. Adolescents are particularly at risk because their bones are still growing, making them more susceptible to these types of stress injuries. In fact, the injury is considered a stress fracture when its injury related.
Most cases of low back pain are generally managed conservatively through relative rest, load modification, manual therapies such as massage and joint mobilisation, and specific strengthening and stretching exercises. However, if symptoms persist for more than six weeks, imaging may be considered, especially for adolescents. Sometimes a pars defect is suspected early on, and imaging will be used sooner rather than later to assist diagnosis. Pars defects are typically diagnosed with an X-ray which you can obtain a referral through your physiotherapist, osteopath, GP, or sports physician. If additional detail is needed, an MRI or CT may be recommended, particularly in the cases of significant and constant pain. CT scans visualise pars defects better but they do result in significant radiation exposure which needs careful consideration in developing adolescents. The choice of who oversees your recovery is entirely up to you - a physiotherapist or osteopath can provide guidance on this, often in conjunction with a sports physician.
Management and Treatment of spondylolysis / pars defects
Rest and Activity Modification: The first step in treating a pars defect is reducing load. This means avoiding activities that could aggravate the injury, such as sports or exercises that involve heavy lifting, backward bending, or twisting. That doesn’t mean to say no movement at all – general day to day movement is ok and important to do! Typically, reducing load for 3-6 months is necessary to allow the bone to heal properly.
Physiotherapy/Osteopathy: Physiotherapy or Osteopathy is a key component of the recovery process. Early on, the focus is on reducing pain and inflammation. As your child starts to feel better, the therapy will shift to exercises targeted towards strengthening, improving flexibility, and correcting any movement patterns that might have contributed to the injury.
Strengthening exercises: These exercises are designed to strengthen the muscles surrounding the spine, including and especially the abdominals, providing support and reducing the risk of future injuries. Initially, certain aggravating movements - such as end-range twisting or backward bending - are avoided, with the goal of gradually reintroducing these movements as tolerance improves.
Flexibility training: Stretching exercises, especially for the hamstrings and hip flexors, can relieve pressure on the spine and improve your child’s range of motion. However, if stretching isn’t tolerated or if muscle tightness is due to growth spurts, alternative approaches such as gentle mobility exercises, massage, or heat therapy can help maintain flexibility and comfort.
Posture and movement education: Learning about posture and safe movement patterns is essential for preventing re-injury. This includes refining sporting techniques to reduce strain on the lumbar spine, gradually progressing sport specific exercises, and developing strategies to manage pain if it reoccurs. Communication with coaches is important during this process.
Bracing: In some cases, wearing a back brace may be recommended (usually in consultation with a sports physician) to provide support and reduce pain while the bone heals.
Gradual return to activity: Once your child is pain-free and has regained their strength and flexibility, they can slowly start returning to physical activities. This should be a gradual process, beginning with low-impact exercises and slowly progressing to more strenuous activities, always under the guidance of a healthcare professional.
Returning to sport after a pars defect is a step-by-step process that requires patience. Your child should be pain-free and show good strength and flexibility before returning to their sport. Typically, it can take anywhere from 4-6 months for minor cases, but in more severe cases, it could take up to a year or more.
Time off sport can result in fear, low self-esteem and frustration. Communication with coaches, teachers and parents, about recovery estimates can be very helpful. Finding alternative ways to maintain cardiovascular fitness can provide a positive focus while gradually returning to sport. It is alos important to follow the advice of your healthcare team and not rush the return to sport. A slow and steady approach reduces the risk of re-injury and ensures that your child can get back to enjoying their activities safely and confidently.
Pars defects can be challenging for young athletes, but with the right care and a structured approach to recovery, most adolescents can return to their favoured sports. Understanding the condition and working closely with your healthcare team will help your child heal properly and get back to doing what they love. If you have concerns about your child’s back pain or their recovery process, don’t hesitate to reach out to a healthcare professional for guidance.
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