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Spondylolysis (Pars stress fracture)

Spondylolysis is a medical term for stress fracture of the back. The type of fracture is found between two vertebra, it is often known as a pars stress fracture as shown in fig 1. This is because it affects a part of the spine known as the pars interarticualris, which is a small portion of the spine that connects the small joint from the above vertebra to the one below. This area is the weakest area of the vertebra. With overuse of overloaded movements, this can cause this area in particular to become vulnerable to injury.  Approximately 90-95% of cases of this injury are at the last vertebra in the body as we tend to adapt and hinge from one vertebra without known causing increases stress on this area.

Symptoms

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Common symptoms include:

  • Pain eased with rest
  • Spontaneous onset of pain on one side of the back
  • Pain that radiates into the thigh or glutes
  • Aggravated by standing or functional activities
  • Initial sharp pain – dull in nature later

If your symptoms include one or more of the below symptoms you should seek medical advice before beginning your own self-management.

  • Change/loss of bladder or bowel function
  • Worsening back pain
  • Leg weakness, pin and needles, numbness or tingling
  • Difficulty walking or loss of balance

Causes

Typically, spondylolysis is caused through activities that stress the pars interarticularis causing the stress fracture. These are normally hyperextension or extension type movements often found in cricket bowlers, gymnasts and divers.

Other sports where spondylolysis has a high incidence:

  • Ice skating
  • Track and field
  • Ballet dancing
  • Wrestling
  • Weightlifting

Managing your pain

The main complaint with his injury is pain followed by inflammation over the damaged area. Managing your acute symptoms will give you the best platform to move forward with recovery from this injury.

Firstly, reducing your activity levels is key in initial phases of recovery. This allows the body to process the damage and work on its natural methods of healing. To aid the method you can apply ice packs to the area to reduce the swelling and decrease sensitisation which will reduce your pain. In addition, NSAIDs (non-steroidal anti-inflammatory drugs) can be used to decrease the swelling in the area, reducing the irritation caused in the injured area. Medications such as ibuprofen to assist with your pain and swelling reduction.

If your symptoms to don’t improve over three to five days you should see a physiotherapist for further examination of your back. They will be able to recommend a back and core stabilization programme that will allow you to strengthen muscles within your back and other areas to reduce the load placed on injured structures. This will help you to make a faster recovery.

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