Stress fracture of the pars interarticularis factsheet
Introduction
The spine is made up of 33 small bones called vertebrae. Vertebrae are connected by thin pieces of bone on each side called the pars interarticularis.
A stress fracture of the pars interarticularis is a small break on one or both sides. This type of fracture usually happens in the lower back, also called the lumbar region.
This condition is also known as:
- a pars defect
- spondylolysis.
This type of fracture is often caused by repeated, ongoing strain. This can commonly be from activities that involve bending, stretching, or twisting the lower back, such as:
- cricket
- gymnastics
- diving
- soccer
- weight lifting
- tennis.
Some children are born with weaker bones in their spine, which means they can develop the condition even without playing sports.
Children and teenagers are more at risk because:
- their bones are still growing
- they are also more likely to play sports
- they are generally more physically active.
Signs and symptoms
Symptoms generally include pain:
- on one or both sides of the lower back
- that spreads to the bottom
- that worsens with bending backwards, standing for a long time, or running
- that slowly gets worse over time.
See your local doctor or physiotherapist early, even if your child’s pain is mild or only during activity.
Diagnosis
Your child’s local doctor or physiotherapist will check your child’s back and ask them to bend or twist gently to see where it hurts.
They may order scans such as:
Treatment
Treatment depends on how severe the fracture is and whether it is likely to heal on its own.
Your child’s doctor may recommend:
- taking a break from sports and activities for 6-12 weeks
- wearing a back brace to prevent any painful movement that can make the fracture worse
- seeing a physiotherapist to build strength and improve posture
- checking your child’s movement and pain during growth spurts
- medications to help with pain and swelling.
With the right treatment and enough rest, the fracture can heal, and the pain should improve over time.
Management
Returning to sports and activity
The doctor and physiotherapist will let you know when and how your child can return to activities. They must start slowly to avoid making the fracture worse.
Let your child’s school, coach or activity organiser know so they can help with a safe return to activities.
Long-term issues
Children born with weaker bones are more likely to get stress fractures.
If not treated properly, the fracture can lead to:
ongoing back pain that makes it hard to bend or twist
spondylolisthesis – when part of the vertebrae slips forward, causing pain, tight muscles and possible nerve damage.
See your local doctor if your child’s pain does not improve after treatment.
Preventing stress fracture in the pars interarticularis
Stress fractures usually develop slowly. Good habits can help prevent them.
When doing sport and physical activity, encourage your child to:
- take regular breaks and stop if there is pain
- stretch regularly
- warming up before and cooling down after physical activity
- use proper safety gear
- build strong core muscles and posture
- learn the proper techniques, especially for sports that involve bending and twisting.
Children with weaker spines or a history of stress fracture should avoid high-risk sports, including:
- cricket
- gymnastics
- diving
- soccer
- weightlifting
- tennis.
