 Caused by a defect in the pars interarticularis

without any displacement.

 Degeneration of vertebra, affecting intervertebral
discs.
 Can cause spondylolisthesis.
 Pars interarticularis
between lamina & inferior facet
underneath the pedicle and
superior facet above; joins
adjacent facet joints of the
spine.
 Narrowing of vertebral column
and area between pars articularis.
 Defect in continuity of vertebral
bodies
 Potential mechanical instability
 Mechanical stress to the neural
arch
 Osseous defect bridged by
connective tissue and cartilage
 Exert pressure on nerve root.
 Repetitive mechanical stress-
hyperextension & trunk
rotation
 Greatest load with flex/ext
movement at L5/S1
 Congenital defect
 Genetic predisposition
 Direct trauma to the isthmus with non-
adhesion
 Indirect trauma with a stress fracture
 Possible weakness in pars
interarticularis
 Condition: asymptomatic or slight to
severe pain in lower back
 ↑ incidence in athletes, gymnasts &
football.
 Incidence varies according to
ethnicity, sex, sports activity,
family history, occupation &
relevant diseases.
 Relevant diseases= osteoporosis,
osteogenesis imperfecta, cerebral
palsy, Scheuermann’s disease &
scoliosis.
 Repetitive mechanical stress.
 Athletes at Risk (Sport):
 Gymnasts
 Divers
 Offensive linemen in football
 Pole vaulters
 Weight lifters
 Wrestlers
 Dancers
 High jumpers
 Incidence: 6% of general
population
 Common in adolescents
 Present without any obvious
symptoms
 Pain with hyperextension
 Pain increases- starts with sport, present
in ADL’s and eventually interferes with
sleep.
 Hyperlordotic lower back
 Aching lower back, usually unilateral which
localises around belt area.
 Back stiffness
 No nerve root pain
 Symptoms eased by rest
 Standing one-legged
hyperextension test:

Stand on the leg of the same

side on which there is pain
 The doctor will perform a
physical exam.
 Diagnosis is also based upon
clinical history
 An X-ray of the lower back can
show any fractured vertebra.
 CT scan or MRI to detect very
small fractures.
 Early diagnosis is important
 Rest
 Mobilise joints for pain relief:
 PA grade 2 for pain
 Relieve muscle spasm
 Strengthen postural muscles
lumbar & abdominal stabilisers
 Mobilise lumbar fascia
 Muscle stretches – short spinal ,hamstrings
 Massage
 Anti-inflammatory medication

 Surgery:
 Spinal fusion between lumbar vertebra & sacrum
 Support lower back maintaining
abdominal & back stabilisers
 Do activities that do not place
stress on the lower back
 Avoid over-exercising
 Maintain a good posture
 Kinetic handling
 Good back support – sit for long
periods