Pars interarticularis is a small piece of bone located at the base of our spine where L4 and L5 vertebrae are located. Any defect of the pars interarticularis will cause pain, stiffness, and severe discomfort in your lumbar area. This could be due to muscle soreness, trapped nerves, or inflammation. Get to know its Causes, Preventive measures, Diagnosis, and Treatment Options.
The area of our lower spine is generally referred to as lumbar area. The bottom of our spine contains 5 lumbar vertebrae which are numbered 1 to 5: from L1, which starts around your middle back, to L5, which connects to our sacrum (the triangular-shaped bone between our hip bones).
Spondylolysis vs. Spondylolisthesis
Generally, when we search for painful ailments that affect the lower back and are connected with pars defect, you will come across spondylolysis and spondylolisthesis. You will probably have spondylolysis or spondylolisthesis if you damage your pars interarticularis. Although these lumbar conditions cause similar symptoms, there is a difference between them.
Spondylolysis is a stress fracture which occurs commonly in pars interarticularis at the L5 vertebra. According to the Asian Spine Journal, spondylolysis is one of the most common causes of lower back pain. This is a common condition among sports people or individuals frequently lifting heavy objects.
Spondylolisthesis occurs when a vertebra slides forward over the bone below it. Mostly it’s the L4 or L5 lumbar vertebra which pushes on the bone below when slips out. This can be caused by joint damage from aging or a trauma or injury.
Spondylolisthesis often causes pain in the back area and pain and numbness in one or both legs. You may also suffer from sciatic pain (pain radiating down one or both legs).
Spondylolisthesis commonly happens when the L5 vertebra slips forward and presses on the sacrum causing pain and discomfort.
Causes of Pars Interarticularis Defect
Get to know about various possible conditions that can cause pars defect, what could be done if you suffer pars interarticularis, and how can you avoid putting more strain on your lower back?
Muscular weakness and strain
Muscular weakness and Straining in the lower back can put extra pressure on your lower spine and eventually lead to a pars defect.
Stress fractures in the L4 or L5 vertebrae are the most common reason for pars defect that can also lead to spondylolisthesis and spondylolysis.
Degenerated disc disease
Degenerated disc disease can also cause pars defect as intervertebral discs and vertebrae in the lower back become weaker and dry out. It is commonly seen in older and arthritis patients. Degenerated disc disease affects your L4 & L5 vertebrae, you may also develop leg weakness after walking or standing for a long time. It is also possible that you have tingling or pain in your legs.
Sacroiliac joint dysfunction
Related to pars defect and lower back pain is sacroiliac joint dysfunction.
A herniated disc between your L4 and L5 vertebrae can cause shooting pains in your lower back and cause a defect in your pars interarticularis.
Sports, gymnastics and Athletic activities cause more strain on the spine leading to Pars Defect. Certain sports like tennis, weightlifting, wrestling, ball games, and dancing can cause repetitive and forceful stress on the vertebrae.
Movement of the spine
Movements of the spine like extreme twisting or a combination of both exert stress on the pars intercularis, hyperextension.
Pars Interarticularis Defect Symptoms
Initially, young adults with Pars defect won’t notice any type of symptoms, an episode of injury or repeated stressful activities can cause lower back pain during their growth years.
- Back pain is the most common presenting feature of Pars Interarticularis
- Pain associated with pars Interarticularis defect is usually sharp initially and may become dull in the chronic stage.
- Pain is often worse by sports, activities and is relieved by rest.
- In some players, pain associated with pars Interarticularis defect may disappear temporarily during the rest period, but gradually reappear once the stressful or sports activities are resumed.
- For any low back pain persisting for a duration longer than Two weeks, proper clinical evaluation is essential.
Diagnosis of Pars Interarticularis Defect
In the initial stages, Pars Interarticularis defect may not be always visible on the X-rays. Further advancement can be seen on X-rays, but healing in such cases can be difficult. Pars Interarticularis defect or the stress fracture could also be diagnosed using other imaging studies such as CT scan, MRI, or bone scan.
Treatment for Pars Interarticularis defect
Pars Interarticularis defect is considered as a stress injury or fracture of the vertebra, adequate rest, and immobilization of the area, mechanical support and time can heal the condition. Pain medications for Pars Interarticularis defect are often advised depending on the condition, however, rest and proper healing is essential before resuming sports or other activities.
Physiotherapy for patients with pars defect can speed up the healing process. Physiotherapy for pars defect would include the use of warm and cold compresses, electrical stimulation, ultrasound, soft tissue massage, trigger point therapy, use of appropriate braces for back, hydrotherapy etc. This treatment modality can help relax the muscle in the surrounding area and relieve pain associated with pars Interarticularis defect.
A proper treatment plan for pars defect should be drawn with the help of an expert. It generally includes rest period, activity restrictions and use of back braces in the initial period. Then active physiotherapy like back strengthening exercises, training for flexibility and lumbar stabilization would follow in the treatment program for Pars defect. The final phase would include continuation of exercises and gradually resuming sports if there is no pain.
Meanwhile, a period of rest for an average of 2-4 weeks can provide beneficial effects by modulating pain, decreasing inflammation, and decreasing the risk for further progression of a pars stress reaction to a frank fracture. Applying ice to the injured area for 20 minutes 3-4 times a day in conjunction with performing gentle ROM exercises and stretching of the quadriceps and hamstring muscles is strongly advised.
The patient is advised to stop the activities for 2-4 weeks. Activity modification is recommended.
In particular, the patient should avoid any activities involving hyperextension. So kindly consult a good physiotherapist for stretching of quadriceps and hamstrings muscles.
Once the low back pain is controlled during the acute phase of treatment, a therapy program can be initiated. If the patient’s symptoms significantly decrease with rest and activity modification, a regimen of hamstring and hip flexor stretching, abdominal strengthening, lumbar flexion exercises, and cross-training with extension precautions can be instituted. If the patient requires the use of a brace, an initial program of hamstring stretching while wearing the brace can be started.
As the symptoms continue to decrease, lumbar flexion exercises, abdominal strengthening, and hip flexor and hamstring stretching can be instituted without the use of the brace. Cross-training in non-extension activities can be performed, such as the stationary bike and hydrotherapy.
Indications for surgery include:
- Persistent pain unrelieved by rest and immobilization for more than 6 months
- Progression to spondylolisthesis
- Spondylolisthesis of greater than grade II in a patient about to undergo the preadolescent growth spurt
- Surgical interventions include direct repair of the spondylolytic defect, reduction and fusion, and vertebrectomy.
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MEDICATION (under the guidance of the physician)
Medications recommended for the treatment of pain in spondylolysis include non-steroidal anti-inflammatory drugs:
- NSAIDs such as [Ibuprofen (Ibuprin, Motrin); Celecoxib (Celebrex); Naproxen (Naprosyn, Naprelan, Anaprox)]
- Analgesics [Acetaminophen (Tylenol, Feverall, Tempra)]
- Muscle relaxants [Cyclobenzaprine (Flexeril).
NOTE: Before prescribing these medications, review the contraindications, adverse side effects, and mode of action.
How to prevent Pars Interarticularis Defect?
We can prevent Pars Interarticularis defect as if detected early stages, appropriate measures can be taken to promote timely healing and further damage to the spine, and also by:
- Avoiding of stressful activities
- Maintaining regular fitness
- Patient education regarding proper posture
Sportspersons need to follow below-mentioned activities:
- Warm-up exercises
- Proper fitness regimen
- Athletic conditioning and also take adequate breaks from their sports.
If for some reason an experienced doctor is not available to you, then you can contact us here.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.