Pars Fractures

Today I want to talk about something called a pars fracture.

This is a condition I commonly see in developing teenagers, especially within a few specific athletic populations.

First, a little anatomy is helpful.

The most common place for a pars fracture to occur is in the lumbar spine, which is the low back. The vertebrae in the spine stack on top of one another and have small bony extensions in the back that connect one vertebra to the next. These connections help keep the spine stable and prevent the vertebrae from slipping too far forward or backward.

One of these structures is called the pars interarticularis, often shortened to just “the pars.”

The pars experiences increased stress when the low back is repeatedly extended, such as during a backbend, or when large forces travel through the spine, such as during a heavy back squat.

Because of this, pars fractures are most common in kids who are going through a rapid growth spurt while simultaneously increasing their activity level.

This is why we often see these injuries in athletes between roughly 8th grade and 10th grade, although they can occur at other ages as well.

The type of sport also matters.

I most commonly see pars fractures in dancers, cheerleaders, gymnasts, football players, and baseball players.

For dancers, cheerleaders, and gymnasts, the common theme is repetitive spinal extension. Backbends, tumbling routines, and basing all place repeated stress on the low back, often for hours at a time during practice and rehearsals.

Every year, I treat several athletes who fit this exact pattern.

For my football and baseball athletes, the mechanism is often a little different.

When athletes get to high school, there is usually a major emphasis on weight training. I do not think this is a bad thing at all. Strength training is extremely important when performed correctly.

The problem is often that athletes progress too quickly.

Many of the athletes I see with pars fractures have very little lifting experience before entering a high school weight room. Suddenly they are training alongside older athletes who may have been lifting consistently for 4 or more years.

Naturally, competition kicks in.

Unfortunately, this can lead to younger athletes loading movements like squats, deadlifts, or overhead lifts with more weight than their spine is prepared to handle.

Whether the stress comes from repetitive back extension or excessive loading, both situations can overload the pars and eventually lead to a fracture on one or both sides.

This is a serious condition, but when identified early and treated appropriately, most athletes recover very well without long term problems.

Typically, treatment involves roughly 12 weeks away from heavy athletic activity, along with a structured physical therapy program.

The goal during rehab is not only to allow the bone to heal, but also to improve the strength, control, and movement quality needed to safely return to sport.

This usually includes improving core control, hip mobility, spinal stability, and gradually rebuilding the body’s tolerance to loading and rotation.

If you would like to see a good exercise progression for pars fractures, we will link a video here.

Dr. Caleb