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Pars fracture and how to Manage it

What is Pars fracture?

Pars fracture is a unilateral or bilateral overuse or fatigue stress fracture of the bony pars interarticularis of the posterior vertebral arch. This injury occurs commonly in the lower lumbar region. And in the athletes who play sports that require repetitive lumbar loading in extension and rotation like- ballers in cricket, gymnastics, football, weight lifting, etc.

Pars interarticularis is the part of the vertebra located between the superior & inferior articular process of the facet joint. Or in the transverse plane, it is in between the lamina & pedicle.

Its normally occurs on both sides of the pars interarticularis but sometimes only on one side. Also,  if the fracture happens only on one side, the opposite side bears all the stress and can ultimately fracture. And once the fracture occurs on both sides, all the shear forces exerted on the disc as the pars interarticularis protect the intervertebral disc from the shear forces. And due to pars fracture, the disc becomes very prone to get an injury.

Patients with pars interarticularis fracture presented with acute or insidious onset of lower back pain that is aggravated by continued lumbar loading.  Stiffness of lower back, it feels like a muscle strain.

PHYSIOTHERAPY TREATMENTS OF PARS FRACTURE INCLUDES:

Firstly, have rest for 2-4 weeks, and use TLSO bracing,

Then, precautions to be taken to not doing active or passive lumbar extension,

Passive ROM exercises (progress to active assisted > active exercise),

Low impact aerobic conditioning,

Neural spine stabilization,

Resistive strengthening exercises,

Abdominal strengthening exercise,

Stretching of the upper and lower limb,

Cardiovascular exercise (stationary bicycling),

Pelvic tilting exercise,

Sports-specific training started after 2 months,

Bridging,

Supine hamstring curls,

Squatting,

Also, Plyometric exercises.

Return to sports drills.

In addition, if you have this issue, it may be better to sleep on your sides with your knees curled up (in the fetal position). This alleviates strain on the nerve root. Another possibility is to sleep on a reclining chair or an adjustable bed. This permits the head and legs to remain elevated, relieving nerve pressure.

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