Patients with a stress fracture of the pars interarticularis typically experience pain on one side of the lower back that progressively increases with movements involving hyperextension. Symptoms generally decrease with rest. Pain in the lower back is usually felt on the opposite side of the body to the arm performing the repetitive movement. Pain may be reproduced by firmly pressing on the affected area, or, by extending backwards whilst standing on the affected leg, with the aid of a therapist.

A thorough subjective and objective examination from a chiropractor may be sufficient to diagnose a stress fracture of the pars interarticularis. X-rays may or may not demonstrate a stress fracture, depending on the severity of injury. Usually a bone scan is used to confirm an area of bony damage. Following this, a CT scan may be used to determine the presence of a stress fracture.

Treatment for a stress fracture of the pars interarticularis involves an initial period of rest from the aggravating activity. Alternative exercises placing minimal force through the affected bones should be performed to maintain fitness. Stretches for the back, hips, gluteal and hamstring muscles, as well as exercises to strengthen and improve core stability, should also be performed with direction from a chiropractor.

Rehabilitation following a stress fracture of the pars interarticularis usually occurs over weeks to months, and will vary depending on the severity of injury. With appropriate treatment, most minor stress fractures should be able to achieve bony union in 6 to12 weeks. More severe fractures may require an extended period of rehabilitation.

In some cases, stress fractures of the pars interarticularis may result in non-union of the bone and on-going problems (especially if they are managed inappropriately). Accurate diagnosis, treatment and management in the early stage is therefore vital.

The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. These joints are designed to support body weight and enable spinal movement.
During certain movements of the spine, compressive forces are placed on the facet joint. These forces are then transmitted through a bony region known as the 'pars interarticularis'. If these forces are excessive and beyond what the bone can withstand, damage will result. This initially results in a bony stress reaction, however, with continued damage may progress to a bony fracture. When this happens, the condition is known as a stress fracture of the pars interarticularis.

Stress fractures usually occur as a result of repeated or forceful hyperextension activities, especially when combined with rotation. They are typically overuse injuries and are more common in the younger athlete whose bones are yet to reach skeletal maturity.
Stress fractures of the pars interarticularis are most commonly seen in the following sports:
• cricket
• gymnastics
• tennis
• dance
• weight lifting
• wrestling
• pole vaulting
• high jump
• throwing sports
Stress fractures of the pars interarticularis typically occur on one side of the spine, although occasionally both sides are involved. This can result in one vertebra slipping forwards on another and is known as a spondylolisthesis.

Despite appropriate chiropractic management, a small percentage of patients with stress fractures of the pars interarticularis fail to improve adequately and may require other intervention. This may include further investigations or assessment from an orthopaedic specialist. The treating chiropractor can advise if this is required and will refer to the appropriate medical authority if it is warranted clinically.

There are several factors that may contribute to the development of a stress fracture of the pars interarticularis. These need to be assessed and corrected with direction from your chiropractor, and may include:
• poor sporting technique
• inappropriate training volumes
• inappropriate sporting surfaces
• poor posture
• lumbar spine stiffness
• a lack of core stability
• muscle weakness or tightness
• poor foot biomechanics

Chiropractic for a stress fracture of the pars interarticularis can hasten the healing process and is vital to ensure a safe return to activity.
Treatment may comprise:

• soft tissue massage
• mobilization
• acupuncture
• education
• activity modification advice
• biomechanical correction
• exercises to improve flexibility, strength, posture and core stability.

Technique adjustment should also be made to restrict the amount of extension during sporting activity.