What is the role of physical therapy in the treatment of acute pars interarticularis injuries?

Updated: Jan 22, 2019
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

During the acute phase of rehabilitation for patients with spondylolysis, the focus is to reduce the pain. Instruction in posture and biomechanics with activities of daily living (ADL) can help to protect the injured pars, thus reducing symptoms and preventing further injury. 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. Activity modification is recommended. The patient is advised to stop the activity or sport that evokes the back pain for an average of 2-4 weeks. [24, 46, 54] In particular, the patient should avoid any activities involving hyperextension.

A retrospective study by Selhorst et al found that in adolescent athletes with acute spondylolysis who were referred to physical therapy after less than 10 weeks of rest, the median period for full return to activity was almost 25 days shorter than it was for those referred to physical therapy after more than 10 weeks of rest, with no statistically significant difference in the risk of adverse reactions seen between the two groups. [55]


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