How are pars interarticularis injuries treated during the recovery phase?

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

Once the LBP 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 nonextension activities can be performed, such as the stationary bike and hydrotherapy. [3, 11, 27, 46, 49, 57, 59, 61, 62, 63]

These exercises are eventually incorporated into a more comprehensive rehabilitation program that includes spinal stabilization exercises that help the patient in finding the neutral position of the spine (ie, the position that produces the least amount of pain). This position is dependent on the specific individual and is determined by the pelvic and spine posture that places the least stress on the elements of the spine and supporting structures. In classic spondylolysis pain, the neutral spine has a flexion bias. Dynamic lumbar stabilization exercises may be used to help provide dynamic muscular control and to protect the spine from biomechanical stresses, such as tension, compression, torsion, and shear. [72]


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