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  • Q&A with Australian Health Practitioners

    What are the best core exercises for Pars stress fracture in teenager?

    Related Topics
    Back & Neck Pain Pain Sports Injuries & Prevention
    Which core exercise most benefit recovery of Pars (lower back) stress fracture in a growing teenage male
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    Tim Cottman - Fields

    Exercise Physiologist, Physiotherapist

    Tim is considered a movement specialist - using exercise, education and hands on therapy as his main treatments, helping everyone achieve optimal function. His interests … View Profile

    A stress fracture to the pars interarticularis AKA Spondylolysis is a very common condition especially in adolescents and particularly in sports like cricket, gymnastics and rugby.

    Strengthening of core muscles is vital for optimal recovery and to protect the healing process of the fracture. In these instances depending on the time since injury retraining of the deep core muscles is important (especially transverses abdominis and lumbar multifidus) as research has shown these muscles reduce in activation and size (hence strength) during low back injuries.

    See a physiotherapist or exercise physiologist with specific training in spinal rehabilitation to get help with exercise prescription and training variables. Ideally, see someone with a Real Time Ultrasound to use to assess proper activation of these muscles – this is gold standard.

    Additionally a focus needs to be functional exercises (exercises to mimic daily activities or sport specific exercises etc.) these incorporate exercises with multiple planes of movement, whilst helping to improve posture and body awareness.  

    Such exercises that might be beneficial include:

    • Seated core activation progressions on Swiss ball (for postural control in seated position)
    • Front planks/ side planks (used for muscular endurance)
    • Half curl ups (used for strengthening of abdominal muscles)
    • 4 point arm and leg lift (used for strengthening muscles deep in low back)
    • Balancing exercises (i.e. single leg eyes closed – used for proprioception)
    • Pilates based exercises

     

    1. Correct retraining of deep core muscles
    2. Progressive functional exercise that emphasise total body movements 

    Hope that helps 

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    Tom Cartwright

    Chiropractor

    I'm Tom Cartwright, I hold a Bachelor's degree in Chiropractic Science, and a Master's degree in Chiropractic, from Macquarie University. I complemented my studies with … View Profile

    I use a lot of the research behind Stuart McGill's work:

    http://www.backfitpro.com

    I have found his approach to training the core musculature a great way to manage people's unique conditions such as pars fractures, disc herniations, and post-operative presentations.

     

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    Dr Martin Timchur

    Chiropractor

    Martin is a senior lecturer in radiology and one of Australia's most experienced chiropractic radiologists. View Profile

    Thank you for your question. It is important to obtain some additional information in order to provide suitable advice.

    1. Was the fracture diagnosed from x-ray or MRI (An MRI can tell you if the lesion is currently active and whether pain is likely to be from the lesion or not). It will also tell you if the fracture is recent or old.

    2. Is the fracture on one side or both? This is important, again because an MRI will show if there is a developing lesion on the other side, called a stress lesion. This impacts recommendations for care and restricted activity.

    3. Is there any forward slippage of the vertebra and if so, by how much? (there are some surgical techniques that may be employed for minor slippages to assist with healing).

    4. Which level is it at?

    5. Is the teenager playing representative sport or just club sport on a weekend. This is important in deciding the approach to restriction in activity.

    there are other mechanical and pathological considerations, but they are too great to cover here.

    Generally speaking, pars fractures will not re-unite, and they rarely progress. THis may seem concerning, but in most cases, they will not cause pain in the long term.

    The most important consideration is whether the lesion is active and if there is any activity on the other side, and his level of sporting activity.

    Strengthening is important, though unlikely to make any difference to the fracture itself.

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