I have a client that has a "Bi Lateral Pars Defect" at L3 and L4. What exactly is this, and what can I do to help her?
A pars defect is a fracture or separation of the Pars Interarticularis. This is the small bridge of bone known as the neural arch that connects the facet joints at the back of the spine. A pars defect can be referred to as spondylolysis or spondylolisthesis. A spondylolysis is presence of the defect only. Individuals with a bilateral pars defect can progress to spondylolisthesis - a forward slipping of the vertebral body of the vertebra with the defect on the adjacent vertebrae.
People can develop a pars defect at a young age and go for years with without pain or limitations. As they age and/or become deconditioned, the body’s compensation mechanisms become exhausted, and they often experience pain that they associate with a specific event. But that event, many times, is the proverbial “straw that broke the camel’s back.
The combination of lumbar extension and rotation are typically contraindicated for individuals with one of these conditions.
As always, you should do a musculoskeletal assessment on your client. Pars defects are often (but not always) associated with anterior shear forces acting on the lumbar spine. These shear forces can be seen in individuals with increased lumbar lordosis and poor core function.
If your client has not already done so, begin with corrective exercises to address segmental alignment and facilitate proper motor recruitment. It is important you assist her in recognizing inappropriate movement strategies that may be an underlying contributing factor or a result of her condition.
Progress to more challenging exercises only after she has demonstrated the ability to sustain lower level contractions over time. There are many great articles available on PTontheNET.com addressing core function and motor learning that can help guide you along the way.
Best of luck!