Spondylolysis is a stress fracture or defect in the pars interarticularis, a small bony segment of the vertebra, most commonly affecting the lower lumbar spine (L5). It is a frequent cause of lower back pain, particularly in adolescents, athletes, and individuals engaged in repetitive spinal extension movements.
At Adaptive Physiotherapy & Massage in Booragoon, we use an evidence-based approach to manage spondylolysis, incorporating cautious manual therapy, targeted rehabilitation exercises, and movement retraining to help patients restore pain-free function and prevent recurrence.
What is Spondylolysis?
Spondylolysis is a defect or stress fracture in the pars interarticularis, a thin section of bone between the facet joints of the vertebrae. It occurs due to repetitive stress, particularly hyperextension of the spine, and can progress to spondylolisthesis if the vertebra slips forward.
Common Causes of Spondylolysis
- Repetitive hyperextension movements (e.g., gymnastics, football, cricket fast bowling).
- Poor movement mechanics and muscle imbalances, leading to excessive spinal stress.
- Congenital predisposition, as some individuals have a thinner pars interarticularis.
- Previous lumbar injuries, which weaken the structural integrity of the spine.
Symptoms of Spondylolysis
- Lower back pain, typically localized around the lumbar spine.
- Pain aggravated by extension-based activities, such as backbends or overhead movements.
- Discomfort with prolonged standing, walking, or running.
- Relief with spinal flexion, as bending forward reduces stress on the affected vertebrae.
At Adaptive Physiotherapy & Massage in Booragoon, we perform comprehensive assessments to differentiate spondylolysis from discogenic pain, facet joint dysfunction, and muscle-related conditions, ensuring an accurate diagnosis and treatment approach.
Evidence-Based Treatment for Spondylolysis
The treatment of spondylolysis focuses on pain relief, spinal stabilization, and movement retraining to prevent future injury.
1. Initial Pain Management and Activity Modification
The first stage of rehabilitation focuses on reducing pain and avoiding aggravating movements.
- Activity Modification:
- Avoid high-impact sports, hyperextension movements, and repetitive spinal loading.
- Modify training programs to reduce lumbar stress while maintaining overall fitness.
- Pain Reduction Strategies:
- Heat therapy (for muscle relaxation and circulation improvement).
- Gentle spinal mobility drills (to maintain movement without aggravating symptoms).
- Short-term bracing (in some cases for pain relief and lumbar support).
2. Manual Therapy for Spondylolysis: Caution Required
Manual therapy must be approached with caution to avoid worsening symptoms.
Recommended Manual Therapy Techniques
- Soft Tissue Release for overactive lower back muscles (erector spinae, quadratus lumborum).
- Gluteal and Hip Flexor Release to reduce lumbar compensations.
- Joint Mobilization (Avoiding Anterior Pressure on the Lumbar Spine) to prevent excess stress on the pars interarticularis.
Key Considerations for Manual Therapy
- Avoid direct pressure on the lumbar spine, as anterior-directed forces can worsen symptoms.
- Positioning the patient in partial spinal flexion during treatment helps reduce lumbar stress.
- Focus on indirect techniques, targeting hip mobility, pelvic alignment, and soft tissue release.
At Adaptive Physiotherapy & Massage in Booragoon, our physiotherapists customize manual therapy strategies to maximize relief without aggravating the stress fracture.
3. Exercise Rehabilitation for Spondylolysis
A progressive rehabilitation program is essential for rebuilding spinal strength and preventing recurrence.
Phase 1: Core Activation & Neutral Spine Control
- Abdominal Hollowing & Bracing (engages deep stabilizers without excessive spinal stress).
- Supine Dead Bug Variations (low-load core activation with minimal lumbar extension).
- Bird-Dog Exercise (encourages controlled movement with spinal stability).
Phase 2: Strength Development & Load Tolerance
- Glute Bridges (reinforces posterior chain support without excessive spinal flexion).
- Side Planks & Anti-Rotation Exercises (targets obliques and stabilizers for spinal control).
- Hip Hinge & Romanian Deadlifts (with neutral spine focus) (builds posterior chain strength safely).
Phase 3: Functional Strength & Return-to-Activity
- Squat Variations (progressively reintroducing loaded movement patterns).
- Step-Ups & Single-Leg Stability Drills (enhances neuromuscular control for sports and daily activities).
- Controlled Plyometric Progressions (gradual return to dynamic loading in athletes).
At Adaptive Physiotherapy & Massage in Booragoon, we tailor exercise progressions to match each patient’s movement capacity and sport-specific demands.
Return to Sport & Long-Term Injury Prevention
Once pain is under control and movement is optimized, the focus shifts to progressive strength training and injury prevention strategies.
Key Strategies for Long-Term Spinal Health:
- Consistent core training (maintains lumbar support and spinal endurance).
- Hip mobility and glute activation drills (reduces excessive lumbar compensation).
- Gradual reintroduction of spinal extension movements (avoiding premature overload).
At Adaptive Physiotherapy & Massage in Booragoon, we ensure that rehabilitation transitions seamlessly into performance-based movement retraining, preventing recurrence while enhancing spinal function and resilience.
Conclusion
Spondylolysis is a manageable condition when treated with structured rehabilitation, movement retraining, and progressive strength development.
At Adaptive Physiotherapy & Massage in Booragoon, we provide an evidence-based approach, integrating cautious manual therapy, individualized exercise rehabilitation, and postural education to help patients regain control over their spinal health.
If you are experiencing persistent lower back pain or movement restrictions, contact Adaptive Physiotherapy & Massage in Booragoon today for a comprehensive rehabilitation plan tailored to your needs.
References
- Micheli, L. J., et al. (2014). “Spondylolysis and stress fractures in young athletes.” British Journal of Sports Medicine, 48(14), 1022-1028.
- McGill, S. M. (2016). Low Back Disorders: Evidence-Based Prevention and Rehabilitation.
- Standaert, C. J., et al. (2008). “Evidence-informed management of spondylolysis in athletes.” Physical Medicine & Rehabilitation Clinics of North America, 19(1), 235-250.
- Hides, J. A., et al. (2011). “Multifidus muscle recovery following treatment for spondylolysis.” Spine Journal, 11(7), 646-654.
- Cholewicki, J., et al. (2015). “Core stability and neuromuscular control in spondylolysis rehabilitation.” Journal of Orthopaedic & Sports Physical Therapy, 45(9), 758-770.
