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Young Athletes and PARS Stress Fracture

PARS Stress Fracture

The PARS stress fracture (spondylolysis) usually occurs in the lower back (lumbar spine) and results from repetitive hyperextension (bending backwards) and rotation activities. This fracture is often considered an “overuse injury.”

Athletes who participate in sports or activities that involve twisting movements and backward bending are more likely to experience a PARS stress fracture. The PARS stress fracture is estimated to occur in 30% of young athletes. Sports where hyperextension of the back routinely occurs include gymnastics, diving, football (offensive linemen), pole vaulting, weight lifting, wrestling, dancing, high jumping, and volleyball.

Avoid PARS stress fractures with these four steps:

  1. Know the danger
  2. Educate young athletes about nutrition and overuse injuries
  3. Watch for signs of a problem.
  4. Prevention

Athletic Energy Deficit (AED)

Athletic Energy Deficit (AED) is also likely to play a role in athletes who experience a PARS stress fracture. AED is an energy imbalance that results when high levels of physical activity, training or sports (energy output) are not balanced with an adequate and appropriate diet (energy input). AED often develops when there is pressure to change eating habits, particularly in some sports where a low body weight may be encouraged.

The years around puberty are a time of rapid bone growth. Girls and boys build 60% to 80% of their bone mass by age 18. During this time, pre-teens and teenagers who do not eat enough to meet their energy needs face an “energy deficit” that can impair proper bone growth and mineralization. Once bone growth is complete, PARS fractures are rarely seen.

With insufficient energy intake there may be slower bone formation and mineralization of the bone. Theoretically, insufficient energy leading to slower bone formation combined with repetitive hyperextensions of the back put enormous pressure on developing bones, making them more susceptible to fractures. Left unchecked, AED and poor bone growth may result in more stress fractures and early osteoporosis, a disease where bones become fragile and are more likely to break.

Download>> Parents and Coaches Beware: Preventing Athletic Energy Deficit syndrome in young female athletes

Recovering from a PARS Stress Fracture—Remember the Four Rs

  1. Rest—A short time of rest may help bones repair.
  2. Replenish—Focus on bone-strengthening nutrition.
  3. Rehab—Work with your coach on a program of strengthening and stretching.
  4. Relearn—Learn how to modify and prevent the overextension and rotation of the spine.

Download>> Compromising the Competitive Edge: Prevent PARS Stress Fractures in Young Athletes


Posted: 12/5/2016; Revised: 02/19/20. 
As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician

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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.