The pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression.

OBJECTIVE: To review the classification, etiology, clinical and radiologic evaluation, and management of the pars interarticularis stress reaction, spondylolysis, and spondylolisthesis progression. DATA SOURCES: Grateful Med was searched from 1980 to 1998 using the terms "spondylolysis," "spondylolisthesis," "female athlete" "spondylogenic," and "pars interarticularis." DATA SYNTHESIS: The progression from pars interarticularis stress reaction through spondylolysis to spondylolisthesis is common in adolescent athletes, and, because of hormonal influences and cheerleading and gymnastic maneuvers, females are particularly at risk. Proper diagnosis and management include a thorough evaluation, radiographs (possibly with technetium bone scan or single-photon emission computed tomography), activity modification, dietary counseling, a therapeutic exercise program focusing on proper trunk and hip muscle strength and extensibility balances, and education regarding proper back postures, positioning, lifting mechanics, and jump landings. CONCLUSIONS/RECOMMENDATIONS: The athletic trainer plays an integral part in managing this injury progression, particularly with identifying at-risk individuals and intervening appropriately.