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.


METHODS
Grateful Med was searched from 1980 to 1998 using the terms "spondylolysis," "spondylolisthesis," "female athlete" "spondylogenic," and "pars interarticularis."


RESULTS
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
The athletic trainer plays an integral part in managing this injury progression, particularly with identifying at-risk individuals and intervening appropriately.
Physical Therapy Program, University of Kentucky Center for Rural Health, Hazard, KY.
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