- Dec 7, 2011
- 2,366
- 38
As some of you might know, right in the prime of my DD’s HS pitching career she has been on the disabled list with a pars interarticularis fracture (broken back from repetitive stress – also called spondylosis or “spondy”). I am going to write down here everything I know, as a geeked-out parent, NOT a doctor, with the primary hope that it might help at least one other DD, DD parent, or pitching coach.
Here are the most relevant details I have picked up along the way from my intensive medical readings on pars breaks:
1. The pars interarticularis part of the vertebrae is the part that keeps the stack of vertebrae “hooked” together in the column of vertebrae in the spine.
2. The critical responsibility that the pars has in the case of pitchers or any other back hyperextension and twist move, is to establish the “limits” to which the stack of vertebrae can range in motion.
3. These spine “stops”, which the pars does, get hit with extra force each and every pitch. (They’re like door stops and every time the door gets slammed open the door-stop is supposed to stop the door without anything breaking).
4. Well just like any bone in the body, if it gets hit with too many repetitive hits it WILL start to create bone damage that can lead to a fracture.
5. Some pars break patients will experience massive pain and spasms that go along with the pars break and some will experience relatively no pain at all in the SAME bone break.
6. The pars can break bilaterally or unilaterally (left and/or right side). When the pars breaks on both sides (bilaterally) the vertebrae is now unattached and can displace forward to cause spondylolisthesis. This more damaged condition we never want an athlete to progress to. This will most likely be accompanied with many back pain problems for life…..
7. On a related topic, there have been many studies on the “Kinetic Chain”, which is the study of how shock gets relayed from the foot through the whole skeleton when, for example, the pitchers stride foot slams down to launch the pitch.
8. Some doctors think that the shock from the slamming of the stride foot has a critical relationship to the pars break and other will state that it is just the hyperextension and twist-torque. I am of the opinion that there could be a strong relationship and I think it’s an easy one for pitching coaches and pitchers parents to guard the young pitcher against undue stride foot shock by (training proper landing of that stride foot, always having newer shoes to absorb some shock, and limit the number of practice pitches thrown on hard surfaces. I am looking into orthotics since my DD has very high arches which are thought to relay the most shock to the spine.)
9. So that is the one Kinetic Chain comment I have for the coaches and parents to potentially help the young pitcher BUT the young pitcher should do some things herself to ward off pars breaks.
10. What the pitcher should do is to keep their core rock-strong. This does NOT mean just do crunches. It means the lower core which is all about supporting the lower lumbar and effectively “cushions” the pars hits they receive each and every pitch. It means doing pelvic tilts etc. This along with stretching hamstrings etc to build the most straight up-and-down muscle-supported lower spine. (of course this needs to be body-maturity-adjusted)
11. Many time pars breaks are misdiagnosed (as was the case of my DD). I can’t emphasize enough that if your DD starts to experience a recurring lower back pain, that isn’t relative to oblique muscle strains, that you have an MRI or bone scan done to rule out pars breaks.
12. Pars breaks can heal. BUT if they are misdiagnosed and the pitcher keeps on pushing through the back pain they could end up with a pars fracture that does not come together any more. The bone starts to think “hey, mabe I am not meant to be as one”… This is bad. This would require surgery then to screw the two pars parts back together.
13. The pars break should be given anywhere between 6-12 weeks to heal. (these are the extremes I have seen on how long it takes)
14. Then on returning to the sport it appears to be crucial to slowly ramp the pitcher back into activity. Doctors suggest a 10% rate of increased load from game-day to game-day (keeping with the needed rest-days in a given week)
15. The other thing that I think is crucial is overall down-time from sports that do hyperextension/twisting/torquing to the back. The year leading up to my DD’s pars break was her first year of “ahhh I don’t need rest and I really want to get as tuned-up with pitching as I possibly can.” I think annual rest periods for backs should be that same 6-12 weeks that is the same time span for bone healing.
16. Note that one study concluded that as much as 30% of pitchers have/had pars breaks at one time, mostly in their adolescence.
17. I definitely am convinced that there are congenital factors in play here too.
Here are the most relevant details I have picked up along the way from my intensive medical readings on pars breaks:
1. The pars interarticularis part of the vertebrae is the part that keeps the stack of vertebrae “hooked” together in the column of vertebrae in the spine.
2. The critical responsibility that the pars has in the case of pitchers or any other back hyperextension and twist move, is to establish the “limits” to which the stack of vertebrae can range in motion.
3. These spine “stops”, which the pars does, get hit with extra force each and every pitch. (They’re like door stops and every time the door gets slammed open the door-stop is supposed to stop the door without anything breaking).
4. Well just like any bone in the body, if it gets hit with too many repetitive hits it WILL start to create bone damage that can lead to a fracture.
5. Some pars break patients will experience massive pain and spasms that go along with the pars break and some will experience relatively no pain at all in the SAME bone break.
6. The pars can break bilaterally or unilaterally (left and/or right side). When the pars breaks on both sides (bilaterally) the vertebrae is now unattached and can displace forward to cause spondylolisthesis. This more damaged condition we never want an athlete to progress to. This will most likely be accompanied with many back pain problems for life…..
7. On a related topic, there have been many studies on the “Kinetic Chain”, which is the study of how shock gets relayed from the foot through the whole skeleton when, for example, the pitchers stride foot slams down to launch the pitch.
8. Some doctors think that the shock from the slamming of the stride foot has a critical relationship to the pars break and other will state that it is just the hyperextension and twist-torque. I am of the opinion that there could be a strong relationship and I think it’s an easy one for pitching coaches and pitchers parents to guard the young pitcher against undue stride foot shock by (training proper landing of that stride foot, always having newer shoes to absorb some shock, and limit the number of practice pitches thrown on hard surfaces. I am looking into orthotics since my DD has very high arches which are thought to relay the most shock to the spine.)
9. So that is the one Kinetic Chain comment I have for the coaches and parents to potentially help the young pitcher BUT the young pitcher should do some things herself to ward off pars breaks.
10. What the pitcher should do is to keep their core rock-strong. This does NOT mean just do crunches. It means the lower core which is all about supporting the lower lumbar and effectively “cushions” the pars hits they receive each and every pitch. It means doing pelvic tilts etc. This along with stretching hamstrings etc to build the most straight up-and-down muscle-supported lower spine. (of course this needs to be body-maturity-adjusted)
11. Many time pars breaks are misdiagnosed (as was the case of my DD). I can’t emphasize enough that if your DD starts to experience a recurring lower back pain, that isn’t relative to oblique muscle strains, that you have an MRI or bone scan done to rule out pars breaks.
12. Pars breaks can heal. BUT if they are misdiagnosed and the pitcher keeps on pushing through the back pain they could end up with a pars fracture that does not come together any more. The bone starts to think “hey, mabe I am not meant to be as one”… This is bad. This would require surgery then to screw the two pars parts back together.
13. The pars break should be given anywhere between 6-12 weeks to heal. (these are the extremes I have seen on how long it takes)
14. Then on returning to the sport it appears to be crucial to slowly ramp the pitcher back into activity. Doctors suggest a 10% rate of increased load from game-day to game-day (keeping with the needed rest-days in a given week)
15. The other thing that I think is crucial is overall down-time from sports that do hyperextension/twisting/torquing to the back. The year leading up to my DD’s pars break was her first year of “ahhh I don’t need rest and I really want to get as tuned-up with pitching as I possibly can.” I think annual rest periods for backs should be that same 6-12 weeks that is the same time span for bone healing.
16. Note that one study concluded that as much as 30% of pitchers have/had pars breaks at one time, mostly in their adolescence.
17. I definitely am convinced that there are congenital factors in play here too.
