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Pain and Spine Medicine

Back Pain in a Violinist: An Alternate Cause of Pars Interarticularis Defect

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Hannah Park, DO

    Resident
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • MM

    Margaret Martinez, DO

    Resident Physician
    New York University Grossman School of Medicine PM&R Program
    Westwood, New Jersey

  • CK

    Charles Kim, MD

    Assistant Professor, NYU Grossman School of Medicine
    NYU Langone Medical Center - Center for Musculoskeletal Care
    New York, New York

Disclosure(s):
Hannah Park, DO: No financial relationships to disclose
Case Diagnosis: 28 –year-old female found with L5 pars interarticularis attenuation versus defect in the setting of playing the violin for 22 years.

Case Description or Program Description: Patient is a 28-year-old female who presented to the clinic with chronic low back pain since 2010. She reported playing the violin since she was 6 years old and had developed progressive, non-radiating back pain that worsened with prolonged walking and standing and improved with lumbar stretching and rest. Examination revealed pain with facet loading bilaterally with no neurologic deficits. An MRI of the lumbar spine was obtained, demonstrating a right L5 pars interarticularis attenuation versus defect without spondylolisthesis.

Setting: Outpatient pain clinic

Assessment/Results: Patient completed a course of physical therapy outpatient and returned to the clinic after two months with subjective improvement of her symptoms. Initially, there was consideration for interventions with injections but was deferred given her improvement in pain.

Discussion (relevance): Pars interarticularis defects are a cause of non-radiating low back pain in adolescents. They are frequently associated with repetitive axial loading from sports or dance injuries, especially those involving lumbar loading in extension and rotation. They occur primarily in the lower lumbar region, seen at the L5 level in 86 to 95% of cases, and bilateral defects can increase the risk for spondylolisthesis. Management of pars defects is often non-operative unless there are signs of instability and entails physical therapy with a focus on hamstring stretching, pelvis tilts, and core strengthening, and occasionally bracing.

Conclusions: Pars interarticularis defects are often associated with athletic and dance injuries in adolescents. This case highlights another potential etiology of pars interarticularis defects in musicians, especially those with more exaggerated rhythmic and repetitive spinal movements such as soloists and those with more modern techniques such as the electric violin.