The spine is a complex region of the body comprising of bone, muscle, nerves, discs, ligaments, and joints that are delicately articulated to each component. The spinal column has varying degrees of flexion, extension, rotation in both directions left or right and is limited by the mere fact of its architecture.

• • The diagnoses is of critical importance if the correct rehabilitation programme is to be designed.
  • Baseline measurements must be measured during the assessment process, in order to determine possible return to practice or match.
  • The improvements of these measurements during the rehabilitation process will reduce the anxiety levels of the player.
  • Daily symptoms may fluctuate depending on daily movements or re-injury. The player must bring these changes to the attention of the physiotherapist.
  • The physiotherapist must demonstrate to the player simple do’s and do not’s related to sitting, standing and lying down and getting up.
  • The Physiotherapists will know the basic movements the sport that the player is involved with, so that first phase rehabilitation could be very specific to the related sport.
  • Players who are fit, recover much quicker from lower back pain depending the nature of the injury.
  • Mobility, flexibility and range of motion are important components of first phase rehabilitation.
  • Second phase rehabilitation will be done by the biokineticists who will then take the player back to full fitness.

Stuart McGill (2007) designed a five stage plan to the rehabilitation of the back. These are:

There is no recipe for the activity programme, rather guidelines with the correct mix of exercise for the related injury. Specimen exercises are listed below:

Lateral abdominal side strengthening

Lats pull down

It is more complex to determine return to practice or play for lower back injuries. A multi-disciplinary team approach is required.

It is of utmost importance that a multidisciplinary team assess the player for practice or match readiness.

The important components to assess would be:

• Range of motion and flexibility, core stability and grooved motion patterns.
• Functional testing.
• Muscular endurance and strength measurements.
• Aerobic fitness and anaerobic capacity.
• Speed, agility, co-ordination and balance.
• Finally, skill testing related to the game, the coaches input is essential for this parameter.
• Isokinetic back extension and flexion strength tests may be done, if the equipment is available for testing.
• All of the results of these testing protocols should be at least 95 % of tests prior to injury.
• The lower back is a complex region of the body, hence, testing should be taken seriously, or else re-injury may occur.

Education related to back injury is essential for all injuries or surgical interventions. The player must continue with the rehabilitation programme even once he is at full fitness and return to play.

1. McGill, S, (2007) Lower back disorders- Evidence based prevention and Rehabilitation. Human Kinetics. Champaign. Illinois.
2. Prentice, W.E. (2000) Rehabilitation Techniques in Sports Medicine. McGraw Hill. New York.
3. Mellion, M.B. (1994) Sports Medicine Secrets. Mosby. Boston.
4. Bruckner, P and Khan, K. (2007) Clinical Sports Medicine. McGraw Hill. New York.