Return to Sport Guidelines after Back Injury

Rehabilitation Principles for the Lower Back

Consult your professional/s for treatment and rehabilitation as these are academic principle guidelines only and not prescriptive.
ASSIC does not dispense medical and/or exercise advice.
Consult your professional regarding exercise, treatment and rehabilitation exercise regimes and medical advise.
The contents of the following web page are principle guidelines and must be utilized under the supervision of a relevant medical and/or exercise professional.

70% of the population will suffer from lower back pain some time in their life.

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:

Stage 1:

Groove motion patterns and do corrective exercise – Address basic motor patterns and balance challenges.

Stage 2:

Build whole body and joint stability while sparing the joints and apply patterns into daily activities.

Stage 3:

Increase muscular endurance and aerobic fitness progressively. This will address basic endurance of movement’s and aerobic fitness for performance.

Stage 4:

Develop strength and address movements related to proprioception.

Stage 5:

Design programmes to achieve speed, power and agility which are important parameters related to return to practice or match.

Rehabilitation should be done daily rather than three days per week, better results are achieved.
Research has proven that combining aerobic walking with the first phase and subsequent phases of rehabilitation.
The best time to begin rehabilitation or exercise should be at least 2-3 hours after waking in the morning.

Basic specimen exercises for lower back

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:

Flexibility:

Prayer stretch

Pelvic Tilt: progress from basic lying pelvic tilt with back straight initially to more advanced pelvic strength exercise

Reclining hand to big toe stretch

Bridge pose

Camel

Plank

Muscular Endurance:

Body weight squats

Lunges (use body weight and then progress using weights)

Bird dog

Push ups

Strength Exercises:

Dead lift

Lateral abdominal side strengthening

Lats pull down

Leg press

Leg Curls

Back Extension

Speed and Agility include:

Ladder Drill
Slalom run
Lateral ladder

Shuttle run

Plyometric Exercises:

Squat jumps

Also include Box Jumps (currently unavailable)

Push up and clap

Alternate high knee lifts

Double knee lift

Return to practice or play guidelines

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.

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References:

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