Introduction
Athletic low back pain is common across athletes and needs to be assessed properly. Evidence based guidelines for acute lower back pain center around exercise as a primary treatment, with heat, manual therapy, and pharmacological interventions as adjunct treatments. When assessed by a physical therapist, the therapist first determines what tissue is affected and what movements are provocative. After assessing this, the therapist typically works on reducing the tissue load, maintaining training load, and then gradually reloading the affected tissue with a return to normal training and competition.
Acute Phase
In the initial phases of acute low back pain, the primary goals are to offload affected tissues, control pain and restore normal movement patterns. Based on prior assessment, the therapist determines what movement and postures to temporarily avoid or limit. The athlete needs to return to tolerating flexion, but initially the pain needs decreased. To control pain, pharmacological agents can be used for pain management. Taping the back for pain control can help limit provocative motions as well.
When dealing with acute low back pain, initial movements are often restricted due to discomfort and irregular muscle activation, such as heightened engagement of the erector spinae. The aim is to rehabilitate by choosing positions that reduce strain on the lumbar spine while promoting mobility. Some notable exercises that are typically done in this phase include quadruped rocking, pelvic tilts in quadruped, or even reverse lunges. Since there isn't a universal exercise suitable for all athletes, it's essential to assess the individual's condition and progressively introduce various movements to identify the most effective exercises for them.
Sub-acute Phase
Once pain is managed and normal movement is regained, the therapist can progress to enhancing an athlete's fitness without putting undue stress on the lumbar spine. During this phase, initial strength and conditioning exercises will involve adapted versions of their typical training methods. As tissue sensitivity diminishes, familiar exercises can be gradually reintroduced. Additionally, manual therapy can complement this process by aiding in pain management. In the beginning, the athlete's sensitivity may make the manual therapy uncomfortable. As tolerance improves, manual techniques can be employed to alleviate muscle tension.
During this rehabilitation phase, exercises should impose minimal strain on the lumbar spine while gradually resembling familiar training movements and delivering a substantial training effect. While numerous exercise options are available, notable examples include front squats, hip thrusts, and various lunge variations, depending on the athlete and their progress.
Return to Sport
Initiating return-to-sport planning from the outset is paramount, involving collaboration among the athlete, coach, and relevant personnel. Following assessment, establishing a tentative recovery timeline becomes essential to guide training and eventual return to competitive activity. Initially, training will predominantly consist of modified exercises, deviating from sport-specific routines. As rehabilitation progresses, there should be a gradual transition towards restoring pre-injury training volumes and incorporating sport-specific drills, while reducing reliance on modified training regimes. Ideally, the modified training regimen should mirror the structure of the athlete's typical training schedule. Furthermore, attention should be directed towards enhancing key movement capacities to mitigate the risk of recurrent low back pain.
Conclusion
Effective management of athletic low back pain hinges on a comprehensive assessment, tailoring exercises according to the athlete's feedback, and orchestrating a collaborative return-to-sport strategy. Initially, the focus lies on alleviating stress on the affected tissues and adjusting training regimens to preserve overall fitness levels. Subsequently, there's a gradual transition towards increasing the intensity of regular training while scaling back on modified exercises. As the athlete progresses toward full training and competition, their strength and conditioning program may incorporate targeted elements to address specific deficits, such as diminished hip mobility or anterior trunk strength, aiming to decrease the likelihood of recurrence.
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