Abstract

Lecture 12

Low back pain is one of the most common cause of loss playing time at athletes. The best rehabilitation in low back pain can be considered the early prevention. In the case of injury is important to know and to understanding the phases of rehabilitation and needed. At the level of low back during its motions is important to know the kinetic and kinematics aspects. The kinematics of spinal flexion and extension are associated with a shifting instantaneous axis of rotation. Spinal kinetics at athletes includes intrinsic and extrinsic forces that can affect the spine. The sources of low back pain include the intervertebral disc, nerve roots, sacroiliac joints, ligamentous, muscular tissue. Assessment begins with history of pain and relation with sport activity, location of the pain in relation with body position, walking, effort, daily moment and also progressivity. In assessment we include clinical examination of the entire kinetic chain of the spine, by assess the posture, mobility and also using some specific tests like: Gielett, Faber, Thomas, Gaenslen completed by imaging evaluation (MRI, plain radiographs, bone scan, CT scan). Most common causes of low back pain to athletes are: fractures, acute disc herniations, muscular contusions and strain or degenerative disc diseases, spondylolysis, spondylolisthesis, facet syndrome, lordotic posture, sacroiliac inflammation.

Rehabilitation depends of how we understanding the involved sports and according to the injury. Are three phases: acute and subacute, rehabilitative phase and sport specific rehabilitation. Medication includes non-steroidal anti-inflammatory drugs (NSAIDs) and also brace, manipulation.

Acute and subacute phase: propose few days of rest, icing, ultrasounds, iontophoresis, laser therapy and brace. In subacute phase is possible aerobic activity in the pool. For entire period we recommend isometric contraction for abdominal and extensors muscle.

Rehabilitative phase: in this phase we prefer core stabilisation and depend of pathology mechanism, we shall promote flexion or extension programme, for obtain neutral zone that involves comfortable spinal motion. We begin the closed chain strengthening and co-activated muscular coordination for improvement muscle balance. In second part of rehabilitation phase, the programme depends of sports activity, because the core have to transfer the forces from lowers limbs to uppers limbs or to generate forces and recoil forces. For this the athletes must to make these motions.

Sport specific rehabilitation is the third phase and prepare the returning to sport activity. So, are specific programmes for dancers, gymnasts, golf and racquet sports, football, throwing, weightlifters. The programmes must to involve decrease of stress forces at the back, to maintain the static of spine and decrease the disc injuries. All of these programmes have to be included in the training programmes for minimising recurrence and improve sport performance.