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Pain and Sports Treatment
Acute phase
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Cold therapy for a short period (up to 48 hours) should be applied to limit localized tissue inflammation land
oedema. Electrical stimulation can be used in conjunction with ice to decrease pain and inflammation.
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The patient should be instructed in proper body mechanics for doing everyday tasks (e.g. getting in/out of bed) to ensure no unnecessary stress is applied to the injured area.
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In the acute phase, bed rest may be considered for a short period of time (up to 48 hours). However, most studies now support maintaining some activity level even in the acute phase as this leads to rapid functional recovery.
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Sport activities, particularly those involving weight lifting and extreme movement of the spine should be avoided as long as the pain persists.
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A lightweight lumbosacral belt also may be used to help control muscle spasm. Use of the belt should be discontinued as soon as the spasms stop.
Recovery phase
Physical therapy in the recovery phase involves a light programme of muscle stretching and strengthening for both abdominal and paraspinal muscles. In conjuction with this programme use of heat, ice, ultrasound, electrical stimulation, and soft tissue massage will help to reduce pain. Upright posture should be maintained when lifting or moving things, sitting, and standing. This reduces load on the disc.
Maintenance phase
Physical therapy programme must be tailored to the individual patient. The individualized programme should take into consideration the initial status of pain, muscle strength, and shortening of any given muscle group. The programme should then be adjusted according to the progress made in pain, reduction, strength, and flexibility. A balance between muscle strengthening and flexibility must be sought. When muscles are strong enough, strengthening and flexibility exercises also should be performed. All exercises should consider abdominal, paraspinal and hip muscles.
Return to play
Return to play is an individualized process. While no specific time frame exists, a safe return to play is only possible when the patient feels neither pain nor discomfort. This is possible after the rehabilitation programme is complete and the athlete demonstrates full pain-free range motion with sport-specific activities.
Return to play under medication is not recommended, since the medication can take away the natural warning signals to stop a painful and subsequently harmful action, thereby increasing the risk for aggravating the existing injury or causing re-injury.
Surgical intervention
Patients with chronically painful discs in whom conservative care has been unsuccessful are candidates for surgery.
Long-Terms Outlook
Most (90 per cent) lumbosacral injuries have been reported to subside within six weeks irrespective of treatment. The remaining 10 per cent may develop into chronic lumbosacral pain.
Prevention
Injury prevention is best accomplished through good coaching, proper techniques of sport-specific activity, adequate training prior to participation, and appropriate safety measures, including proper protective equipment and adherence to the rules of the game. All athletes should be educated about proper warm-up exercises, proper stretching exercises and correct techniques for their sport.
