Sports Medicine Approach to Low Back Pain

Mathew W. Lively, DO

South Med J. 2002;95(6) 

In This Article

Sports Medicine Model

In the athletic setting, the goal of rehabilitation is to return the athlete to participation in a safe and timely fashion. This is accomplished through early exercise that is controlled, active in nature, and progressive. The sports medicine approach to LBP applies these principles to the rehabilitation of back injuries in the general population. An advantage of this approach is that it can be used with patients who have either acute or chronic nonspecific LBP or sciatica. Once a thorough history and physical examination have ruled out serious or emergency causes for LBP, the basic advice for treatment is the same, regardless of the diagnosis.

Active patient participation is the first component of the sports medicine model that separates it from the more traditional treatments for LBP. Individuals with a back injury are often advised to rest, apply ice or heat, and are prescribed analgesics and muscle relaxants. All of these traditional treatments, however, are passive in nature (ie, patients do not take an active role in their recovery). Passive treatments tend to promote illness behavior by reinforcing the role of being sick and bolstering patients' feelings of loss of control for the back injury and recovery. In contrast, active treatments (eg, early activity) encourage personal control and help to convince patients that they are not as disabled as they often perceive themselves to be after a back injury.

With sports injuries, return to activity is the goal of rehabilitation. Likewise, when managing LBP, treatment should focus on a return to normal function, while de-emphasizing the pain and disability components of the injury. Early and progressive activity using a time-dependent, goal-oriented program is the means by which function is restored in the sports medicine model. In individuals with LBP, studies of exercise programs that base progression on set goals instead of symptoms have shown that exercise subjects demonstrate less disability than controls,[21,26,28,29] and that as exercise capacity increases, complaints of pain decrease.[25,27] When advising activity for individuals with LBP, however, initial goals often need to be set low to guarantee achievement, thereby encouraging patient compliance and avoiding the frustration of unmet expectations. Progression, though, remains based on preset functional goals instead of pain complaints. Patients must understand that they will most likely experience some initial increase in pain, and that this is not an indication that the exercise is harmful, but simply evidence that out-of-condition muscles are being used, similar to the soreness athletes experience when beginning a training program. The concept of exercising with pain is the most difficult aspect of the sports medicine approach for patients to embrace and often requires more educative effort on the part of the physician to ensure compliance.

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