Acute Phase
Rehabilitation program
Physical therapy
Cold therapy for a short period (up to 48 h) should be applied to the affected area to limit the localized tissue inflammation and edema. The physical therapist may recommend electrical stimulation to be completed in conjunction with the ice to help further decrease pain and inflammation. The patient should also be instructed in the proper body mechanics with everyday tasks (eg, getting in/out of bed) to ensure no further unnecessary stress is applied to the injured area.
Medical issues/complications
In the acute phase of LBP, bed rest may be considered for a short period (< 48 h). However, most studies now support the affected individual maintaining some activity level, even in the acute phase, as this results in a more rapid functional recovery. Sports activities, particularly those involving weight lifting and extreme ROM of the spine, should be avoided as long as the patient's pain persists.
Other treatment
Intramuscular (IM) injections of muscle relaxants or nonsteroidal anti-inflammatory drugs (NSAIDs) at the site of the pain may help to control muscle spasms.
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Avoid manipulation of the affected area during the acute phase of the injury.
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A lightweight lumbosacral corset may also be used to help control muscle spasms. [15] Use of the corset should be discontinued as soon as the spasms have resolved.
Recovery Phase
Rehabilitation program
Physical therapy
Physical therapy in the recovery phase of LBP initially involves a light program of muscle stretching and strengthening for the abdominal and paraspinal muscles. In conjunction with this program, various modalities (eg, heat, ice, ultrasound, electrical stimulation) and soft-tissue massage may help make the athlete more comfortable.
Recreational therapy
In everyday life, the athlete should be instructed to maintain an upright posture of the spine when sitting, standing, and lifting or moving things.
Surgical intervention
Surgery is generally not necessary in the treatment of lumbosacral spine sprains or strains.
Consultations
If the athlete does not have a good response to conservative treatment, and radiographs or laboratory tests suggest a rheumatic disease, the athlete should be seen by a rheumatologist. If a neurologic deficit surfaces or if one that was previously noted progresses, a spine surgeon should be consulted.
Other treatment (injection, manipulation, etc.)
Light muscle massage to relax the involved muscle group and chiropractic manipulations have been reported to relieve muscle pain and spasms, thus making the athlete more tolerant to his or her rehabilitation exercise program. However, IM injections of muscle relaxants may still be necessary.
Maintenance Phase
Rehabilitation program
Physical therapy
A physical therapy program must be tailored to the individual patient and should take into consideration the initial status of the patient's pain, muscle strength, and shortening of any given muscle group. The program should then be adjusted in every session according to the progress that is made in the patient's pain reduction, strength, and flexibility. Physical therapy programs may need to be implemented for 1-2 weeks, or they may need to be continued for several months.
A balance between muscle strengthening and flexibility must be sought. When the affected muscles are strong enough, strengthening and flexibility exercises should also be performed on labile surfaces (eg, Swiss ball [Sissel-Online Ltd, Mission, British Columbia, Canada]) to rehabilitate the proprioceptors. All exercises should take into consideration the abdominal, paraspinal, and hip muscles.
