Returning to Sports after Back Pain: What role does Physiotherapy play?

Do you suffer from back pain while bending over and standing up? And want to get back to running? Then doing the right kind of exercises without straining your back, can help you relieve your back pain. The exercises can be done under the guidance of a well-trained physiotherapist who recommends a  tailored exercise program depending on the intensity of your pain and its causes. In this blog, we will discuss the steps that should be taken,  to safely return to running when you have back pain.

 

1: Understanding the cause

Understanding the cause is the key to recovery. Your physiotherapist tries to know the cause behind your back pain and does a physical examination to find out the structures that are involved so that it is easy for him/her to plan out the exercises that should be done. A skilled physiotherapist will be able to assess and provide you with a diagnosis and treatment plan.

 

2: Treatment plan

Plenty of different structures like muscles, ligaments, tendons, joints, discs, and nerves can injure your back by different types of injuries like overuse, compression, repetitive movement, etc. The treatment plan includes pain relief, range of motion (PROM and AROM), and strengthening exercises.

 

·    Range of motion exercises

Treatment is started with pain relief modalities like TENS, Ultrasound, Laser, Shockwave, etc followed by passive range of motion and active range of motion exercises done in pain-free ranges to maintain the joint movement. Once these are achieved the therapist starts stretching exercises are started.

 

·    Strengthening exercises:

Strengthening exercises help to improve circulation and increase the strength of the muscles to support your spine. These exercises are set at the correct level for the specific type of injuries so that these exercises do not cause any pain during or after the treatment session. There is an endless list of exercises that can be done, but your physiotherapist chooses the appropriate exercises to strengthen your back.

 

·    Moving:

Movement is encouraged for the back pain sufferers to remain active. For the patient with acute pain, short walks can be recommended. But other options like a long walk, swimming or cycling. While doing these exercises the patient might feel mild discomfort which is normal.

 

3: Time

The healing process takes time as new healthy cells are produced to replace the damaged ones. Strength and flexibility also take several weeks to increase.  An average time taken for healing can be :

• Mild sprain –  5 to 6 weeks
• Severe sprain – 8 weeks or several months
• Mild disc injury –  10 to 12 weeks
• Severe disc injury – This can vary a lot but almost from 6 months to 2 years to get back to full function.
• An injury affecting one of the nerves in the leg – This can vary a lot depending on the type of injury but can take almost from 3 months to 2 years.

 

4: Walk/Run program

Walking or running is a part of the treatment program. Walking and running allow the lower back to slowly get used to the impact forces. Short-run intervals are quite short, which might cause mild discomfort that settles quickly. Whereas long continuous running can cause an intense flare-up that may take several days to settle down.

 

The level of pain does not indicate the severity of the injury. It is often found, once a person starts doing the right things, severe pain settles down to very mild levels. We can usually predict much more effectively how long an injury will take to recover by observing how a person's pain changes within the first 2 weeks of following the treatment advice.

 

Celebrating World Physiotherapy Day 2021: Managing Long COVID Symptoms with Physical Therapy

Individuals who have suffered from COVID-19 can experience prolonged symptoms lasting for weeks to months even after the infection has gone, ultimately resulting in "LONG COVID".  One of the possibilities for LONG COVID is the overdrive of one’s immune system towards the virus resulting in harming one’s own tissues. This usually happens with people having a very strong immune system. Another possibility is the presence of the fragments of the virus in the body, usually in the dormant form, even after the recovery from the deadly infection, thus giving way to ''LONG COVID''. For the recovery from the symptoms and impairments of "Long COVID", multi-disciplinary approach assessment and management is essential.  Rehabilitation for individuals recovered from COVID-19 requires the consultation of a physiotherapist, who makes sure that the exercises are done with care to minimize the risk of overexertion. He also ensures the exercise programs are restorative and do not make an individual's symptoms worse. In this blog, we will discuss the physiotherapist's treatment for "LONG COVID" patients.

 

Symptoms of long COVID:

The severity of symptoms varies and many individuals have been left unable to perform strenuous tasks. The symptoms include fatigue, post-exertional symptom exacerbation (PESE), insomnia, breathlessness, chest pain, heart palpitations, dizziness, muscle and joint pain, depression and anxiety,  earaches, diarrhea, stomach aches, a high temperature, cough, sore throat, changes to sense of smell, or taste, problems with memory, and many more.

 

Physiotherapy treatment:

Assessment:

The physiotherapist carries out a detailed assessment and takes various tests to find the causes of symptoms to plan out a rehabilitation program.

Depending on the symptoms of each individual the physiotherapist designs a tailored rehabilitation program. The therapist uses safe, effective techniques and interventions to enhance the recovery process and increase functionality. During exercising, utmost care is taken to prevent oxygen desaturation, hyperventilation, and breathing pattern disorders.

 

Pacing:

Pacing is a self-management technique of breaking up the activity into smaller tasks, with rest intervals to make the activity less intense, this is to avoid post-exertional symptom exacerbation (PESE). The physiotherapist teaches the individual to monitor the heart rate and advice to do activities with less exertion and not to keep doing until one feels tired which in turn can worsen their symptoms. 

 

Breathing exercises:

While breathing the body has a sufficient supply of oxygen, thus the muscles have more energy stored that increases the lung endurance. Breathing exercises or Chest Physiotherapy steadily increase lung capacity and also increases the lungs' ability to maintain a sufficient supply of oxygen over time.

 

Diaphragmatic breathing:

When the diaphragm is functioning effectively as the primary muscle of inspiration, ventilation is efficient and the oxygen consumption of the muscles is very low during quiet relaxed breathing. Diaphragmatic breathing, help decrease the work of breathing, improves the efficiency of ventilation, increases the excursion of the diaphragm, and improves gas exchange

 

Pursed lip breathing:

Controlled expiration with gentle pursed-lip breathing. This mechanism keeps the airways open by creating backpressure in the airways. Pursed lip breathing increases the tidal volume decreases the respiratory rate and improves exercises tolerance.

 

Incentive Spirometry:

Incentive spirometry is a technique used for maximal inspiration. It is a form of ventilation training that focuses on sustained maximum inspiration. The spirometer provides visual or auditory feedback when the patient inhales and breathes in as deeply as possible

 

Lateral costal expansion:

The lateral costal expansion focuses on the movement of this portion of the lower rib cage (bilaterally or unilaterally) and is thought to facilitate diaphragmatic excursion.

High-intensity exercises are recommended after the symptoms improve to maintain flexibility and endurance e.g. core strengthening exercise, increase the walk time, and increase the activity levels gradually. During activities don't forget to take a rest with no mental stress.

 

Muscle Strain: Its Physiotherapy Treatment and Prevention

Although different sports cause different injuries and complications, but muscle strains are by far the most common of all sports-related injuries. Muscle strain also known as muscle tear or pulled muscle, often happens when a muscle is stretched beyond its normal range, by sudden pressure. The lower back, hamstrings, quadriceps, and gastrocnemius muscles are most prone to such strain, while they are rapidly accelerated and decelerated. There is a range of treatments for muscle strain that help to reduce pain, swelling and encourage full recovery. Physiotherapy is one such treatment, the physiotherapist will devise a sports-specific rehabilitation program tailored to the needs. In this blog, we will discuss muscle strain and its physiotherapy management.

 

Muscle strain

There are many degrees of muscles strain from mild to severe. Symptoms can include pain, swelling, stiffness, and bruising. Depending upon the severity they are graded as:

 

Grade 1 strains-The signs may not be observed until the activity is over. There may be a sensation of muscle tightness, cramps, or a feeling of slight pain when the muscles are stretched or contracted but there is no loss of strength or movement.

Grade 2 strains - Immediate pain on stretching or contracting the muscle, swelling, reduced strength, and movement are limited due to pain.

Grade 3 strains - It is a very serious injury. An athlete is unable to walk due to burning pain. The muscle is completely torn and a large lump of muscle tissue is observed. There is immediate pain, swelling, bruising and complete loss of function.

 

Role of physiotherapist in the prevention of muscle strain

The physiotherapist prescribes the following steps to prevent the occurrence of muscle strain:

• Proper warm-up  and cool-down exercises
• Maintains  full joint range of motion
• Treats muscle tightness and fatigue
• Prevents muscle strength imbalances
• Prevents reinjury.

 

Physiotherapy treatment for muscle strain

Physiotherapy treatment depends on the healing phase. As an immediate treatment, POLICE protocol is followed i.e.  – protect, optimal loading, ice, compression, and elevation. This protocol aims to reduce the bleeding and damage within the muscle tissue. Rehabilitation can be started after 48 hrs post-injury. The physiotherapist designs the treatment program to meet the requirement of the player, it can take 12 months to achieve full strength and endurance.

Physiotherapy interventions used for muscle strain include:

 

Cryotherapy

Inflammation and swelling can be decreased by applying cryotherapy in form of ice packs, and cold water baths to the affected area. Continuous application of cold several times a day for 20-30 minutes at a time is recommended.

 

Compression

Compression helps reduce swelling and inflammation, which results in a decrease in pain and enhances the process of healing. Static compression can also be used with an elastic bandage to apply consistent pressure and help prevent additional swelling. To remove excess fluid in the injured area active compression (pumping action) can be given, this action also increases the flow of oxygenated blood, required for tissue repair and healing.

 

Massage

Therapeutic massage helps to increase blood flow and loosen the tight muscles which help to heal the damaged tissues. By applying pressure to the injured muscle tissue, excess fluid and cellular waste products are removed. Massage to the injured and surrounding muscles helps decrease pain and improve the range of motion.

 

Thermotherapy

Thermotherapy may be applied to help relieve pain. Thermotherapy can be given in the form of hot water bottles, electric hot pads, hot cloths, warm baths, etc. Thermotherapy increases blood flow, thus promotes healing and relaxation of the muscles. Alternate use of thermotherapy and cryotherapy helps to reduce pain and swelling caused by a muscle strain.

 

TENS

Transcutaneous electrical nerve stimulation (TENS) provides pain relief, caused by muscle strain.

 

Ultrasound

Ultrasound is very effective in breaking adhesions and thus increases circulation and mobility.

 

Shockwave therapy

Shockwave therapy carries high energy to painful spots and promotes regeneration resulting in healing.

 

Laser

LASER helps in the reduction of inflammation, pain, and healing of damaged tissues thus causes an overall reduction in healing time by increasing intracellular metabolism.

 

Range of motion

A physiotherapist uses hands-on techniques to maintain joint range of motion. Initially simple range of motion exercises are given to maintain mobility in the injured area. After acute management of the injury such as crutches, bracing or pain relief interventions are also given.

 

Strengthening exercises

Strengthening exercises begin with gentle muscle toning exercises. Later, exercises with weights are added. Minimal resistance exercises are recommended for muscle strength.  Progression of the weights, repetitions, and sets are changed depending on the patient's condition. During the recovery phase, the exercises should be done safely to promote muscle strength and healing to prevent reinjury.

 

Stretching exercises

The physiotherapist recommends stretching exercises that may help to maintain flexibility and range of motion. Gentle resistance and stretching exercises are important as they help to align the scar tissue that is formed during the process of healing.

 

Sports should be avoided for a few weeks, even if the player no longer feels pain. Once the injury is healed, full strength and mobility are attained the player can return to play successfully and reduce the risk of occurrence.