“But when can I play again?” – Return to sport after back pain

Having injury or pain put you out of play is tough. Not being able to do what you love, whether its chasing a ball around a field, swinging a golf club or lacing up your shoes and heading out for a run, can often make you feel both depressed and bouncing of the walls with impatience. So no wonder that one of the first questions that pops up in the clinic is: “When can I play again?!”. Like most things related to your back/spine the answer is rarely clearcut and a lot of variables come into play when determining when you can get back on the field, court, track or gym.

Unlike the specific amount of time it takes to bake (or burn) your favourite chocolate chip cookies, there isn’t a s set time for “return to sport”. There are a ton of different variables that will affect your recovery time. These variables include; what type of injury you’ve had, the severity of your back injury, your fitness level, your mental state, your commitment to recovery, what sport you play and so on. Back injury recovery is variable, because back injury is multifactorial. Not only is there so many different structures that could be the pain generator, but there is also a lot of psychology involved – back pain is rarely a purely structural phenomena. Since pain is not just a physical sensation, your emotional state plays a direct role in how you experience pain, as well as in how well you overcome pain, and is therefore something that shouldn’t be neglected in your recovery program. Another thing that is important to remember is that recovery isn’t a linear graph. It is more like the stock market – it will have its ups and downs, but over the long haul it will and should be an upward facing slope.

Key words to any recovery/rehab, and ultimately return to sport, is “progression” and “graded exposure”. One of the first steps in implementing this is clarifying and separating between the terms “return to sport” and “return to sporting activities”. While “return to sport” is referring to a player being back to full participation at his or hers previous level of sport and competition, “return to sporting activities” is part of the road to get there. In other words, before an athlete truly “returns to sport” they must first be cleared to do “sporting activities”. This will include breaking down the demands and key movements of your sport and then reintroducing them, one small step at a time. To illustrate lets use soccer as an example. Before a soccer player is able to return to play he or she must first be able to handle running, directional changes, jumps and lands and fast accelerations/decelerations etc. These are all key elements of soccer, but also elements that can be broken down and regressed into smaller components and step by step progressions. By doing so your body is much more likely to be a “team player” during your rehabilitation. Ultimately, getting back to participating in your sport will be gradual. It will happen over time once you’ve continued to progress.

“So how much should I push and when should I back off??”

Knowing when to push through pain and discomfort, and when to back off, can be tricky, but the best rule of thumb here is to learn to listen to what your body is telling you. When we experience pain or injury our pain threshold automatically drops and our bodys comfort zone shrinks. This is a natural protective reaction and our bodys way of creating a “safety buffer” for itself. The main aim for your recovery is to reverse this and re-expand your comfort zone, so that it once again has room for all the different demands of your sport. Now, being pushed out of ones comfort zone is not always something we find comfortable and this goes for your back as well. Meaning that it is natural for your body to act up and push back a little once you start poking it – just make sure to not smack the hell out of it on your first go. Again, the key here is small tangible steps and gradual progressions… Setting a final goal and then deconstructing it into multiple steps is important because it will help you stay focused and positive through your progression. It will also help you regain confidence and reduce the mental obstacle of return to sport and fear of re-injury.

So to recap some good general guidelines before you start sporting activities again are:

• You should have resumed regular activities of daily living (you can walk up and down the stairs, bend over to tie your shoes, reach for a can at the top cabinet etc.)
• Your pain should be tolerable (simple movements dont cause pain)
• You have received clearance from your medical team (doctor, physical therapist, chiropractor etc.)
• You’re feeling mentally prepared and confident (not afraid)
• You feel like you’re making progress with your recovery/rehab (your slope is facing upwards)
• You’ve broken down your end goal (your full return to sport/competition) into smaller, tangible tasks and steps
• You have a support system around you and a rehab program that is multimodal and takes a holistic approach to recovery

Anja B.