BokSmart: Preventive rehabilitation for rugby injuries to the lower back and core

Abstract

Background. The low back is an integral part of the entire movement chain as it functions as part of a complex network of the skeletal, muscular and nervous system. Eighty to 90% of acute low back pain episodes dissipate within 8 -12 weeks regardless of any intervention, but 5 -10% regress into chronic low back pain. As a result of its undistinguished aetiology, the treatment for low back pain remains controversial. Treatment options for low back pain include the following: analgesics, muscle relaxants, antidepressants, nonsteroidal anti-inflammatory drugs, epidural steroid injections, manipulation, back schools, electromyographic biofeedback, traction, orthoses, behaviour therapy, transcutaneous electrical nerve stimulation, acupuncture, and exercise therapy.Results. Therapeutic exercises for low back pain have been shown in 6 different randomised controlled trials to be beneficial in reducing pain by up to 60% and improving functional ability by up to 47%. Furthermore, a Cochrane review on low back pain found strong evidence that exercise therapy is an effective intervention in the treatment of low back pain. When prescribing exercises for an individual with low back pain the following goals need to be considered: (i) improve performance in endurance activities; (ii) improve muscular strength around the spine; (iii) eliminate any impairments in spinal flexibility; (iv) reduce the intensity of the pain being experienced by the individual; and (v) reduce back pain-related disability. A rugby player will have increased core stability/strength and a reduced risk of injury if the internal support mechanisms of the spine have been conditioned to resist distortion or injury from external forces. Not only will improved core

The interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® screening protocol amongst professional rugby players

“…9 Moreover, the spinal column, together with the rib cage and pelvis forms part of the central component of the skeleton which together with the surrounding soft tissue function to absorb and dissipate forces which act upon the body. 10 Hopkins et al 10 conclude that amongst other interventions, improved muscular strength around the spine and eliminating impairments in spinal flexibility not only benefit players' on-field performance but also prevent injury during strength conditioning. Considering the above, the authors included tests challenging trunk and low back mobility and strength.…”

“…Dysfunction of the spine's protective and load distributing capacity therefore increase the risk of back injuries among athletes involved in high impact sports such as rugby. 10 The double leg lower test as described by Krause et al 50 and Zanotti et al 4 , is performed at a slow pace (10 seconds for lowering the legs from a 90 vertical hip flexion to 0 hip flexion) and only test muscle strength up to the angle at which the participant fails to maintain abdominal wall contraction. According to the principle of dynamic correspondence, 34 inferences regarding muscles' strength capabilities cannot be made if not performed under the same circumstances (angles, velocity, etc.)…”

“…Rationale for inclusion of the test: As mentioned above, elite level rugby players suffer more frequent and severe LBP compared to the nonathletic and lower level player population. 10 Additionally, posterior muscle chain (especially hamstring) strains are one of the most prevalent injuries among forward and back line players. 41 The combined, simultaneous lumbar spine and hip joint rotary movements that occur in the frontal plane during running, plays integral role in the decoupling of the pelvic and from the shoulder girdle motions.…”