Athlete Profile:17-year-old female soccer player on a local high school varsity soccer team and a competitive travel team. A demanding schedule of practice 5 days a week, 1-2 games a week and frequently travelling out of state for multiple games on weekends.
The Injury:The patient began to experience left lower back pain while at a summer soccer camp. Due to the severe pain, she was unable to continue the camp and returned home for treatment.
The Initial Treatment:Upon her return home, an appointment was made with her orthopedic physician, who took x-ray and MRI with no injury noted. She was referred to physical therapy at a local clinic for 9 months, who gave her a functional strengthening program that showed initial improvement which regressed with no lasting improvement with each attempt to return to play.
A comprehensive evaluation of the lower back was performed, and a biopsychosocial evaluation for the patient’s readiness for return to play. The physical assessment showed pain, limited range of motion of the lumbar spine, left low back muscle spasm, poor low back core stability, a significant muscle imbalance around the hip that included weakness and tightness of the left hip muscles, knee and ankle muscles and poor ability to balance on the left leg as compared to the right leg. Patient was unable to walk fast due to pain and found running, hopping and jumping and landing impossible without significant pain. Not surprisingly, our athlete rated a 20 on a 0–100 scale, demonstrating she had no confidence for return to play with her injured back.
The patient’s rehabilitation program included a sport-specific approach that includes tissue pathology and tissue healing. The early focus was on pain relief, joint movement, increasing low back movement, decreasing muscle spasm, early initiation of low back core stability, stretches and stability exercises for the hip, stretching exercises for the knee. Patient was seen initially 3 times a week for 6 knees then twice a week for 1 month.
After 2 weeks of rehabilitation, a sport-specific optimal loading program for the low back was initiated that included stretching, progression of core stability of the low back with progression from a stable supported position to an upright position and movement of the joints of the low back were performed. Functional stretches and strengthening exercises for the knee and hip were introduced.
At 4 weeks cardiovascular exercises were introduced - both static bike and elliptical machine. At 5 weeks patient was 70% improved. In weeks 5-9, a sports specific functional strength program for the lumbar spine was introduced progressing optimal loading for the lumbar spine and hip and knee structures. Balance exercises progressed and running started. Sports specific soccer tasks were introduced and progressed.
At 6-7 weeks, she was allowed to return to practice while still attending physical therapy. She now demonstrated full movement of the low back, full functional core stability, full functional strength of the left hip and knee and full balance ability of the left leg equal to the right leg. Patient was also to perform sports specific functional tasks as kicking the ball, hopping, running, jumping and landing, cutting and pivoting without pain.
Return to Play:
The progression involved all 3 components of the Pro•Motion Performance graded “Return to Play” program - “return-to-participation”, “return-to-sport” and “return-to-performance”.At the 9-week period patient was back playing soccer without pain and any functional limitation for the low back.
The patient was given specific instructions of Pro•Motion Performance’s re-injury prevention program that is incorporated into the patient’s warm-up. Psychological Screen for readiness for return to sports was 95 on a 0 – 100 scale, indicating she was psychologically ready for return to soccer.
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