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The goal of treatment is return to play by the athlete. Athletes can perform a certain level of activity if they have conditioned themselves both physically and mentally. Patient education is the key to obtaining compliance in the rehabilitation of the athlete. Although the pathology of a spinal problem appears to be complex, the athlete may better understand the rehabilitation of an injury if described using a simple analogy of a fractured long bone in the leg.

The bone will heal with either nonoperative (casting) or operative (plate and screw fixation) treatment. Once the bone heals solid after a predetermined length of time, the athlete likely will have subpar performance on the first game day, with a much greater chance of injury to another part of the body, if he or she returns to a competitive sport without general fitness conditioning of the body as well as specific range-of-motion, strengthening, and proprioceptive training of the healed “lower limb.”

The bottom line is that the athlete will need intensive rehabilitation regardless of whether surgery is performed for the injury. The specifics for rehabilitation of the spine will be dealt with elsewhere in this book; however, the basic goals of regaining range of motion with stretching exercises, trunk strengthening of the paraspinal and abdominal muscle groups, as well as cardiovascular training for general fitness should be achieved before an athlete’s return to sport-specific practice.

The use of narcotic analgesics should be limited to a few weeks after the traumatic injuries or surgery. Non-narcotic analgesia, either acetaminophen or nonsteroidal anti-inflammatory agents, should be the analgesia of choice during the rehabilitation period.

The use of physical modalities can help with pain relief during physical rehabilitation. The choice of one modality over another, however, is based solely on the athlete’s response or lack thereof to the treatment modality. Remember that many nontraumatic pains are self-limiting and will heal despite the treatment modality. A back support can be used after an acute traumatic injury.

A thoracolumbosacral orthosis (TLSO) is basically a removable body cast, and it can be used for stable fractures of the thoracolumbar spine. For acute spondylolytic defects, a lumbosacral orthosis can be used until symptoms subside. Lumbosacral supports also have been used in nontraumatic conditions, and if it reduces the pain, such a support may be temporarily helpful.

It does not act as body protection from recurrent injury, however, nor does it immobilize the spine during athletic activities. If the lumbar support gives an athlete the confidence to perform his rehabilitation exercises better, he should begin to wean himself out of the brace as soon as appropriate trunk reconditioning has been started.

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