Thursday , Jun , 26 , 2003 C.Y. Ellis

Water rehabilitation for player with lower back pain

A small portion of all backaches do have clear causes-for instance, a ruptured disk or some underlying disease. But in the great majority of cases, the exact diagnosis isn’t known. Is the cause of a basketball player’s backache that sudden movement yesterday when he bent to pick up a ball, or is the problem that he has been exercising too much? Or could it be his poor posture, or just everyday wear and tear? In fact, it’s probably a combination of all these.

A backache can range from mild discomfort to excruciating pain. Usually X-rays show nothing wrong despite the pain-yet in some cases there’s dramatic damage to disks but no pain whatsoever. Back injuries are often made worse by tension and stress, or posture, a sagging mattress, or poor body mechanics, especially when lifting heavy objects.
Physical therapy can benefit many basketball players with low back pain. An excellent form of therapy now used by many therapists is aquatic rehabilitation, also known as aquatherapy, or pool therapy. This gentle form of rehabilitation combines the beneficial effects of exercise and water to create an optimal environment for rehabilitation. Using aquatherapy, I have rehabilitated basketball players with backache, both for relatively slight injuries as well as more serious ones, including sciatica and post-surgical rehabilitation following disk surgery.

The greatest benefits of pool therapy are primarily due to three physical properties of water: buoyancy, viscosity, and hydrostatic pressure. These physical properties make this medium superior to air for exercising, especially early in the rehabilitation process.
Together, these three properties allow development of a therapeutic exercise regimen that controls such critical factors as the weight placed on the spine (axial load) and risk of injury due to unintended movements. Let’s look closely at each benefit.
Buoyancy. Water works wonders because the buoyancy of water suspends the body and reverses the effects of gravity. Buoyancy can allow the low-back pain patient effective partial weight-bearing support that can be enhanced by the use of flotation devices. This may allow the patient to begin rehabilitation earlier and result in an earlier return to the basketball court. One of the greatest benefits of water exercise is its effect on flexibility.
Water is a welcome environment for performing stretches that might otherwise be difficult on land. Because the effects of gravity are lessened, athletes can move their joints through a wider range of motion and achieve longterm flexibility. In addition, water exercise acts as a cushion for weight-bearing joints, resulting in low impact across the low back. The buoyancy of the water also allows athletes to exercise harder and longer than on land.
Viscosity: Water is denser than air, which provides increased resistance to movement. Actually, water results in upwards of 12 times the resistance encountered when performing the same exercise on land. It’s this increased resistance in every direction that adds to the workout and is the primary reason why an athlete can improve both strength and resistance while exercising in water. Using special equipment, such as flotation jackets or water weights, or adding turbulence to the water, can increase resistance, which can produce significant strength gains in weak low-back muscles.
Hydrostatic pressure. Water also produces hydrostatic pressure to all submerged body parts. This means there is equal pressure from the water on the body that increases with the depth of the body part. This pressure opposes the tendency of blood to pool in the lower extremities and therefore reduces any swelling.

When it comes to rehabilitating low-back pain in basketball players, a well-designed aquatherapy exercise program can be used alone or in conjunction with other forms of physical therapy for the patient. Aquatherapy offers many of the same benefits associated with a carefully designed land-based program, including development of a treatment plan that is carefully tailored to the individual patient.
Water-based exercises should only be performed under the guidance of a qualified health professional. Aquatherapy should not be used in cases involving fever, cardiac failure, incontinence, infection, and other conditions.
Athletes with severely limited endurance or range of motion may pose safety issues.

Depending on the depth of the pool, aquatherapy can be divided into two types: deep water and shallow-water rehabilitation. Deep-water exercise is usually performed in a pool at least 210 centimeters (seven feet) deep, with the athlete usually wearing a flotation device. A drawback to deep-water training is that an athlete cannot be left alone in deep water and a therapist should be in the water with him. Shallow water rehabilitation, however, is performed in water that is approximately waist-deep, 120 centimeters (four feet).

Here are some typical shallow-water exercises:

l Warm-up. (With flotation jacket) Walk and/or jog in the water, for 5 to 10 minutes

l Scissors. Have the athlete support himself at the edge of the pool with both arms relaxed. If the athlete is just beginning or does not know how to swim, have him sit on a step at the side of the pool. If he is more advanced and has strong abdominal muscles, he can do this at the side of the pool, with his arms on top of the pool edge, his neck slightly bent forward to relax hisr neck muscles, and his legs at about a 45 degree angle in the water. Separate the legs into a “V” position and then bring them across each other, like a scissors opening and closing. Alternate right leg across left, left leg across right. This will require the use of abdominal muscles to maintain this position while he crisscrosses or scissors his legs. Do this for five to ten minutes.

l Leg swings. While holding on to the edge of the pool, swing a straight leg forward toward the surface of the water, then down and backward. Pull backward only within a pain-free range.

l Leg circles. Standing away from the pool wall, start with very small circles. Lift the leg straight forward, then sweep it through a smooth circular motion out to the side, then behind the body. Complete the circle by brushing the leg past the standing leg and beginning the next circle. After completing the repetitions, reverse the direction of the circle, going from clockwise to counterclockwise or the opposite. Perform four to five repetitions. Courtesy of Writer: Dr. Piero Benelli is the team doctor of Scavolini Pesaro, a Division I team in Italy. He is a sports medicine specialist, Director of the Sports Medicine Center and Professor of the Motor Science Institute at the University of Urbino. He is also President of the Italian Association of Basketball Doctors, and a member of the medical staff of the Italian Men’s National Basketball team.