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You can still continue a core-stabilisation programme while having spinal injections, in fact it should be compulsory for effective rehab!

Treatment Options include: 1. First aid measures, analgesia, ice packs, relative rest etc. (4) 2. Mobilisation/manipulation (5) 3. Dynamic lumbar stabilisation exercise programmes 4. Trigger point, facet joint, epidural or nerve root injection (6) 5. Sclerosant injection (prolotherapy)(7) 6. Sport specific and functional restoration programmes.

Concurrent multi-model therapy and rehabilitation programmes Measures are initially taken to reduce inflammation and mobilise restricted joints. In the case of a disc prolapse, a caudal epidural injection should be considered and/or a periradicular nerve block. A dynamic stabilisation programme should be instigated as soon as pain allows to enhance the effectiveness of other modalities and to re-educate co-activation of the tonic deep stabilisers. These approaches have been shown, time and again in world lit- erature to be fundamental to a rehabilitation programme (5,8).

Pilates

Pilates-based rehabilitation programmes have been in use for decades now with ballet and dance but recently they have shown increasing benefit in the traditional sporting arena. 1. Postural re-education 2. Floor-based exercises and use of the Swiss ball (Figs.1,2)

3. Exercise on Pilates-evolved equipment ie. The Reformer, Trapeze, Ladder Barrel, Combo Chair etc.(Fig.3)

4. Sports specific exercise on Pilates and other equipment eg. Fitter, Sit Fit, swivel plates, medicine balls, trampette etc. (Figs.4,5,6)

5. Sport-specific exercise programme using bunjees, tubular elas- tic, wobble boards, floor hurdles, ladders, irregular bouncing balls etc. (ie. SAQ system) (Figs.7,8)

Exercise equipment can be adjusted to simulate the sporting envi- ronment and a graded programme can be introduced to return the athlete to his or her chosen sport as soon as the back is capable of performing the rigorous demand of their sport.

These pictures demonstrate the versatility of certain pieces of equipment accurately recreating the sports technique using resis- tance to train the abdominal and lumbar stabilisers.

The same principles apply as in any muscle rehabilitation for example static, isometric contractions in the neutral position pro- gressing through to dynamic inner range exercises using concen- tric and eccentric movements at low speed. Finally high speed dynamic sport specific movements with total balance and control.

Studies of specific exercise programmes in low back pain rehabil- itation have initially shown them not be effective (9,10). But as we all know, exercise programmes need to be tailored to suit each individual’s requirements.

Studies of ‘combined’ therapies tailored to each individual athlete

Below: Figure 3: Sprint take off on the Allegro Reformer

Right: Figure 4: Wind surfing, kite surfing, snowboarding using swivel plates

Left: Figure 1: Swing technique in golf using Swiss ball for pro- prioceptive re-education

Above: Figure 2: Trunk stability in ball contest

Below: Figure 7: Adductor resis- tance combined with lumbar and abdominal co-activation

Right: Figure 8: Cricket using bunjee between ankles

Left: Figure 5: Ball play sitting on sit fit balance cushion with feet off floor

Above: Figure 6: Intense co-acti- vation on the ‘Feldenkrais Roll’ while throwing a medicine ball

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