You may play sports rarely, on a regular basis, or at a competitive level. No matter how involved you are, consider these questions before returning to any sport after a back injury:

• Do you want to still play the sport, even though it stresses your back?
• If you continue with the sport, will you continue at the same level or play at a less intense level?
• When did your back injury occur? How severe was the injury? Did you need surgery?
• Have you talked about wanting to return to the sport with your doctor, physical therapist, or other health care providers?
• Have you been doing exercises to strengthen and stretch the muscles that support your back?
• Are you still in good shape?
• Are you pain free when you do the movements your sport requires?
• Have you regained all or most of the range of motion in your spine?

Back injury - returning to sports; Sciatica - returning to sports; Herniated disc - returning to sports; Herniated disk - returning to sports; Spinal stenosis - returning to sports; Back pain - returning to sports

In deciding when and if to return to a sport after having low back pain, the amount of stress that any sport places on your spine is an important factor to consider. If you would like to return to a more intense sport or a contact sport, talk to your health care provider or physical therapist about whether you can do this safely. Contact sports or more intense sports may not be a good choice for you if you:

• Have had surgery on more than one level of your spine, such as spinal fusion
• Have more severe spine disease in the area where the middle of the spine and the lower spine join
• Have had repeated injury or surgery in the same area of your spine
• Have had back injuries that resulted in muscle weakness or nerve injury

Doing any activity over too long a period can cause injury. Activities that involve contact, heavy or repetitive lifting, or twisting (such as when moving or at high speed) can also cause injury.

These are some general tips about when to return to sports and conditioning. It may be safe to return to your sport when you have:

• No pain or only mild pain
• Normal or almost normal range of motion without pain
• Regained enough strength in the muscles related to your sport
• Regained the endurance you need for your sport

The type of back injury or problem you are recovering from is a factor in deciding when you can return to your sport. These are general guidelines:

• After a back sprain or strain, you should be able to start to return to your sport within a few days to several weeks if you don't have any more symptoms.
• After a slipped disk in one area of your spine, with or without having a surgery called diskectomy, most people recover in 1 to 6 months. You must do exercises to strengthen the muscles that surround your spine and hip for a safe return to sports. Many people are able to return to a competitive level of sports.
• After having disk and other problems in your spine. You should be under the care of a provider or physical therapist. You should take even more care after surgeries that involve fusing bones of your spine together.

Large muscles of your abdomen, upper legs, and buttocks attach to your spine and pelvic bones. They help stabilize and protect your spine during activity and sports. Weakness in these muscles may be part of the reason you first injured your back. After resting and treating your symptoms after your injury, these muscles will most likely be even weaker and less flexible.

Getting these muscles back to the point where they support your spine well is called core strengthening. Your provider or physical therapist will teach you exercises to strengthen these muscles. It is important to do these exercises correctly to prevent further injury and strengthen your back.

Once you are ready to return to your sport:

• Warm up with an easy movement such as walking. This will help increase blood flow to the muscles and ligaments in your back.
• Stretch the muscles in your upper and lower back and your hamstrings (large muscles in the back of your thighs) and quadriceps (large muscles in the front of your thighs).

When you are ready to begin the movements and actions involved in your sport, start slowly. Before going full force, take part in the sport at a less intense level. See how you feel that night and the next day before you slowly increase the force and intensity of your movements.

Ali N, Singla A. Traumatic injuries of the thoracolumbar spine in the athlete. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 129.

El Abd OH, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 48.