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For most athletes, being down for the count is tough. Not being able to do what you love (whether it’s golf, tennis, football, a solo sport etc.) is unbearable. It’s no surprise that in the wake of an injury, one of the first questions athletes ask is “when can I start playing again?”. Like most things related to your back/ spine, the answer isn’t clearcut. A lot of variables come into play in determining when you can get back on the field, court, track or jungle gym (thought we’d throw that one to if you’re paying attention!).

To learn more about returning to sport safely, we spoke with Michael Lau, PT, DPT, CSCS, all-star Doctor of Physical Therapy and founding member of The Prehab Guys. Michael has a deep understanding of pain science and has a special interest in sports medicine, specifically return to sport for ACL reconstruction.

Read on as we deconstruct the “rules” of returning to sport and share tips and exercises for getting you back to doing what you love.

When Can I Safely to Return to Sports?

Unlike the specific amount of time it takes to bake (or burn) a pineapple upside down cake, there isn’t a set time for “return to sport”. There are a ton of different variables that will affect your recovery time. These variables include: what type of injury you’ve had, the severity of your back injury, your fitness level, your mental state, your commitment to recovery, the sport you play etc.

Michael Lau, physical therapist explains, “Back injury recovery is variable. It all depends. There are so many different structures that could be the pain generator. In addition, there is so much psychology involved – back pain is not purely a structural phenomena.” In other words, a lot of different factors weigh-in to affect someone’s recovery timeline. With back pain, there is a huge mental component that lives outside of the physical injury itself. Since pain is not just a physical sensation, your emotional state plays a direct role in how you feel pain and how well you overcome pain.

Understandably, this all may feel ambiguous but have no fear! Michael shared one rule of thumb for recovery and return to sport: “progression”. Lau explains, “recovery isn’t a linear graph. It’s not a straight line from 0-10. Like the stock market it will go up and down, but over the long haul will and should be an upward slope”.

Ultimately, getting back to participating in your sport will be gradual. It will happen over time once you’ve continued to progress.

Before you start sporting activities again:

  • You should have resumed regular activities of daily living (you can walk up and down stairs, bend over to tie shoes etc.)
  • Your pain should be tolerable (simple movements don’t cause pain)
  • You have received clearance from your medical team (doctor, physical therapist, chiropractor etc.)
  • You’re feeling mentally prepared and confident (not afraid)
  • You feel like you’re making progress with your recovery/ injury ReHab
  • You’ve broken down your end goal into staggered, tangible, bite-sized steps

Planning Your “Return to Sport”

Are there some back injuries that mean one should never return to sport? Michael from The PreHab Guys explains, “We’re big proponents of never telling people not to do something…If running gives you a ton of joy and there’s no pain, I will not tell someone not to run. I will make modifications like cutting down mileage, improve running mechanics, or strengthening the muscles are the knee to better handle the loads placed on it. There will always activities that are better or worse for people depending on previous injuries, but there are always modifications that can be made.”

“Return to sport” is a phrase that is common and popular in orthopedics. It is the terminology used when referring to injured athletes who begin playing again. However, the term should be clarified. Before an athlete truly “returns to sport” they first must be cleared to do “sporting activities”. In other words, after a back injury, a player is unlikely to jump back into a game-setting. That player will not be back to full participation, but will return to sporting activities like practice, training, and reintroducing key movements with the goal of eventually participating at a pre-injury level.

To illustrate, Dr. Lau uses golf as an example. He explains, “if someone wants to get back to golf it will be a step by step progression. At first it may be walking, then going to the driving range, then trying 3 holes with a golf cart, then 3 holes walking, then 9 holes etc. It may be starting with just putting, moving onto chipping, and finally driving off the tee.” He adds that it’s absolutely imperative to “make an end goal and break it down into doable steps”. This means that if you want to get back to your pre-injury level, you’ve got to break down your ultimate athletic goal into a series of achievable milestones.

When getting back to sporting activities after a back injury, let pain be your guide.

Knowing when to push through pain and discomfort is tricky, but listen to what your body is telling you. If your back pain has become chronic, lasting longer than the “normal” healing time of an injury, it may not be entirely pathoanatomical. In other words, back pain isn’t always tied to structural or mechanical findings on an MRI or xray. It’s important to incorporate injury ReHab activities that address your emotional state and are proven to decrease physical pain too.

Learn more about chronic pain and how it is linked to stress, anxiety, and your emotional state.

Setting a final goal and deconstructing it into multiple steps will help you stay focused and positive with your progression. It will also help you regain confidence. In regards to playing sports again, Dr. Lau underscored that “confidence is the biggest thing, so graded exposure is key.” Your physician, physical therapist, and trainer can help you break down your return to sport into safe, tangible steps.

To recap, your “return to sport” should:
return to sport
  • Actually be a “return to sporting activities” after you’ve nailed your normal, everyday movements.
  • Begin with determining your end goal and thoughtfully breaking it down into steps. This keeps your eye on the prize and lets you track your progress.
  • Be supported by a ReHab program that is multimodal and takes a holistic approach to recovery (e.g. treats the mental components of pain).

Having back/spine surgery? PeerWell’s daily PreHab and ReHab program for back surgery and recovery is a must! Learn more.

12 Exercises for Lower Back Pain/ Injury

After a back injury and pain, you won’t be moving normally. Craig, another founding member and physical therapist with The PreHab Guys explains that in the face of pain, “You forget how to move. The body is really smart and will do everything it can to not cause pain.” As a result, when your body overcompensates in other ways to avoid pain it alters your perception of movement. For example, you may be holding your breath, moving stiffly etc.

It’s important to reprogram your movements by completing a list of exercises designed to combat back pain. The following exercises can be done at home and aim to improve body awareness, posture control, mobility, stability, and prevent future injury.

Here are 7 recommended, low-impact exercises for back injury/ pain that you can do at home:

Body Awareness Exercises

Improving your body awareness lets you understand your body and how certain positions contribute to your symptoms. Greater body awareness helps with movement control and learning movement modifications to avoid pain.

1. Pelvic Tilts (on back, hands and knees)

10-25 reps 2-3x a day during a flare-up (or once a day for prevention)

2. Pelvic Tilts (seated/ standing)

10-25 reps 2-3x a day during a flare-up (or once a day for prevention)

Mobility Exercises

By improving the mobility in your lower back, lumbar spine, and supporting muscles you can offer your back greater support and flexibility. This can improve movement patterns, posture, and mitigate risk of unnecessary stress and strain on the back.

These are the best mobility exercises that target your back and can help improve chronic or acute back pain:

3. Cat cows

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

4. Open books

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

5. Work break mobility flow

Repeat routine 3-4 times a day, 5 times a week/ during work hours

6. Hip flexor stretching

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

7. Glute stretching

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

8. Quadruped rock back

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

9. Child’s pose stretch

10 reps x 2, 3-4 times a week (perform when you feel stiff/ tight)

Stability Exercises

Stability exercises can sometimes cause more pain. If they do, avoid them until your flare-up has passed. Stability exercises strengthen the lower back, hip, and spine while giving you better control of your movements.

10. Low Back Control & Hip Flexor Strengthening Exercise

10-25 reps, 1-2 sets, 3-4 times a week

11. Bridge exercise (progressions for glute strengthening)

10-25 reps, 1-2 sets, 3-4 times a week

12. Hip flexor strengthening

10-25 reps, 1-2 sets, 3-4 times a week

For a full list of exercises (and videos) designed by The PreHab Guys for lower back pain, click here.

Be a part of our supportive community for back pain sufferers! Also, be the first to get early access to our blog for back pain.

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