Managing Acute Low Back Pain for the Tennis Athlete

By Miles Nicholas, PT, DPT, CSCS, FDN-C

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Acute, sudden onset, low back pain is a common complaint in both sedentary and athletic populations, including amongst tennis athletes. In fact, nearly everyone will have at least one case of low back pain in their lifetime. Luckily, acute low back pain has an excellent prognosis via “natural course of history.” This means that >/ 80-90% of individuals who have a sudden onset of low back pain will be symptom-free or moving significantly in that direction over the course of 4-6 weeks, often in as little as days to a week. The common occurrence and excellent prognosis of acute low back pain have led to the nickname: “the common cold of the musculoskeletal system.” 

Most low back pain (~90-95%) is considered non-specific, meaning it’s challenging to determine the exact structure that’s irritated. Fear not, because physical therapists and physicians are skilled at determining if there are any specific causes at play. These include the scary causes of fracture, infection, cancer, neurological issues, and autoimmune inflammatory conditions. Once these have been ruled out, you and your physical therapist can begin creating your comeback plan. 

Recommendations for Acute Low Back Pain

The most essential recommendations following the onset of acute low back pain are to:

  • Avoid bed/couch rest
  • Continue daily/work/exercise activities to one’s tolerance
    • Keep in mind, this may be less than your typical levels!
  • Feel free to temporarily avoid/modify movements that significantly aggravate your symptoms
    • Physical therapists are skilled at helping you determine what to do and what not to do!
  • Avoid getting a scan (x-ray/MRI) of your back in the first 6 weeks, unless recommended by your medical team (physical therapist, MD/DO)
  • Remind yourself: your spine is strong and resilient, low back pain is exceedingly common, and you will likely feel much better in the coming days/weeks

Shown below are three “feel-good exercises” to promote tolerable movement of your low back during a flare-up of low back pain. We recommend only performing the ones that feel tolerable or good! If any of the movements are promoting symptoms moving away from your back and into your leg, we’d recommend not performing that movement. Notice that none of these movements are stretches, they are movements. Stretching is an excellent “feel good” activity, but can further irritate an acutely painful area, so we don’t recommend it when low back pain has recently onset. 


Open Book

Press Up

Forward Plank

The other two movements(Forward Plank and RDLs) are trunk/back (“core”) strengthening drills. We recommend the initiation of these types of drills after the initial pain has begun to settle down because trying to perform these in the initial flared-up period may irritate symptoms further. These are helpful to begin reconditioning the area to tolerate the demands of life/tennis again.


In Closing

If you are looking for assistance in dealing with a flare-up of acute low back pain or persistent low back pain symptoms, the physical therapists at Evolution should be your first call. We can provide you with:

  • A detailed workup to rule out the specific causes of low back pain
  • Advice and education on how to proceed over the next days to weeks
  • Exercises to promote both pain-relieving movement and athletic reconditioning
  • Manual therapies to facilitate symptom management
  • Workload management in your return to athletic activities
  • The reassurance that you will return to your normal life and tennis activities

For more guides on preventing tennis injuries and building core strength, check out our article on the Importance of Thoracic Mobility for Tennis Players or our guide on how to help prevent back injury during the winter season.

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