Back & Neck Injuries
Immediate, Subsequent Care, & Return to Athletics
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The spine is divided into three regions — the cervical (neck), thoracic (mid-back), and lumbar (low back) — all of which play key roles in posture, stability, and movement. Athletic back and neck injuries often result from muscle strain, repetitive overuse, poor posture, or trauma. Proper management in the early stages is crucial for preventing chronic pain and facilitating a safe return to sport.
Athletes are at risk for a variety of injuries, including strains, disc injuries, and "spondies" (spondylolysis/spondylolisthesis).
Overview
Overview
Proper management during the first 24–48 hours is critical for a safe and efficient return to sport. We follow the PEACE & LOVE approach for acute injury care — prioritizing protection, gentle movement, and long-term healing over outdated ice-heavy methods.
If you notice a visible deformity, seek care at an Urgent Care center or Emergency Department immediately. See our “Where Should You Go?” page for guidance.
Always follow up with your Athletic Trainer as soon as possible after an injury.
Immediate Care
Immediate Care
Key PEACE & LOVE Takeaways for the back & neck:
Avoid prolonged rest: Gentle movement within pain-free limits helps maintain mobility and prevent stiffness.
Avoid Ice & NSAIDs for first 48 hours: Swelling is part of the healing process; use acetaminophen (Tylenol) as needed for pain relief.
After 48 hours, use NSAIDs (Advil, Motrin, Ibuprofen, Aleve, Naproxen) to help manage pain relief.
Self-massage / light mobility: Apply a warm compress or use a massage gun or foam roller on adjacent, non-painful areas to maintain circulation.
Posture reset every hour: Stand tall, gently retract shoulders, and take deep breaths to maintain thoracic mobility.
Seek immediate evaluation if there is numbness, tingling, weakness, loss of sensation, or radiating pain into arms or legs.
Subsequent Care
Subsequent Care
After 24–48 Hours Post-Injury
After 24–48 Hours Post-Injury
Depending on the clinical diagnosis of the injury, please complete the rehabilitation protocol. Continue only if pain-free or working at a tolerable level of discomfort. If swelling/bruising persists, continue to add the Immediate Care hourly range-of-motion exercises at each stage.
The timeframes listed in each injury protocol's stages are more of a loose guideline than a concrete program, as each injury's severity can vary from athlete to athlete.
Cervical (Neck) Strain
Cervical (Neck) Strain
A cervical muscle strain, also known as a neck strain, is an injury that occurs when the muscles or ligaments in the neck are overstretched or torn.
Stage 1 – Pain Management & Isometrics (0–3 days)
Stage 1 – Pain Management & Isometrics (0–3 days)
Goals: Decrease pain, reduce stiffness, restore gentle motion.
Exercises:
Chin tucks (isometric): 10×5-second holds
Gentle neck rotation and tilts (pain-free range): 10 reps each direction
Scapular retraction isometrics against wall: 10×5 seconds
Self-care:
Heat or gentle massage along upper traps and neck extensors
Tennis ball wall massage for upper traps and levator scapulae
Stage 2 – Active ROM & Light Strength (3–7 days)
Stage 2 – Active ROM & Light Strength (3–7 days)
Goals: Restore full range of motion and postural control.
Exercises:
Resistance band cervical retraction and extension: 2×10
Shoulder blade squeezes: 2×15
Wall angels or “Y-T-W” band exercises: 2×10
Self-care:
Foam roll thoracic spine before neck exercises
Gentle soft-tissue work with massage gun (low setting)
Stage 3 – Functional Strength & Stability (1–2 weeks)
Stage 3 – Functional Strength & Stability (1–2 weeks)
Goals: Improve dynamic neck and upper back stability.
Exercises:
Prone “I-Y-T” lifts on stability ball: 2×10
Scapular push-ups or wall slides: 2×10
Band-resisted chin tucks (front, sides): 2×10
Farmer’s carries (light weight): 2×30 seconds
Stage 4 – Sport-Specific Return (2–3 weeks)
Stage 4 – Sport-Specific Return (2–3 weeks)
Goals: Restore strength, posture, and impact tolerance.
Exercises:
Medicine ball chest passes and overhead slams (controlled): 2×10
Reaction and head movement drills (for contact or visual sports)
Maintenance:
Daily neck mobility and posture resets
Continue scapular and core stability 2–3×/week
Thoracic (Mid-Back) Strains
Thoracic (Mid-Back) Strains
A thoracic muscle strain is an injury to the muscles in the upper back, located between the shoulder blades and the lower ribs.
Stage 1 – Pain Management & Mobility (0–3 days)
Stage 1 – Pain Management & Mobility (0–3 days)
Self-care:
Heat or warm shower before movement
Foam roll upper and middle back 2×/day (avoid painful areas)
Gentle breathing drills to expand thoracic motion
Exercises:
Cat-Cow: 2×10
Thoracic extension over foam roller: 2×10
Scapular retraction isometrics: 2×10
Stage 2 – Active ROM & Light Strength (3–7 days)
Stage 2 – Active ROM & Light Strength (3–7 days)
Exercises:
Quadruped “thread the needle” rotations: 2×10 each side
Resistance band rows: 2×15
Prone “W” lifts: 2×10
Self-care:
Massage gun on rhomboids and mid traps (30–60 sec/area)
Postural corrections every hour
Stage 3 – Functional Strength & Stability (1–2 weeks)
Stage 3 – Functional Strength & Stability (1–2 weeks)
Exercises:
Dumbbell or cable rows: 2×10
Stability ball back extensions: 2×10
Medicine ball wall rotations: 2×10
Bird dogs: 2×10
Self-care: Continue foam rolling and stretching before/after practice.
Stage 4 – Sport-Specific Return (2–3 weeks)
Stage 4 – Sport-Specific Return (2–3 weeks)
Return to overhead and rotational sport movements gradually.
Include resisted trunk rotation and anti-rotation (Pallof press).
Continue thoracic mobility and postural work 2–3×/week.
Lumbar (Low Back) Strains
Lumbar (Low Back) Strains
A pulled lumbar muscle, also known as a lumbar strain, is an injury to the muscles and tendons in the lower back.
Stage 1 – Pain Management & Core Activation (0–3 days)
Stage 1 – Pain Management & Core Activation (0–3 days)
Self-care:
Avoid sitting >30–45 min without standing
Use heat and gentle massage around paraspinals
Avoid heavy lifting or twisting
Exercises:
Diaphragmatic breathing: 5×10 breaths
Pelvic tilts: 2×10
Glute bridges (pain-free): 2×10
Stage 2 – Active ROM & Light Strength (3–7 days)
Stage 2 – Active ROM & Light Strength (3–7 days)
Exercises — Twice a day:
Cat-Cow or Child’s Pose Stretch: 2×10
Bird Dog: 2×10 each side
Side planks (modified): 2×20 sec
Stretches — Four times a day:
Hip flexor stretches: 2×30 sec each
Hamstring stretches: 2×30 sec each
Stage 3 – Functional Strength & Stability (1–2 weeks)
Stage 3 – Functional Strength & Stability (1–2 weeks)
Exercises:
Plank with shoulder taps: 3×20 sec
Glute bridge march: 2×10
Cable or band Pallof press: 2×10
Dead bugs: 2×10
Stage 4 – Sport-Specific Return (2–3 weeks)
Stage 4 – Sport-Specific Return (2–3 weeks)
Gradual reintroduction to loaded lifting, running, and cutting.
Focus on hip hinge (RDL) mechanics and trunk control.
Continue core strengthening 3×/week.
Lumbar Disc Injuries (Bulging or Herniated Disc)
Lumbar Disc Injuries (Bulging or Herniated Disc)
Lumbar disc injuries, or bulging/herniated discs, occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its outer ring, often causing pain, muscle weakness, numbness, or spasms in the back, legs, or feet. Treatment typically begins with conservative methods like physical therapy, pain medication, and rest, with many cases resolving on their own within weeks.
Stage 1 – Pain Management & Extension Bias (0–5 days)
Stage 1 – Pain Management & Extension Bias (0–5 days)
Self-care:
Avoid forward bending and sitting slouched
Heat before movement, not prolonged sitting
Exercises:
Prone press-ups (McKenzie extensions): 10×5 sec holds
Abdominal bracing and gentle glute activation: 2×10
Walk every 2–3 hours to maintain mobility
Stage 2 – Controlled ROM & Stability (5–14 days)
Stage 2 – Controlled ROM & Stability (5–14 days)
Exercises:
Bird Dog: 2×10
Side plank (modified): 2×20 sec
Standing hip extensions: 2×10
Continue McKenzie press-ups as tolerated
Stage 3 – Functional Strength (2–4 weeks)
Stage 3 – Functional Strength (2–4 weeks)
Exercises:
Glute bridges and marches: 2×10
Pallof press: 2×10
Cable rows or lat pulldowns (neutral spine): 2×10
Stage 4 – Sport-Specific Return (4–6 weeks)
Stage 4 – Sport-Specific Return (4–6 weeks)
Progressive return to lifting, sprinting, and change-of-direction work.
Emphasize neutral spine under load and strong hip hinge patterns.
Spondylolysis / Spondylolisthesis
Spondylolysis / Spondylolisthesis
Stress fracture or slippage in the lumbar vertebrae, common in extension sports like gymnastics, football, and cheer.
Spondylolysis: A stress fracture in the pars interarticularis, a narrow part of the vertebra that connects the upper and lower parts of the spinal bone.
Spondylolisthesis: A condition where one vertebra (bone in the spine) slips forward over the vertebra below it.
Stage 1 – Pain Management & Neutral Spine Awareness (0–7 days)
Stage 1 – Pain Management & Neutral Spine Awareness (0–7 days)
Self-care:
Avoid hyperextension and rotation
Heat and massage for muscle tightness (not directly on spine)
Exercises:
Pelvic tilts: 2×10
Dead bug (no arching): 2×10
Glute bridge holds: 2×20 sec
Stage 2 – Core Stabilization & Hip Mobility (1–3 weeks)
Stage 2 – Core Stabilization & Hip Mobility (1–3 weeks)
Exercises:
Bird Dog: 2×10
Plank (modified, knees): 3×20 sec
Hip flexor and hamstring stretches: 2×30 sec
Side plank (modified): 2×20 sec
Stage 3 – Functional Strength (3–6 weeks)
Stage 3 – Functional Strength (3–6 weeks)
Exercises:
Glute bridge march: 2×10
Pallof press: 2×10
Squat to chair (neutral spine): 2×10
Stability ball rollouts: 2×10
Stage 4 – Sport-Specific Return (6+ weeks)
Stage 4 – Sport-Specific Return (6+ weeks)
Gradually reintroduce sport motions (no forced extension).
Emphasize hip hinge control, glute activation, and trunk stiffness.
Continue anti-extension core work 2–3×/week.
Return to Athletics
Return to Athletics
Coming soon!
Resources planned: Return to sport recommendations, Core exercise circuits, and more!
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