EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT):
In the case of a minor condition, even if priority is given to active rehabilitation, combining it with shockwave therapy can quickly improve pain and function. All of this has been validated by numerous analyses and meta-analyses (Walewicz et al 2020). 23
Neuromuscular Electrostimulation (NMES) NMES can be used to facilitate awareness and strengthening of deep muscles (transverse abdominis, etc.) that are often hypoactive in patients with spinal disorders. 24 The use of biofeedback is very useful.
Rehabilitation Mobility exercises focus on flexibility of the pelvis and hips (stretching the hip flexors, hamstrings, and psoas) and mobility of the spine to restore proper kinematics.
Core strengthening (plank, bird-dog) is the fundamental exercise for preventing recurrence of skiers’ low back pain, as it stabilises the trunk against the stresses of the terrain. However, for professional athletes, it is essential to work on strengthening in the ski position. This involves positions that are harmful to the spine but essential for practicing this sport (Spörri et al 2019). 25
Therapy
Specific Role in Spinal Treatment
Clinical Benefit
Photobiomodulation (PBM)
Immediate pain relief, reduction of muscle spasms and inflammation.
Facilitates patient engagement in strengthening exercises. Helps reduce dependence on anti- inflammatory drugs.
ESWT (Shock Waves)
Generally not a priority, except in cases of very specific myofascial trigger points.
Targets chronic contractures that do not re-spond to other treatments.
NMES
Facilitates awareness and strengthening of deep muscles.
Combats hypoactivity of stabilisers to prevent recurrence.
Rehabilitation
Basic core strengthening (plank, bird-dog) to stabilise the trunk. Work on flexibility of the pelvis and hips
Restores proper kinematics. It is essential for professionals to work on strengthening in the skiing position.
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