Disc herniation is found to be more prevalent in athletes than non-athletes due to the unnatural dynamic loading, lateral bending, and shear and compressive forces on the spine athletes undergo during exercise. (1, 2) These spinal injuries can significantly reduce an athlete’s career time by causing them to miss practices and game time because of neck and back pain. (3) However, disc herniation can also be asymptomatic as 27% of general patients have asymptomatic disc bulges, and this rate can be higher in athletes. (3) With asymptomatic athletes, they still can have radiographically visible changes to the spinal disks. (6) The treatment options for disc injuries also vary among athletes. Conservative, non-surgical treatment is effective for some athletes, while surgical intervention such as a discectomy, the surgical removal of an abnormal disc, is more effective for others. (9) The prevalence of disc herniation and clinical outcomes post-treatment varies among types of sport and individual athletes. (4,8,10)
The risk of disc herniation during sports can depend on the type of sport and position played. For example, American football is a popular sport where lumbar spine injuries are common. Disc herniations account for 28% of lumbar spine injuries in football athletes. (4) Because offensive and defensive linemen are known to sustain more injuries than other players, and these linemen are most often tackling and blocking, tackling and blocking are suspected to be the mechanisms of their spinal injury. (5) Studies have also found radiographic changes in the lumbar spines of former elite track and field athletes. One study looked at 159 males who were former track and field athletes to measure the heights of their lumbar discs, disk concavity index, and the presence of vertebral osteophytes (bone spurs that grow at the edge of a bone, causing pain, stiffness, and reduced range of motion (7)). The highest prevalence of radiographic changes was found in throwers, who had increased height of lumbar discs and a higher prevalence of osteophytes in the lumbar spine. (6) These studies’ results show how certain kinds of sports can lead to radiographic changes in athletes’ spines, and they also show how even within a sport, the type of position played and movements performed are factors affecting the risk of injury.
The athletic outcomes post-treatment for herniated discs can depend on the type of treatment undergone and the type of sport played. The effectiveness of different treatment methods for herniated discs in athletes can vary. In one study, 100 athletes (median age 23) in various sports like rowing, baseball, basketball, and rugby with symptomatic lumbar disc herniation were evaluated on their ability to return to play with conservative, nonsurgical treatment. Seventy-nine percent returned to play at an average of 4.8 months, and they were able to sustain the athletic activities until at least a 6-month follow up check. This study indicates that the average time of return to play for athletes who have undergone conservative, nonsurgical treatment is relatively brief. (8) However, in a different study, a group of National Football League (NFL) athletes were studied to determine the performance-based outcomes after a discectomy for a lumbar disc herniation. Ninety-six NFL players underwent surgical treatment and 34 underwent non-surgical treatment. It was shown that the surgically-treated players statistically played in more games post-treatment (36 games on average) while the non-surgically treated athletes played in fewer games (20 games on average). This study concluded that it was the rigorous rehabilitation following surgical treatment that allowed the football players who went through discectomy to have better performance outcomes than players who went through conservative treatment for lumbar disc herniation. (9) Comparing these kinds of treatments further, another group study evaluated the return to playtime and performance in the major American sports leagues such as football and baseball. Two hundred twenty-six patients underwent surgery for lumbar disc herniation, and 184 (81%) successfully returned to play for an average of 3.3 years post-surgery. NFL players took a shorter time to return to play and showed a positive treatment effect. Conversely, MLB players who underwent discectomy showed not only a longer time to return to play but also a statistically significant decrease in career length compared to the non-operative group. This study showed that clinical outcomes of lumbar discectomy differ significantly within sports because of the sports’ different physical demands. (10)
The prevalence of herniated disc injuries in athletes is dependent on many factors such as type of sport and position played. The clinical outcomes after a treatment also differ based on treatment methods and type of sport. The studies presented show that the need for individualized therapy is important because each sport and position will require different physical demands, making the athletes more or less susceptible to disc herniation and other spinal injuries. The rehabilitation process is an important factor in a player’s ability to perform well post-treatment. (4) Esurgi’s Biostabilizer is a digital device that measures the effectiveness of physical therapy exercises. It can deliver automated feedback to ensure correct core engagement will support increased spinal stabilization. Using a biofeedback device that provides real-time feedback can be beneficial to treating individual athletes uniquely as it boosts individuals’ awareness of their body and eliminates time spent on ineffective therapy sessions.
How would using the Biostabilizer be useful for treating athletes with spinal injuries in your practice?
- Ong A, Anderson J, Roche JA pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic GamesBritish Journal of Sports Medicine 2003;37:263-266.
- Minhas, S. V., Kester, B. S., & Hsu, W. K. (2016). Outcomes After Lumbar Disc Herniation in the National Basketball Association. Sports health, 8(1), 43–49. https://doi.org/10.1177/1941738115608361
- Yamaguchi, J. T., & Hsu, W. K. (2018). Intervertebral disc herniation in elite athletes. International Orthopaedics, 43, 833-840. doi:https://doi.org/10.1007/s00264-018-4261-8
- Ball, J. R., Harris, C. B., Lee, J., & Vives, M. J. (2019). Lumbar Spine Injuries in Sports Review of the Literature and Current Treatment Recommendations. Sports Medicine – Open, 5(1). doi:10.1186/s40798-019-0199-7
- Mall, N. A., Buchowski, J., Zebala, L., Brophy, R. H., Wright, R. W., & Matava, M. J. (2012). Spine and axial skeleton injuries in the National Football League. The American journal of sports medicine, 40(8), 1755–1761. https://doi.org/10.1177/0363546512448355
- Schmitt, H., Dubljanin, E., Schneider, S., & Schiltenwolf, M. (2004). Radiographic changes in the lumbar spine in former elite athletes. Spine, 29(22), 2554–2559. https://doi.org/10.1097/01.brs.0000145606.68189.69
- Bone Spurs: Causes, Symptoms, Diagnosis & Treatment. (2017). Retrieved November 17, 2020, from https://my.clevelandclinic.org/health/diseases/10395-bone-spurs
- Iwamoto, J., Sato, Y., Takeda, T., & Matsumoto, H. (2011). Return to play after conservative treatment in athletes with symptomatic lumbar disc herniation: a practice-based observational study. Open access journal of sports medicine, 2, 25–31. https://doi.org/10.2147/OAJSM.S17523
- Hsu W. K. (2010). Performance-based outcomes following lumbar discectomy in professional athletes in the National Football League. Spine, 35(12), 1247–1251. https://doi.org/10.1097/BRS.0b013e3181bf8bb5
- Hsu, W. K., MD, McCarthy, K. J., MD, Savage, J. W., MD, Terry, M. A., MD, Gryzlo, S. M., MD, & Schafer, M. F., MD. (2011). The Professional Athlete Spine Initiative: Outcomes after lumbar disc herniation in 342 elite professional athletes [Abstract]. The Spine Journal, 11(3), 180-186. doi:https://doi.org/10.1016/j.spinee.2010.12.009