It’s no surprise that athletes are highly susceptible to injuries, but more commonly we think of sprains and strains as the culprit. If the ice/heat treatment doesn’t seem to be working, your lower back pain could be the result of something more serious.
Within the general population, disc herniations are most common among older individuals. Within the athletic population, however, it is not uncommon for disc herniations to occur in adolescents, although relatively rare. In many instances, symptoms related to a lumbar disc herniation begin during weight training or during a pivot or turning movement; in others, the onset is more insidious and is likely due to the accumulation of multiple smaller or minor injuries. Athletes exposed to sports that require heavy lifting in competition or training, collision sports, and bowling may have higher rates of lumbar disc herniations.
Lumbar disc herniations may present more subtly with only back pain and spasms, though athletes may also experience tingling or numbness in the arms and/or legs.
Physical examination of adolescents or teenagers is important in diagnosing a disc herniation. This can be accomplished by reviewing symptoms and an MRI study that reveals the anatomy of the disc and its relation to the nerves.
Treatment decisions are more complicated in the elite athlete, because the pressure to return to play is pitted against the well-known success rates of conservatively managed lumbar disc herniations. As in all patients, absolute indications for surgery in the athlete with lumbar disc herniation include severe pain and progressive nerve damage; relative indications include continued pain and inability to compete in athletic competition. This last scenario merits particular consideration; the threshold for surgical intervention in the elite athlete is lower if lumbar disc herniation is a barrier to competition. If pain is considerable and there are inadequate conservative options to allow the athlete a return to performance in a timely fashion acceptable to all parties involved, surgery may be considered.
The rehabilitation program is a critical determinant to how soon the athlete can return to play, and is guided in part by the timing of the injury in relation to the athletic calendar. As always, the safety of the athlete is paramount: his or her athletic longevity and the capabilities that the player will have after his or her athletic career is ended should always be considered. A recovery program may differ if the injury is sustained at the end of a season rather than midway through. Aggressive core strengthening and increased flexibility and range of motion form the basis of most programs. Athletes may return to play after a sufficient time for healing and recovery, when symptoms are minimal or absent. This decision is made jointly by the athlete and healthcare professionals. It is preferable that the athlete follow the standard course of rehabilitation after surgery, and that top-level competition only be resumed when all postoperative symptoms subside and range of motion has returned so that the chance for further injury is minimized. In rare cases involving highly motivated athletes who will follow an aggressive rehabilitation program, these individuals may return to play as soon as 3 weeks post surgery.