As discussed previously (here and here) low back pain is a serious and costly injury. In the event of a lumbar disc herniation, it can lead to serious disability. Our technology to rehabilitate, manage and surgically reconfigure the involved structures is getting better and people are leading not only longer but much fuller lives.
A disc herniation occurs when the intervertebral disc suffers a tear in the annulus letting the soft jelly-like nucleus pulpous leak out into the spinal canal. This generally leads to inflammation around the spinal nerves at or near that level, loss of spinal height, loss of joint mobility and active range of motion among other deficiencies. Patients with such a condition rarely undergo surgery and the condition is generally managed with exercise and manual therapy. In some cases of more extensive damage, surgery is used to repair the disc.
Hsu et al 2011 followed 342 cases of professional athletes from various sports who suffered a lumbar disc herniation over a 36 year period. Only those with at least 2 years of follow-up were included. 226 underwent surgery while 116 were treated non-surgically. Keep in mind these athletes are required to perform at levels most of the general populous will never achieve and thus they are more likely to require the surgery.
82% of athletes returned to play after diagnosis. Interestingly, 81% of those after surgery returned to play. This demonstrates that in cases of pro-sport, surgery is not inherently more risky than manual therapy as both had nearly identical return to play results. Average play time after the injury was 3.4 years with the surgical population playing 3.3 years- again, a negligible difference.
It was found, not surprisingly, that younger athletes returned to play more quickly and had longer post-injury careers. It should be noted that more experienced players (those with more games) also played longer after the injury than those with less experience. While this does not necessarily mean the older athlete, it does not preclude them altogether.
Clearly, while complex and rather difficult to deal with disc herniations are not the end of one’s sports life. With proper management, one can continue to practice sports and athletics at a very high level at the pace of pro-athlete for years.
A review of the studies we cited for warm-ups decreasing injury may also be worthwhile as many have demonstrated decreased back injuries when in use compared to no warm up.