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Lumbar Disk Problems in the Athlete Treatment & Management

  • Author: Luis E Palacio, MD; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Nov 10, 2014

Acute Phase

Rehabilitation Program

Physical Therapy

Patients should avoid prolonged bed rest to prevent joint stiffness, muscle wasting, bone mineral loss, pressure sores, and deep venous thrombosis. Two days or less of relative rest may be prescribed initially.

Cooke and Lutz described a staged approach to LBP as the following[13] :

  • Stage I involves early, protected mobilization with brief rest (48-72 h). Medications and therapeutic modalities including heat, ice, nonsteroidal anti-inflammatory drugs [NSAIDs], soft-tissue mobilization, and epidural injection are considered.
  • Stage II involves dynamic spinal stabilization exercises with co-contraction of the abdominal and lumbar extensors to stabilize the injured segment. Isometric exercises (muscle contraction without changing its length) retrain muscles to maintain a neutral postural position.
  • Stage III involves exercises to strengthen lumbar musculature beginning with extension exercises and progressing to flexion exercises. Flexion exercises are delayed due to their increased load on the disc.
  • Stage IV involves sports-specific exercises and plyometrics such as eccentric strengthening (resisted stretching of the muscle), followed by an explosive concentric contraction.
  • Stage V involves maintenance exercises (home program) to prevent recurrence.

Surgical Intervention

Types of Surgical Intervention

Discectomy  has been recommended for athletes with LBP because there is less anatomic disruption during the procedure, although some investigators argue that athletes have worse outcomes than the general population.[11] These less-favorable outcomes are believed to be secondary to return to play before complete recovery has occurred. In one large case series, pediatric patients made up 0.4% of patients that underwent discectomy.[5]

Percutaneous lumbar disc decompression is indicated in patients with LBP that is associated with radicular symptoms down a lower extremity. Patients should undergo provocative discography examination before surgery.

Criteria for spinal fusion include multiple recurrences of lumbar disc problems or vertebral instability, and at least 4-6 months of symptoms with failed nonoperative therapy. The patient's pain should correlate with imaging studies (MRI). Midline spinal tenderness should correspond to the level of disease.

Randomized, controlled clinical trials have not shown significant long-term benefit with spinal fusion relative to aggressive physical and cognitive rehabilitation protocols.[4] A disadvantage of spinal fusion includes loss of motion at the fused segment that leads to increased stress to the adjacent disc levels, which places the adjacent discs at risk of injury and degenerative changes.

Lumbar total disc replacement has been used in patients with purely discogenic symptoms secondary to DDD. There are, however, many contraindications and possible complications limiting the use of total disc replacement.

A study of outcomes of 87 National Hockey League (NHL) athletes who underwent either nonsurgical treatment (31), discectomy (48), or a single-level fusion (8) for the treatment of lumbar disk herniation found similar high rates for return to play (85%) in all treatment groups. For all players, regardless of treatment, there was a significant decrease in games played per season, points scored per game, and performance score. However, performance measures were not significantly different among the groups. The study data suggest that a lumbar fusion is compatible with a return to play in the NHL, which is in contrast to other professional sports, but this may be due to the small sample size.[14]


Consultations with specialists in primary care sports medicine, orthopedic surgery, neurosurgery, neurology, or physiatry should be sought as indicated.


Recovery Phase

Rehabilitation Program

Physical Therapy

  • Goals for physical therapy include pain reduction, reinforcement of a comfortable body position, core strengthening, and stabilization of the spine.
  • Tight musculature, including the hamstrings, hip flexors/rotators/extensors, and abdominals, should be stretched.
  • A home program should be tailored for performance on a lifelong basis.

Lifestyle modifications

  • Exercise is not beneficial for the acute symptoms of LBP, but it is beneficial for chronic LBP sufferers. Increased activity reduces pain as well as improves functional status.
  • Tobacco cessation improves outcomes for LBP.
  • Weight loss in overweight patients

Medical Issues/Complications

If a patient continues to have pain in the back, buttock(s), and back of the thigh(s) without pain below the knee (true sciatica causes pain below the knee), then the diagnosis can be confusing in cases in which a disc herniation is present on MRI. A large percentage of patients have disk abnormalities on MRI without symptoms.

Surgical Intervention

Considerations for surgical referral include the following:

  • Leg pain greater than back pain
  • Cauda equina syndrome
  • Progressive or profound neurologic deficit
  • Severe and disabling pain that is refractory to nonoperative treatment
  • Herniated disc (at least 4-6 wk)
  • Spinal stenosis (at least 8-12 wk)
  • Confirmation of the lesion on imaging studies

There are no data that prove surgical intervention restores neurologic deficit(s) more rapidly than natural history or nonoperative care.

Surgical complications  include the following :

  • Infection
  • Bleeding
  • Nerve damage
  • Worsened pain
  • Recurrence of herniation
  • Paralysis
  • Idiosyncratic reaction
  • Anaphylaxis
  • Death


Surgical consultation is indicated in the presence of any red flags (see History).

Referral for epidural spine injection or EMG should also be considered, if indicated.

Primary care sports medicine, neurosurgery, orthopedic surgery, neurology, and physiatry are specialties that have expert clinicians who often treat lumbar disc problems.

Other Treatment (Injection, manipulation, etc.)

Steroids may be injected into the epidural space of the spinal canal if the patient's sciatica persists even with bracing. Bracing may take as long as 4 months to be successful.


Maintenance Phase

Rehabilitation Program

Physical Therapy

During the maintenance phase, the performance of exercise stimulates tissue growth, slows or possibly reverses degenerative conditions, and enhances nutrition to the disc. Increasing the strength and endurance in the major muscle groups (eg, quadriceps, hamstrings, hip, and abdominal muscles) is important. Spine flexibility has not been shown to reduce the risk of future injury. Hip flexibility and abdominal strength exercises, however, has been demonstrated to be important, as well as hip ROM stretching and strengthening activities and hamstring and quadriceps stretching and strengthening activities.

Muscle contraction with the spine in neutral position is the most successful exercise program. Sport-specific exercises may now be integrated, and lifelong activity and lifestyle modification should be maintained.

Other Treatment

See the list below:

  • Intradiscal electrothermal therapy (IDET)  – There have been anecdotal reports of high failure rates with IDET in athletes. [5] A randomized, double-blind control trial reported that IDET is a relatively safe procedure, but patients rarely experienced improvement and did not experience better results when compared to sham treatment. [15]
  • Transcutaneous electrical nerve stimulation (TENS)  is not effective for chronic LBP. [5] Limited evidence supports the use of TENS, but this is a safe modality and could be utilized in the acute phase of LBP.
  • Acupuncture lacks controlled randomized studies to prove its efficacy. This therapy is generally safe, but it is not routinely recommended.
  • Conflicting evidence exists regarding spinal manipulation , [5] which is not routinely recommended, but it is generally a safe modality.
  • Prolotherapy  attempts to treat pain through injection of irritant solutions. This therapy is not recommended for the treatment of disc herniation, and there are limited long-term safety data. [8]
  • Back school has been used for patients with chronic LBP and marked functional impairment. There is a question of whether or not back school is a cost-effective option.
  • Intradiscal methylene blue injection  has been studied and reported to be effective in a prospective clinical trial by Peng et al. [6] Methylene blue has a neurotropic effect that results in blocking nerve conduction and destruction of nerve endings. These neurologic changes result in pain relief when the patient's pain is discogenic in nature.
Contributor Information and Disclosures

Luis E Palacio, MD Director of Primary Care Sports Medicine, Northern Nevada Medical Group

Luis E Palacio, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.


Annie Collier, MD Staff Physician, Department of Emergency Medicine, Lincoln Medical Center, Cornell University School of Medicine

Annie Collier, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Jeffrey W R Dassel, MD Associate Director, Sports Medicine and Faculty, Department of Family and Community Medicine, Christiana Care Health System

Jeffrey W R Dassel, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Medical Society for Sports Medicine, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


John Munyak, MD Associate Program Director, Director of Sports Medicine Education, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Disclosure: Nothing to disclose.

  1. McCormack RG, McLean N, Dasilva J, Fisher CG, Dvorak MF. Thoraco-lumbar flexion-distraction injury in a competitive gymnast: a case report. Clin J Sport Med. 2006 Jul. 16(4):369-71. [Medline].

  2. Ong A, Anderson J, Roche J. A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. Br J Sports Med. 2003 Jun. 37(3):263-6. [Medline].

  3. Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007 Apr 15. 75(8):1181-8. [Medline]. [Full Text].

  4. Smeal WL, Tyburski M, Alleva J, Prather H, Hunt D. Conservative management of low back pain, part I. Discogenic/radicular pain. Dis Mon. 2004 Dec. 50(12):636-69. [Medline].

  5. Baker RJ, Patel D. Lower back pain in the athlete: common conditions and treatment. Prim Care. 2005 Mar. 32(1):201-29. [Medline].

  6. Peng B, Zhang Y, Hou S, Wu W, Fu X. Intradiscal methylene blue injection for the treatment of chronic discogenic low back pain. Eur Spine J. 2007 Jan. 16(1):33-8. Epub 2006 Feb 22. [Medline].

  7. Kraft DE. Low back pain in the adolescent athlete. Pediatr Clin North Am. 2002 Jun. 49(3):643-53. [Medline].

  8. Harwood MI, Smith BJ. Low back pain: a primary care approach. Clin Fam Pract. 2005. 7(2):279-303.

  9. Baker RJ, Patel D. Lower back pain in the athlete: common conditions and treatment. Prim Care. 2005 Mar. 32(1):201-29. [Medline]. [Full Text].

  10. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan. 14(1):180-91. [Medline].

  11. Eck JC, Riley LH 3rd. Return to play after lumbar spine conditions and surgeries. Clin Sports Med. 2004 Jul. 23(3):367-79, viii. [Medline].

  12. Krych AJ, Richman D, Drakos M, et al. Epidural steroid injection for lumbar disc herniation in NFL athletes. Med Sci Sports Exerc. 2012 Feb. 44(2):193-8. [Medline].

  13. Cooke PM, Lutz GE. Internal disc disruption and axial back pain in the athlete. Phys Med Rehabil Clin N Am. 2000 Nov. 11(4):837-65. [Medline].

  14. Schroeder GD, McCarthy KJ, Micev AJ, Terry MA, Hsu WK. Performance-based outcomes after nonoperative treatment, discectomy, and/or fusion for a lumbar disc herniation in National Hockey League athletes. Am J Sports Med. 2013 Nov. 41(11):2604-8. [Medline].

  15. Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC. A randomized, double-blind, controlled trial: intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine. 2005 Nov 1. 30(21):2369-77; discussion 2378. [Medline].

  16. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998 Oct 8. 339(15):1021-9. [Medline].

  17. Day AL, Friedman WA, Indelicato PA. Observations on the treatment of lumbar disk disease in college football players. Am J Sports Med. 1987 Jan-Feb. 15(1):72-5. [Medline].

  18. Deyo RA, Loeser JD, Bigos SJ. Herniated lumbar intervertebral disk. Ann Intern Med. 1990 Apr 15. 112(8):598-603. [Medline].

  19. Dreisinger TE, Nelson B. Management of back pain in athletes. Sports Med. 1996 Apr. 21(4):313-20. [Medline].

  20. Earhart JS, Roberts D, Roc G, Gryzlo S, Hsu W. Effects of lumbar disk herniation on the careers of professional baseball players. Orthopedics. January 2012. 35(1):43-9. [Medline].

  21. Faas A. Exercises: which ones are worth trying, for which patients, and when? Presented at: The International Forum for Primary Care Research on Low Back Pain; October 12-14, 1995; Seattle, Wash.

  22. Franklin BA. Low back exercises. Roitman JL, Kelsey M, eds. American College of Sports Medicine's (ACSM's) Guidelines for Exercise Testing and Prescription. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1998. 116-25.

  23. Gerbino PG 2nd, Micheli LJ. Back injuries in the young athlete. Clin Sports Med. 1995 Jul. 14(3):571-90. [Medline].

  24. Kahanovitz N. Surgical disc excision. Clin Sports Med. 1993 Jul. 12(3):579-85. [Medline].

  25. Kraft DE. Low back pain in the adolescent athlete. Pediatr Clin North Am. 2002 Jun. 49(3):643-53. [Medline].

  26. Montgomery S, Haak M. Management of lumbar injuries in athletes. Sports Med. 1999 Feb. 27(2):135-41. [Medline].

  27. Regan JJ. Clinical results of charité lumbar total disc replacement. Orthop Clin North Am. 2005 Jul. 36(3):323-40. [Medline].

  28. Schenck RC Jr, ed. Athletic Training and Sports Medicine. 3rd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999. 389-90.

  29. Singh V. Percutaneous disc decompression for the treatment of chronic atypical cervical discogenic pain. Pain Physician. 2004 Jan. 7(1):115-8. [Medline]. [Full Text].

  30. Stinson JT. Spine problems in the athlete. Md Med J. 1996 Aug. 45(8):655-8. [Medline].

  31. Tall RL, DeVault W. Spinal injury in sport: epidemiologic considerations. Clin Sports Med. 1993 Jul. 12(3):441-8. [Medline].

  32. Wang JC, Shapiro MS, Hatch JD, et al. The outcome of lumbar discectomy in elite athletes. Spine. 1999 Mar 15. 24(6):570-3. [Medline].

  33. Watkins RG. Lumbar disc injury in the athlete. Clin Sports Med. 2002 Jan. 21(1):147-65, viii. [Medline].

  34. Windsor RE. Lumbosacral discogenic pain syndrome. Medscape Reference. [Full Text].

  35. Young JL, Press JM, Herring SA. The disc at risk in athletes: perspectives on operative and nonoperative care. Med Sci Sports Exerc. 1997 Jul. 29(7 suppl):S222-32. [Medline].

Radiograph of the lumbar spine. This image demonstrates L5-S1 disk space narrowing (the most common location).
Magnetic resonance image of the lumbar spine. This image demonstrates a herniated nucleus pulposus at multiple levels.
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