eMedicine Specialties > Sports Medicine > Spine

Degenerative Lumbar Disc Disease in the Mature Athlete: Follow-up

Author: Gerard A Malanga, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey, New Jersey Medical School; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Mountainside Hospital
Coauthor(s): Michal E Eisenberg, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, UMDNJ
Contributor Information and Disclosures

Updated: Apr 6, 2006

Follow-up

Return to Play

Criteria for return to play require the mature athlete to have an absence of signs or symptoms of the original injury (especially if there were radicular symptoms) full ROM, strength and flexibility to within normal limits, and good sport-specific mechanics. Mature athletes must be aware of their own limitations; this awareness is particularly important for the individual gradually returning to a competitive level of activity after injury.

Prevention

Patient education is an important factor in the prevention of low back injury in the mature athlete. Minimizing forces on the spine through proper mechanics in specific sporting activities is important. Additionally, strengthening the dynamic stabilizers of the spine to counteract the significant forces exerted on the spine during certain athletic activities also is important.

Maintaining proper flexibility also is believed to play a significant role in the prevention of back injury in athletes of all ages. Additionally, improvement in aerobic fitness can increase blood flow and oxygenation to all tissues, including the muscles, bones, and ligaments of the spine, and it would be a reasonable addition to any rehabilitation and prevention program. Seasonal athletes should be encouraged to cross-train year round or at least undergo preconditioning before participating in their particular sport.

Education

For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center; Breaks, Fractures, and Dislocations Center; and Sports Injury Center. Also, see eMedicine's patient education articles Back Pain and Vertebral Compression Fracture.

Miscellaneous

Medicolegal Pitfalls

  • One of the questions that a physician must address is the determination of causality between a specific incident or injury and a patient's symptoms. Causality is one of the key components for determining disability and for proceeding with potential legal actions. When there is loss of limb due to an accident, there is little question about causality. However, since LBP is a ubiquitous condition, it is inherently more difficult to clearly link lower back complaints to a specific incident or injury. This is especially true given that the literature documents high numbers of radiologic abnormalities in the lumbar spine in asymptomatic adults. Also, patients seeking compensation for an injury often deny the presence of preexisting symptoms. Fegan et al in a study of 175 subjects found that individuals who sustain a back injury often do not recall that they suffered low back symptoms prior to their injury. These findings may be of medical/legal importance in cases in which compensation is being sought.

Special Concerns

  • LBP in the mature individual has a wider range of possible causes than in younger patients. Malignancy, aortic aneurysm, osteoporosis with compression fracture, Paget disease, and polymyalgia rheumatism all occur almost exclusively in persons older than 50 years. Red flags that may indicate a more serious medical condition need to be identified and properly diagnosed.
    • Red flags for possible spinal compression fracture include major trauma (eg, a fall, motor vehicle accident) or minor trauma or strenuous lifting in patients with osteoporosis.
    • Red flags for tumor or infection include age older than 50 years (or <20 y), history of cancer, constitutional symptoms (eg, fever, chills, unexplained weight loss), and risk factors for spinal infection (eg, recent bacterial infection or immune suppression).
    • All patients presenting with red flags need to be properly evaluated for their symptoms and need to have appropriate workup performed in order to rule in or rule out occult pathology and to avoid potential liability.
  • Physicians who treat patients with LBP must be alert to the rare but potentially life-threatening causes of back pain and the potential legal liability for failing to diagnose these conditions in a timely manner.
 


More on Degenerative Lumbar Disc Disease in the Mature Athlete

Overview: Degenerative Lumbar Disc Disease in the Mature Athlete
Differential Diagnoses & Workup: Degenerative Lumbar Disc Disease in the Mature Athlete
Treatment & Medication: Degenerative Lumbar Disc Disease in the Mature Athlete
Follow-up: Degenerative Lumbar Disc Disease in the Mature Athlete
Multimedia: Degenerative Lumbar Disc Disease in the Mature Athlete
References
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Further Reading

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Keywords

lumbar disc syndrome, intervertebral disc displacement, discogenic low back pain, LBP, degenerative disk disease, DDD, herniated disc, spinal stenosis

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Contributor Information and Disclosures

Author

Gerard A Malanga, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey, New Jersey Medical School; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Mountainside Hospital
Gerard A Malanga, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association for Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Michal E Eisenberg, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Disclosure: Nothing to disclose.

Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, UMDNJ
Stephen G Andrus, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, and Physiatric Association for Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise & Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, North American Primary Care Research Group, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marlene DeMaio, MD, Consulting Staff, Assistant Professor, Department of Orthopedic Surgery, Bone & Joint/Sports Medicine Institute, Naval Medical Center
Marlene DeMaio, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Foot and Ankle Society, and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates
Disclosure: Nothing to disclose.

Chief Editor

William Jay Bryan, MD, Clinical Professor, Department of Orthopedic Surgery, Baylor University College of Medicine
William Jay Bryan, MD is a member of the following medical societies: Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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