eMedicine Specialties > Sports Medicine > Spine

Thoracic Discogenic Pain Syndrome: Follow-up

Author: Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Coauthor(s): James P McLean, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Irfan Alladin, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey; Qing Tai, MD, PhD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey; Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Rachael Smith, DO, Consulting Staff, Mid-Atlantic Pain Institute, PC
Contributor Information and Disclosures

Updated: Jan 8, 2009

Follow-up

Return to Play

Return-to-play criteria following thoracic disc herniation or thoracic discogenic pain syndrome require the athlete to be free of signs or symptoms due to the original injury, to have full range of motion, to have normal strength and flexibility, and to have healthy sport-specific mechanics. Athletes must be aware of their own limitations, a concept that is particularly important for individuals gradually returning to a competitive level of activity after an injury.

Prevention

Trauma and strain due to sport-related injuries or other causes is implicated in only 20% of patients with thoracic disc herniations. In many of these cases, a twisting or torsional movement is involved. Minimizing forces on the spine through the use of 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 is also important.

Maintaining proper flexibility plays a significant role in the prevention of injury in athletes of all ages. Additionally, an improvement in aerobic fitness can increase blood flow and oxygenation to all tissues, including the muscles, bones, and ligaments of the spine. Aerobic conditioning is a reasonable addition to any rehabilitation and prevention program.

Prognosis

The progression of symptoms in patients with thoracic disc herniation varies considerably. When seen in younger patients, traumatic disc herniations may later cause myelopathy. In middle-aged persons, in whom degenerative disc herniation is more common, the course of symptoms involving spinal cord compression is often more protracted.

In patients who present with unilateral symptoms, the progression of symptoms is often slower than that of patients who have a bilateral presentation. In any case, a patient without evidence of myelopathy should receive conservative treatment. A return to previous activity level occurs in approximately 80% of patients treated with nonsurgical measures. Patients with intractable pain, progressive neurologic deficits, or bilateral involvement often require surgical intervention.

Education

See Prevention.

 


More on Thoracic Discogenic Pain Syndrome

Overview: Thoracic Discogenic Pain Syndrome
Differential Diagnoses & Workup: Thoracic Discogenic Pain Syndrome
Treatment & Medication: Thoracic Discogenic Pain Syndrome
Follow-up: Thoracic Discogenic Pain Syndrome
Multimedia: Thoracic Discogenic Pain Syndrome
References
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Further Reading

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Keywords

thoracic discogenic pain syndrome, thoracic disc herniation, thoracic disk herniation, thoracic degenerative disc disease, thoracic degenerative disk disease, TDH, back pain, mid back pain, midback pain, TDPS, TDP syndrome, thoracic pain, thoracic disc injuries

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Contributor Information and Disclosures

Author

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

James P McLean, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
Disclosure: Nothing to disclose.

Irfan Alladin, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry at New Jersey
Irfan Alladin, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Qing Tai, MD, PhD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey
Qing Tai, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Paraplegia Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Stephen G Andrus, MD, Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
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 of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Rachael Smith, DO, Consulting Staff, Mid-Atlantic Pain Institute, PC
Rachael Smith, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, 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, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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