Among the young college athletes and professional athletes alike, low back pain is considered to be one of the most common complaints, estimated to affect more than 30 percent of athletes at least once in their career. A wide number of back injuries can affect the athlete, including muscle spasms and stress fractures, spondylosis, spondylolisthesis, disc degeneration, facet joint arthropathy and disc issues, such as lumbar disc herniation.
Lumbar disc herniation is a well-known type of injury which often causes impairing low back pain, however, it can also compress the nerve roots in the area and generate radicular pain and other symptoms along the lower extremities, such as altered sensations and muscle weakness. Furthermore, this type of injury will not only affect the athlete’s ability to perform during their specific sport or physical activity, it may also become chronic and affect the athlete in the future.
Conservative treatments are frequently utilized when managing lumbar disc herniation in athletes, although surgical options may be considered if the injury is too severe. Many elite athletes often request faster recovery methods for their type of injuries and symptoms in order to minimize their time spent away from training and competition. As a result, a wide number of athletes will seek surgical alternatives earlier than recommended, provided they meet the criteria for lumbar spine surgery. The most popular surgical procedure for athletes with a low back disc herniation is the lumbar disc microdiscectomy.
Anatomy & Biomechanics of the Lumbar Spine
The intervertebral discs of the lumbar spine perform an essential biomechanical role within the spine. These function to provide mobility between the segments of the spine while distributing compressive, shear and torsional forces. These discs are made up of a thick, outer ring of fibrous cartilage, known as the annulus fibrosis, which surround the gelatinous core of the disc, known as the nucleus pulposus, which is contained within the cartilage end plates.
Each intervertebral disc consists of cells and substances, such as collagen, proteoglycans and scattered fibrochondrocytic cells, which function to absorb and conduct increased forces from body weight and muscle activity. In order to effectively perform its function, the disc depends immensely on the structural condition of the annulus fibrosis, nucleus pulposus and the vertebral end plate. If the disc is healthy, it will evenly spread the forces being applied against the spine. However, disc degeneration caused by cell degradation, loss of hydration or disc collapse, can decrease the disc’s ability to withstand external forces and these will no longer be absorbed and conducted evenly across the spinal structures.
Tears in the annulus fibrosis of the disc along with extrinsic loads may ultimately cause the disc to herniate. Alternatively, applying a large, biomechanical force against a normal disc, such as a heavy compression on the spine due to a fall on the tailbone or strong muscle contraction from heavy weight lifting, can also damage the healthy structures of the disc and cause a rupture.
Disc herniation is characterized when the nucleus pulposus, the soft, jelly-like material in the center of a disc, pushes through a tear in the annulus fibrosis, the fibrous exterior of the disc. If the protrusion does not compress the nerve roots that travel along the spine, the individual may only experience back pain. But, if the herniated disc pushes against the lumbar nerve roots or other structures within the lower back, the individual may experience radicular pain along with neurological symptoms, such as numbness and paresthesia.
The pain and other symptoms associated with lumbar radiculopathy occurs due to a combination of nerve root ischemia from compression and due to inflammation caused by the chemicals released from a ruptured disc. During a herniation, the nucleus pulposus places unnecessary pressure against the weakened areas of the annulus, protruding through these weakened sites in the outer structure of the disc, ultimately forming a herniation. It’s important to note that when a lumbar disc herniation occurs, in a majority of cases, some form of disc degeneration may have existed before.
The Process of Lumbar Disc Herniation
Unlike other musculoskeletal tissues of the body, intervertebral discs generally degenerate sooner than other structures. Some studies have shown adolescents between the ages of 11 to 16 with signs of degeneration. As people age, the discs will naturally degenerate further. In a research study conducted using normal, healthy subjects between the ages of 21 to 30, more than one third of the individuals presented degenerated discs.
While the spinal discs may be at risk of injury in practically all fundamental planes of motion, these are often more susceptible to damage or injury during constant and repetitive flexion or hyperflexion along with lateral bending or rotation. Trauma from an injury caused by an excessive axial compression can also harm the internal structure of the discs. This can commonly result after the individual has suffered a fall or due to strong muscular forces being placed against the spine during specific activities, such as heavy weight lifting.
When it comes to athletes, they are frequently exposed to conditions of higher loading. A herniated disc can be categorized according to its location: central, posterolateral, foraminal or far lateral. Herniation varieties can also be classified as: protrusion, extrusion or sequestered fragment. Finally, disc herniation may be identified according to the level where they occurred on the spine. Most develop along the lumbar spine, often affecting the lumbar nerve roots which may lead to symptoms of sciatica. Upper lever herniated discs are rare, but when they do occur along with radiculopathy, they generally affect the femoral nerve.
Disc Herniation in Athletes
Athletes who participate in sports or physical activities which utilized combined trunk flexion and rotation have an increased chance of experiencing herniated discs. Individuals between 20 to 35 years of age are the most common group to herniate a disc, most likely as a result of the nature of the nucleus pulposis and due to behavior. This age group is most likely to be involved in sports which require higher loads of flexion and rotation or they may practice improper postures and positions when carrying weight.
The sports most at risk of disc herniation include: hockey, wrestling, football, swimming, basketball, golf, tennis, weight lifting, rowing and throwing activities, because these sports involve either high loads or high exposure to combined flexion and rotation mechanisms. Additionally, athletes who engage in more intense, continuous training routines appear to be at an increased risk of developing spinal injuries or conditions, similar to those involved in impact sports.
Signs and Symptoms Indicating Discectomy
An athlete is generally driven by motivation and goals when they choose to undergo surgery to treat a lumbar disc herniation. Rather than waiting for the symptoms to decrease over a period of rehabilitation, athletes prefer a relatively simple microdiscectomy.
A conservative period of management for symptoms of a lumbar herniated disc may involve: medication therapy, epidural injections, relative rest and trunk muscle rehabilitation, acupuncture and chiropractic care with massage. However, athletes who experience low back pain with pain radiating down one or both legs, neurological signs and symptoms, mild weakness of distal muscles, such as extensor hallucis longus, peroneals, tibialis anterior and soleus and those who demonstrated positive on the straight leg raise test, may meet the criteria to follow through with a surgical intervention for their lumbar herniated disc.
Generally, elite athletes have a shorter time span in which to allow conservative rehabilitation to be effective. For a majority of the population, medical practitioners often prescribe a minimum 6-week conservative period of treatment with a review at 6 weeks to decide whether they should extend the rehabilitation or to seek treatment from a specialist. This particular healthcare professional may then offer other alternative interventions to treat the issue.
For athletes, however, these time frames are compressed. Epidural injections are often offered to athletes to assess the issue quicker, and if there are no results within a determined period, an immediate lumbar spine microdiscectomy may follow.
Magnetic resonance imaging, or MRI, are considered to be the preferred method for identifying lumbar disc herniation, as these are also very sensitive when detecting nerve root impingements. Because abnormal MRI scans can occur in otherwise asymptomatic individuals, it’s essential to establish a clinical correlation of symptoms before any surgical considerations. Additionally, individuals may present clinical signs and symptoms suggesting the presence of a lumbar herniated disc but they may lack sufficient evidence on MRI to meet the criteria to follow through with surgical interventions. Accordingly, it’s been proposed that a volumetric analysis of a lumbar herniated disc on MRI may be potentially valuable for assessing an individual’s and athlete’s suitability to receive surgery.
Chiropractic and Massage
Fortunately, before considering surgical intervention, although more time and patience may be required, there are several effective, alternative treatment options that can help reduce and eliminate the symptoms associated with a lumbar herniated disc. Chiropractic is a healthcare profession that focuses on injuries and conditions of the musculoskeletal system and the nervous system as well as the effects of these on general health. Chiropractic care emphasizes the treatment of the body as a whole rather than focusing on a single injury or condition. Through the use of spinal adjustments and manual manipulations, two of the most common techniques used in chiropractic, a chiropractor can carefully re-align the spine, helping to restore and reduce the pain and swelling caused by a lumbar herniated disc.
Along with a combination of massage, chiropractic care can ultimately help rehabilitate an injured athlete or individual. A massage, best referred to as myofascial release, is a hands-on technique that involves applying gentle, sustained pressure into the myofascial connective tissue restrictions, to eliminate pain and restore function. Massage can increase blood flow, which delivers more oxygen and nutrients to the muscles surrounding the affected region of the spine. The increased blood flow may also help carry away unnecessary substances which may have accumulated through time. Chiropractic care and massage are safe and effective treatments that can help rehabilitate athletes with lumbar disc herniation without side effects.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Sourced through Scoop.it from: www.elpasochiropractorblog.com
By Dr. Alex Jimenez