Herniated Discs in my Spine: When Can I Return to My Sport?

Spinal cord injuries are common in athletes, especially those participating in contact sports. Thankfully the most severe and devastating spinal cord injuries are rare. There are, however, a variety of injuries that can affect you ability to return to your sport of choice. If you have been diagnosed with a spinal cord injury, such as a herniated disc, vertebral fracture, or spinal stenosis, it will be important for you to understand guidelines that may affect your future athletic participation.

There is universal agreement that athletes who have suffered a spinal cord injury should achieve 4 vital criteria before return to play:

     1) Pain free

     2) Completely neurologically intact (no persistent numbness or weakness)

     3) Full strength

     4) Full range of motion

While these criteria are broadly applicable, cervical (neck) and lumbar (low back) injuries warrant further discussion.

CERVICAL SPINE

Stingers

Definition: A stinger is an injury, common in football players, to the nerve roots that exit the spinal cord in the neck and supply the upper limbs. Compression or traction on these nerve roots can lead to temporary loss in sensation or strength. Often these symptoms will only last a few seconds or minutes.

Return-to-play: An athlete may return to activity if the 4 vital criteria are met. If 3 or more stingers occur, X-rays should be performed to rule out more serious causes. Additional imaging, such as a CT or MRI, may be warranted.

Cervical Disc Herniation

Definition: Disc herniation is when a portion of the vertrebral disc tears, allowing a portion to extrude into the spinal canal, potentially impinging the spinal cord or individual nerve roots.

Return-to-play: Many disc herniations do not cause symptoms. In such cases, return-to-play is safe. For symptomatic herniations, the athlete should be held out of participation until the 4 vital criteria are met. Conservative methods are the recommended treatment, but surgery is also an option. Research suggests 80% of athletes return to their sport within 5 months after conservative treatment. Some athletes, such as Peyton Manning, have returned to their sport after surgical fusion.

LUMBAR SPINE

Stenosis

Definition: Stenosis refers to narrowing of the spaces in your spinal columns that can impinge the spinal cord or individual nerve roots. Stenosis is usually caused by aging, arthritis, or trauma.

Return-to-play: Surgical fusion is one method of treating stenosis. Contact or collision sports are not advised after this type of surgery. If conservative treatment is pursued, the athlete should only return to play after meeting the 4 criteria described previously.

Lumbar Disc Herniation

Definition: Disc herniation is when a portion of the vertrebral disc tears, allowing a portion to extrude into the spinal canal, potentially impinging the spinal cord or individual nerve roots.

Return-to-play: Again, many disc herniations may not produce symptoms. In such cases, return-to-play is safe. When symptoms are present, and can be correlated with MRI findings, conservative management is recommended. Microdiskectomy, or surgery to remove the torn portion of the disc, has shown 50% return at 3 months, 72% at 6 months, 77% at 9 months, and 84% at 12 months. The overall chance of returning to athletic competition at any point is 89%.

 

If you would like to discuss your return-to-play options, we recommend you schedule an appointment with Dr. Carfagno who is board-certified in sports medicine. He can help develop a plan for return-to-play that will get you back to the sport you love.

 

Bryce Kirkman, MS-IV

David Carfagno, D.O., C.A.Q.S.M. 

 

References:

Huang P, Anissipour A, McGee W, Lemak L. Return-to-Play Recommendations After Cervical, Thoracic, and Lumbar Spine Injuries: A Comprehensive Review. Sports Health, 2016(8):19-24.

Sucato D, Micheli L, Estes A, Tolo V. Spine problems in young athletes. Instructional Course Lectures, 2012(61):499-511.

Watkin RG, Hanna R, Chang D. Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes. American Journal of Sports Medicine, 2012:40(11):2530-5.

 

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