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Key Features

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  • Back pain

    • Worse with flexion and sitting

    • Can originate from disk bulging, disk herniation, or disk degeneration

  • Most injuries occur at L4–L5 and L5–S1 vertebrae

  • In adolescents, most disk herniations are central rather than posterolateral

  • Radiculopathy can be present

  • Positive straight leg raise

  • Risk factors

    • Heavy lifting

    • Excessive or repetitive axial loading of the spine

    • Rapid increases in training

    • Trauma

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Clinical Findings

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  • Back pain, which may be increased with activities such as bending, sitting, and coughing

  • Although not as common as in adults, radicular symptoms of pain down the leg can also occur and are often associated with large disk herniations

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Diagnosis

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  • Evaluation includes physical and neurologic examinations, including straight leg testing, sensory testing, and checking reflexes

  • If symptoms persist, imaging is obtained

    • Radiographs

    • MRI is method of choice for diagnosing disk herniation

  • EMG may also be considered in the presence of radiculopathy

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Treatment

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  • Conservative

    • Most disk herniations, even if large, improve spontaneously

    • The athlete can rest the back for a short period, with avoidance of prolonged sitting, jumping, or hyperextension and hyperflexion of the spine, as these activities may increase pressure on the disk, leading to aggravation of symptoms

  • After a short period of rest, a structured physical therapy program should begin, focusing on

    • Core and pelvic stabilization

    • Peripelvic flexibility

    • Sports or activity specific conditioning

  • If symptoms persist, a short course of oral corticosteroids or epidural corticosteroid injection may be indicated

  • Surgery is recommended for patients who

    • Do not respond to conservative therapy

    • Have significant or progressive radiculopathy

    • Have progressive neurologic deficit

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