Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ 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 +++ Clinical Findings ++ 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 +++ Diagnosis ++ 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 +++ Treatment ++ 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 Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth