Disk Herniation

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