Do disc herniations in the back matter?
Often times they do not. Seriously.
Imaging studies reveal people with lumbar disc herniations may or may not develop symptoms, regardless of age or activity level. When symptoms do present, research shows most cases resolve with non-operative care.
What about elite athletes? They put their bodies through greater demands than most people. Will herniations be more impactful to them?
Studies show when a disc herniation is present, symptoms are more common in elite athletes compared to the rest of the population (75% vs. 31%). Elite athletes also face greater pressure to return to the field as quickly as possible. This combination leads to many athletes opting for the knife.
But does it work? Many studies seek to answer that question.
A recent systematic review — a research study that combines multiple research trials on a single topic to determine trends — updated previous reviews.
The older review is from 2015, and the studies within found similar return to play times between operative and non-operative populations. However, the previous review did not distinguish surgical types and new trials have since been published.
The current review — published this year — assessed 20 studies and compared surgery type. The review found operative and non-operative care for lumbar disc herniations to be equally effective.
The review combined the data from the pulled research trials to form one large data set for analysis — known as a meta-analysis.
Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 251 out of 308 patients (81.5%) returned to play in the nonoperative group. The mean time to RTP for patients undergoing lumbar discectomy was 5.19 months (.00–8.70 months), and 4.11 months (3.60–5.70 months) for those treated conservatively. Conservative care included education/counseling, nonsteroidal anti-inflammatory drugs if tolerated, and physical therapy, which entails functional rehabilitation, activity modification, and pain management.
What does this mean for athletes?
Surgery is not always the best route, even if the MRI appears to show a “damaged” or “broken” area. This research builds off many other studies that show lumbar disc herniations can be treated conservatively.
This research does not mean surgery is never appropriate, but attempting to quickly “fix” the “problem” with surgery often is not the answer.