Epidural steroid injections can help athletes return after lumbar herniated discs

Note: I recently attended the 2012 American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco, California. In the next few weeks, I will present some of the important studies presented at its Specialty Day, presented by the American Orthopaedic Society for Sports Medicine.

Football wide receiver making a catch
Lumbar disc herniations can be a difficult problem in football players and all athletes.

Lumbar spine herniated discscan be a challenging problem in high-level athletes, especially college and professional football players. Repetitive hyperextension of the spine, direct contact, jumping, and twisting are all thought to be risk factors for herniated discs, putting athletes, and football players especially, at risk for these injuries.

Treatment of these lower back injuries can be difficult, because rest, physical therapy, other nonsurgical treatments often take a great deal of time before the athlete returns to play without symptoms. And while surgical removal of the disc can have good success in terms of returning to play, it is often a long recovery process. A new study presented at the Specialty Day of the American Academy of Orthopaedic Surgeons Annual Meeting looks at the effectiveness of epidural steroid injections for lumbar herniated discs.

Aaron J. Krych, M.D. et al reviewed the records of 17 players from a single NFL football team from 2003 to 2010. 17 players suffered 27 distinct lumbar disc herniations. One of the team physicians evaluated each player after injury and assessed the player for neurologic defects and other exam findings as well as ordered x-rays and MRI’s. 37 epidural injections were performed for the 27 disc herniations at an average of four days from the injury.

The authors’ findings are encouraging for football players, as they showed that 89% of players returned to play after the injections, with an average loss of 2.8 practices and 0.6 games.  Tweet this statistic. Four players did require a repeat injection, and three of those four ultimately required surgical treatment. Of note, one of the factors associated with failure of the injection was weakness at the time of the physical examination. “These injections are a safe initial therapy in athletes that do not have neurological deficits, allows them to participate effectively in physical therapy sooner, and can significantly reduce the time a player misses,” Dr. Krych noted.

Football team warmupsChristopher A. Merrell, M.D., the Director of Physical Medicine and Rehabilitation Services for the Department of Orthopaedic Surgery at the Medical University of South Carolina, urges some caution about applying these results to the general population. “This fast-track treatment–getting an MRI the same week as onset of pain, and getting an injection within one week–is not typical of what most people get. For most, relative rest, ice, anti-inflammatories, and physical therapy will allow them to heal within 6 weeks. I certainly see the value in the authors’ protocol for professional athletes. It mirrors what we do at MUSC for the athletes that we treat,” says Dr. Merrell.

These findings provide reason for optimism for team physicians and athletes alike, as lumbar disc herniations can be a difficult injury in an athlete during the season. While epidural steroid injections might not always provide complete relief or guarantee successful return to play, they are felt to be safe. And potentially they could help to get a player through the season until a discectomy can be done in the offseason, if needed. While these results might not necessarily apply to the general population, and they don’t suggest that epidural injections should replace surgery as a treatment for all lumbar herniated discs, they can be utilized in pro athletes with a reasonable hope for successful return to play.

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