Assessing Lumbar Conditions in Elite Athletes

Lead author, Wellington K. Hsu, MD, comments on the common conditions, treatments, and return-to-play outlook for this patient subset.

Peer Reviewed

Lumbar conditions among high-level, competitive athletes are common, but it has been only recently that evidence-based literature has provided guidance on the diagnosis, management, and treatment of these patients. In a literature review published in the July 2017 issue of the Journal of the American Academy of Orthopaedic Surgeons, authors explored the most common lumbar conditions suffered by this specific population, and how treatments impacted their return to play.
Baseball player swinging bat in an arena during a night game.Lumbar conditions among high-level, competitive athletes are common. Photo Source:
“Elite athletes are a subgroup of patients who commonly sustain lumbar injuries and require different considerations when it comes to management and treatment,” said author Wellington K. Hsu, MD, the Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery and Associate Professor of Neurological Surgery at Northwestern University’s Feinberg School of Medicine in Chicago, IL.

“Since typical prospective randomized controlled trials are not feasible to conduct in professional players, our research group has focused on compiling large amounts of retrospective data to help answer this question,” Dr. Hsu stated. “Further study will continue to help our understanding of the nuances of treatment for elite athletes.”

Analyzing the Top 3 Lumbar Conditions Suffered by Elite Athletes

Lumbar disc herniation, degenerative disc disease, and spondylolysis are the most prevalent lumbar conditions suffered by elite athletes.

The review found that across all 3 conditions, non-surgical treatments effectively helped athletes recover. The most successful non-surgical modalities included anti-inflammatory medications, rehabilitative physical therapy, and epidural steroid injections.

If elite athletes do not respond to non-surgical treatments, surgery may be warranted. The review revealed that even after lumbar spine surgery, most elite athletes were able to return to play. Those who undergo a lumbar discectomy are particularly well-suited to return to competition, as the evidence showed that 75% to 100% of athletes rejoin their sport after the procedure.  

While surgical outcomes are generally good for elite athletes suffering from lumbar conditions, Dr. Hsu noted that physicians need to take sport-specific considerations into account when contemplating surgery for their elite athlete patients.

“Recent retrospective data suggests that players who undergo lumbar discectomy for a disc herniation have excellent performance-based outcomes after return to play,” he said. “However, athletes of sports that rely heavily on repetitive twisting motions, such as baseball, may have shorter careers after surgery when compared to non-operative care.”

What’s Next? Young Athletes and the Growing Spine

Dr. Hsu says his research group has expanded the purview of their studies to include different types of orthopaedic injuries in addition to spinal ones, and the most fascinating results he’s seeing are those highlighting the difference in outcomes in athletes of different sports.

“Although the fact that the body responds differently to surgery depending on sport-specific demands is intuitive, the data that we have accumulated may allow health care practitioners to properly counsel patients during the decision-making process,” he said.

Additionally, Dr. Hsu and his colleagues are continuing the process of collecting data on adolescent athletes and studying the potential effects of physical activity on the growing spine.

“We believe this knowledge may help train staff and coaches to modulate activities to protect the spine from injuries and pathologic changes,” Dr. Hsu indicated.

Updated on: 08/15/19
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Wellington K. Hsu, MD
Professor of Orthopaedic Surgery
Northwestern University Feinberg School of Medicine
Chicago, IL

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