Athletes of all levels are prone to getting injured to back injuries. Zach Parise, recently underwent spinal surgery. Sports Medicine Physician, Dr. Jason Eggers and Physical Therapist Travis Gunderson discuss microdiscectomy surgery and what a patient can expect during the rehabilitation process.
What is a microdiscectomy?
Dr. Eggers – Microdiscectomy is a surgery to remove a small part of the lumbar disc that has herniated or pushed out into the spinal canal. This procedure is preformed to provide relief from the herniated disc that’s creating pressure on a nerve.
Is this a common procedure?
Dr. Eggers – Yes, this is a common procedure we suggest to patients, typically after conservative options have been tried and are no longer successful. We do try to avoid this surgery if possible, but there are some instance where we can’t.
One of those instance where surgery should be considered sooner rather than later is if you are developing significant weakness in leg muscles. When patients are examined prior to surgery, we’re checking the strength in their legs. If there is pressure on a nerve that causes substantial weakness in the leg, then surgery should be considered. If the pressure on a nerve isn’t removed, it’s harder for the patient to get that strength back.
What are conservative treatment options a patient can go through prior to having surgery?
Eggers – We usually recommend patients start with physical therapy. The next option would be a corticoid steroid injection. This type of injection helps to manage the symptoms while the body heals itself.
Studies have shown that most people a year out after injuring their spine, outcomes are very similar to patients being treated conservatively compared to patients who were treated surgically.
Some patient who are treated by the microdiscectomy are have a slightly greater chance that they will re-herniate
What is rehabilitation like after microdiscectomy surgery?
Eggers – Typically the first six weeks after surgery is fairly limited, while the next six weeks is working on core stability and strengthening.
Gunderson – We often see patients after surgery because they want to see a therapist after their surgery. Typically people have had back pain or pain down their leg for a couple months. When you’re in pain common response is to not use your leg, or not be as active. So your leg muscles can get reconditioned. We can work with the patient on a graduated program to build up the capacity of the muscles in a progressive graded manor so that it’s not too tough at the beginning but gradually gets harder over time.
We’d first have the patient start with simple moves – either laying on a treatment table or sitting – and working in a smooth and relaxed way. This will help build up their range of motion and flexibility of muscles and tissues. Over time the move will gradually get harder.
Why is physical therapy important for patients before or after a microdiscectomy?
Gunderson – The main concern for patients with a herniated disc are the tissues in the back. We want to make sure the nerve tissues are not injured or getting worse. We can do tests to look at the health of those nerve tissues to determine if they are deteriorating or injured. Based on those tests, we may continue to watch and then refer the patient to the physician or surgeon when necessary.
Back and leg pain from a herniated disc are considered nerve pain and can be painful at the beginning. Having a good therapist and physician who understands the patient’s needs and providing individualized care is important.
Are herniated discs common in hockey players?
Eggers – Herniated discs are common in all athletes in general and common in most sports. I’ve seen a herniated discs in a 14 year old and professional athletes. Some people are able to get back and do everything without difficulty, others can re-herniate. It really is individual.
*For more information about herniated disc and how this injury affects athletes watch the Fox 9 news story with TRIA Sports Medicine Physician, Dr. Anne Moore, “Parise’s herniated disc – a common injury or not“