Richard Stockton College Athletic Training

Common Athletic Injuries
 Following is some information on injuries that athletes frequently encounter.
It is brief and to the point, not a detailed medical analysis of an injury.  Therefore use
the information accordingly.


 
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Bulging/ Herniated Intervertebral Discs
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By Doug Wallace, PT, ATC.   Doug is the Director of Rehab at the West Caldwell Care Center, in West Caldwell, NJ.  He graduated from Stockton in 1995 with a BS in Physical Therapy.  He then took additional classes at William Paterson University to get his ATC. 

What is it?

Bulging discs can be a disabling and potentially dangerous condition affecting athletes and active individuals alike.  It is a condition which can be overlooked or misdiagnosed, but should not be taken lightly due to the possibility of serious consequences.

Discs are sandwiched between the spinal vertebrae that make up the bones of the back.    The disc can be compared to a jelly donut, whereas the jelly is the center of the disc, and is known as the nucleus pulposus.  Surrounding the jelly is the donut portion, or the anulus fibrosus, which, as its name implies, is a series of interwoven fibrous rings, designed to contain the central portion of the disc.  If the nucleus pulposus (or jelly) migrates away from the center, the annulus fibrosus will become deformed and bulge.  Continued bulging of the disc may result in a partial or complete herniation, whereas the jelly is squeezed out of the donut. Depending on how much of the nucleus pulposus is displaced determines if is a partial or complete herniation.  The chemical makeup of the nucleus is aggravating to the surrounding structures, including muscles, ligaments, blood vessels and nerve endings, and when the disc herniation irritates these structures pain, spasms, swelling, weakness, paresthesia or even paralysis may be caused. 
It hurts where?

As the disc starts out bulging, a localized pain of the effected area is the common symptom.  As the bulge progresses, so will the pain and resultant disability.  If there is localized swelling around the disc, the affected nerve roots will begin to express pain, parasthesias and progressive weakness to their respective areas of innervation.  If herniation occurs, significant pain and disability will occur, affecting the local area of the disc and the area innervated by the nerve root. 
How does it happen?

As with many injuries, there can be multiple culprits to a herniated disc.  Chronic multiple microtraumas or a macrotrauma may cause the onset of the condition. Factors that may expose someone to higher risk to develop a disc problem include posture, physical condition, anatomic structure and alignment, congenital conditions, and preexisting/coexisting injuries.  For example, a baseball catcher or football lineman may have muscular imbalances and poor posture, which increase the risk of developing a herniated disc.  This may be compounded by multiple microtraumas such as bending, pushing, or twisting inherent in their position; or a sudden macrotrauma such as getting hit while protecting home plate or having to take on an unexpected double team block. In these instances the individual may be predisposed to a disc injury, and by experiencing chronic repeated stressors or a single significant episode, the forces may push the disc beyond the limits of the surrounding cartilage to cause a disc herniation. 
Injury progression...

Typically as the central nucleus of the disc begins to migrate, progressive pain and resultant disability will occur.  It is not uncommon for someone to disregard this pain and discomfort and consider the pain to be related to a sprain or strain of the back or neck.  But if left untreated, and the condition progresses, increased pain, spasms, and disability will likely occur as the nerve root becomes irritated, with numbness, tingling, and burning sensations likely radiating over the effected dermatome, and progressive weakness being experienced in the innervated muscles. 

If the bulging nucleus continues beyond the confines of the surrounding cartilage, this will lead to a partial or complete herniation, depending on the amount of the nucleus that is pushed out.  When this occurs the symptoms will be similar to a bulging disc but substantially magnified, with the parasthesias leading to possible compromised sensation and the weakness progressing to possible paralysis. 
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As can be expected, the ability to continue to participate in a sport or activity is largely dependent on the severity of the symptoms and the individuals personal ability to tolerate them.  However it is only logical that if the disc problem worsens to a point of weakness and compromised sensation, it is likely that the person will not be able to effectively perform, no matter how strong their will and pain tolerance. 
Similar Injuries

Many injuries may be present at the same time as the disc pathology and mask the underlying disc problem.  A simple strain or sprain of the local spinal soft tissue, damaged vertebrae, or growth on or around a nerve root may imitate the disc herniation symptoms.  A shift in the normal bony alignment may also mimic the effects of a disc problem by directly placing abnormal pressure on the nerves, or indirectly from the inflammation caused from the stress on the supporting soft tissue. 
Treatment

The treatment focus is on centralizing the bulging nucleus back into the disc (which is usually only possible for bulging discs due to the difficulty with getting the jelly back into the center of the donut, after it has been squeezed out). Initial management of any pain or spasm that may coexist may be treated by modalities including ice, heat, ultrasound, electrical stimulation or massage, or a host of other common methods.  As the pain is managed and begins subsiding, treatment focus will shift to the core of the problem.  This will include specific exercises to assist in centralizing the disc: spinal extension exercises are indicated with posterior bulging discs; spinal flexion exercises for anterior bulging discs.  Together with a calculated stretching regimen, postural management, and core trunk strengthening and stabilization exercises (to improve endurance, strength and power); successful management of the problem can be achieved.  Some individuals may require spinal manipulation or mobilization techniques, deep soft tissue mobilization, neural stretching, or various other interventions by trained personnel for successful results.  The intervention of a physician or orthopedic surgeon may also be necessary, particularly if the disc is herniated.  However, if the bulging disc is detected early enough and properly treated, successful long-term results are highly likely. 
Participation Status

Athletes who are in the initial stages of a bulging disc will likely be able to continue playing and only be plagued by the initial symptoms of pain, spasms, and the associated limited mobility.  These symptoms may actually become decreased or alleviated as the athlete plays or practices due to the stretching of the soft tissue and interruption of the pain/spasm cycle.  These symptoms will likely prove to limit the playerís participation individually as each personís tolerance to the symptoms.  However if the warning signs are not heeded, and treatment is not sought, it is likely the problem and symptoms will worsen and eventually as the bulging disc/s advances, the symptoms could become disabling to the athlete.  If the condition continues to worsen a complete herniation may occur, and  the athlete will likely need to seek physician intervention for medical management.

 

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