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Keywords

Clinical Practice in Athletic Training

Abstract

Background: The rate for low back injuries in collegiate football players has been reported as 2.70 per 10,000 athlete exposures with lumbar disc herniations (LDH) accounting for roughly 8% of these injuries. In athletic populations, the decision of surgical versus conservative management for LDH can present a unique challenge to the clinician and patient given an patient’s concern for return to play with minimal time loss. This type 3 CASE study will discuss the non-operative management of an L4/L5 disc herniation in a collegiate football player and highlight the interdisciplinary team approach that allowed the athlete to play an entire competitive season without limitations. Patient: In January 2023, a 21-year-old male Division I collegiate football player (long-snapper) presented to the athletic training facility with lower back pain, which radiated down his left leg. No specific MOI was reported. Both lower back and radicular pain were reported to increase during prolonged sitting and standing up from a seated position, as well as lowering into a sport-specific position. The patient was evaluated by the team physician and referred for diagnostic imaging. The MRI revealed an L4 and L5 paracentral disc bulge with increased narrowing of the vertebral foramen. Intervention: Following diagnosis, the patient was cleared by the team physician to continue football-related activities as tolerated. The sports medicine team developed a management approach for this patient which included consults from a pain management physician and spine surgeon, rehabilitation sessions three times a week with a physical therapist, daily rehab and pain management sessions with the athletic training staff, weekly treatment from a chiropractor, and scheduled check-ins with team physician. Physical therapy sessions focused on increasing abdominal strength and stability. Exercises included supine alternating upper and lower extremity lifts with dumbbells, hip hinges, hamstring curls with physioball, quadruped resisted hip extension, and standing lumbar extension. The athletic training staff implemented daily treatments which included the following: lumbar heat pack in combination with electrical stimulation, SI joint mobilizations, piriformis release and stretching, and hip realignment. Additional therapeutic exercises performed twice weekly with the athletic trainer included quadruped fire hydrants, walking lunges, and Pallof marches. Weekly chiropractic care centered on mechanical lumbar traction and mild adjustment. All rehabilitation exercises were performed prior to practice while cryotherapy was provided following activity. Lastly, the patient was directed to take OTC NSAIDs as needed for pain, and received an epidural corticosteroid injection prior to the fall season. Outcomes and Other Comparisons: Given the patient’s position (special team’s long snapper) and limited plays per game, the patient was given the option for conservative treatment in effort to play the entire fall season and delay surgery to season’s end. The patient opted for this conservative approach and received a comprehensive interdisciplinary management plan that allowed him to play the entire season without time loss. Conclusions: The election for surgical versus conservative management of LDH is often dependent on injury timing, patient symptoms, and the sport demands the athlete is returning to. In this case, the patient was a collegiate football player (long-snapper) who elected for conservative treatment. The interdisciplinary team, comprised of athletic trainers, physical therapists, a chiropractor, and team physician, worked together to develop a comprehensive management plan that allowed the patient to continue play throughout the competitive season. Upon completion of the fall season, the patient underwent microdiscectomy surgery to address his LDH. Clinical bottom line: This case highlights the benefits of an interdisciplinary team-based approach to injury management for a collegiate football player diagnosed with a LDH. Since all members of the interdisciplinary sports medicine team have important roles in optimizing patient outcomes following injury, it is important for athletic trainers to consider this approach.

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