Approximately two thirds of disk herniations occur postero-laterally, with the remainder occurring centrally. Both postero-lateral and central herniations can cause sciatica, and 95% of herniations occur at the L4-5 or L5-S1 levels. Although lifting is a mechanism of injury often associated with acute disk rupture, athletic weight lifting has not been shown to increase the risk of herniation.

What causes Disc injury?

There are several possible causes of a ruptured disc. Most commonly, a ruptured disc is the result of normal wear and tear of the disc that occurs with ageing. After the age of 30, the nucleus begins to lose it’s fluid, making you more susceptible to a ruptured disc. Spinal injuries, such as a sudden strain or increased pressure to the lower back, can also cause a ruptured disc. Degeneration of the disc, or degenerative disc disease, is known to cause a ruptured disc as well.

Management

A recent analysis in patients who had sciatica showed that spinal manipulation was more beneficial in treating pain and improving function compared with placebo and compared

with treatments that are considered ineffective or harmful.

Spinal manipulation was not any more or less effective than other conventional treatments, such as exercise, or analgesics.

As pain subsides, more intensive therapy is aimed at improving strength and function. Spine stabilization exercises are directed at improving function by conditioning the muscles

around the lumbar spine. A key component to spine stabilization is establishing a neutral spine position (the midpoint between available anterior and posterior pelvic tilt) that provides the greatest comfort and functional stability

Operative Techniques

Surgery continues to be a treatment alternative for sciatica caused by lumbar disk herniation; however, similar to other management options, timing and careful patient selection play major roles in its effectiveness.

Rehabilitation is a pivotal factor in the speed of recovery following discectomy. In the past, postoperative exercise was restricted until 6 weeks after surgery. Now, studies using early and more aggressive exercise after discectomy report better outcomes than traditional post-surgical care.

Returning to Activity

Few things are more frustrating for an athlete than to be out of sports because of an injury, but one of them is reinjury as a result of a premature return. To minimize the chance of reinjury, the athlete is promoted to the maintenance phase of rehabilitation only after certain criteria have been met. The goal in this phase is to ensure a graduated return to sports while maintaining the gains made during the recovery phase.

The athlete should resume his or her sport at a level or intensity that allows pain-free participation, then increase the time, distance, weight, number of throws, etc, by approximately 10% each week. If the patient’s symptoms return at any point, he or she must drop back to the previous pain-free level and continue working on strength, flexibility, and good mechanics before attempting to advance. A qualified coach can be invaluable in helping many athletes develop proper technique, which will facilitate injury-free participation.