Management of Lumbar Conditions in the Elite Athlete

Wellington K. Hsu, MD; Tyler James Jenkins, MD


J Am Acad Orthop Surg. 2017;25(7):489-498. 

In This Article

Abstract and Introduction


Lumbar disk herniation, degenerative disk disease, and spondylolysis are the most prevalent lumbar conditions that result in missed playing time. Lumbar disk herniation has a good prognosis. After recovery from injury, professional athletes return to play 82% of the time. Surgical management of lumbar disk herniation has been shown to be a viable option in athletes in whom nonsurgical measures have failed. Degenerative disk disease is predominately genetic but may be accelerated in athletes secondary to increased physiologic loading. Nonsurgical management is the standard of care for lumbar degenerative disk disease in the elite athlete. Spondylolysis is more common in adolescent athletes with back pain than in adult athletes. Nonsurgical management of spondylolysis is typically successful. However, if surgery is required, fusion or direct pars repair can allow the patient to return to sports.


In competitive athletes, the prevalence of low back pain (LBP) can be as high as 30%.[1] It is the most common reason for missed playing time and may occur secondary to the repetitive loading and stresses placed on the spine during sports performance.[1,2] Lumbar disk herniation (LDH), degenerative disk disease (DDD), and spondylolysis are the most prevalent lumbar conditions that cause symptoms in this patient population.[1,3] These conditions have been studied extensively in the general population, but generalizing these data to the elite athlete is controversial. The rigorous demands of high-level performance have led athletes and physicians to question the typical management, outcomes, and return to play for lumbar conditions. Although the data are still evolving, the recent literature has provided new insight into the management of lumbar conditions in this patient population.