Degenerative disc disease and triathlon training

author : AMSSM

comments : 0

After surgery for a herniated disc, is running causing a repeat injury?

BT Member Question:

"Does anyone have any experience with degenerative disc disease and running? I herniated my L5-S1 disc three years ago. The first year was a wait-and-see if it gets better by itself, then I had surgery to repair/remove the disk material. The surgery was a complete success. Pain in the back and leg completely disappeared. Two weeks ago I just started running again. I've logged about 10 miles total. But yesterday and today I got the familiar back pain and numbness in the leg that accompanied the first herniated disk. I've done other sports since the surgery with no ill side effects to the back. I'm wondering if the high pressure impact on the back from running could be messing up another disk? If things don't change I'll probably see a doctor in a couple weeks."

Answer by Michael Krafczyk, MD
Member AMSSM

Low back pain is a common symptom among athletes and is estimated to occur in approximately 1 to 9 percent of runners. A history of low back pain is one of the greatest predictors of future recurrences in athletes. One study showed that college athletes with low back pain had three times the risk for recurrence of back pain when compared to those who had no history of back pain. So, unfortunately, your history of low back pain puts you at higher risk for recurrent episodes.

There are many factors that could have contributed to you doing so well up to the point where you began running. The first question is whether you have continued with a maintenance home exercise program. Irrespective of whether you had surgery or not, it is important to have gone through a standard rehabilitation program. The five steps are:

• Step I: Early protected mobilization
   
• Step II: Dynamic spinal stabilization
    
• Step III: Strengthening of lumbar muscles
    
• Step IV: Return to sports activity
     
• Step V: Institution of a maintenance home program.

The next important factor is the type of sports you participated in prior to running. Some sports have lower impact on the spine then others. One study showed that after one hour of running, disc-height is reduced in all positions and the disc with the greatest loss in disc-height was L5-S1. In other words, running does seem to compress the discs more, and may aggravate an already pathologic disc.

As to what to do next, I would recommend getting in to see a physician to further evaluate your back pain. If your current symptoms are from a recurrence of disc disease, the first step is to stop running and begin a physical therapy rehabilitation program to address any core weaknesses. Once these weaknesses are addressed and symptoms improved, you could start back on a running program. Make sure you start with low mileage and gradually work your way back into running more volume and higher intensity as symptoms allow. Running up hills will put more pressure on the front part of the disc, causing it to extrude posteriorly into the spine. So you may want to avoid hill running for a while.

Good luck on getting back on the road. Most likely you will need to continue with a maintenance back program in order to continue to run or do other activities that stress the spine.

Michael Krafczyk, MD

Michael Krafczyk, MD
St. Lukes Hospital
Bethlehem, PA

Sources:

Dreisinger TE, Nelson B. Management of back pain in athletes. Sports Med. Apr 1996;21(4):313-20.

Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. Feb 2004;86-A(2):382-96.

Dimitriadis AT, et al. Intervertebral disc changes after 1 h of running: a study on athletes. J Int Med Res. 2011;39(2):569-79.

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date: December 14, 2011