Back Surgery Does Not End Careers for NFL Linemen

Professional football players, even those in the most physically punishing positions, can undergo back surgery and return to the gridiron, researchers at Northwestern University's Feinberg School of Medicine report in the American Journal of Sports Medicine.

"They aren't broken, they aren't more fragile after surgery," orthopedic surgeon and lead author Dr. Joseph K. Weistroffer told Reuters Health. "Four out of five who have surgery not only return to play, they return to starter positions."

Weistroffer and colleagues decided to look into how often National Football League linemen returned to play following surgery for a herniated disk after hearing a broadcaster declare a player "broken" and unlikely to play again after surgery.

Linemen tend to be the biggest, heaviest players on the team. Their responsibilities require a lot of crouching, twisting and pummeling on the field, putting tremendous stress on their backs.

Herniated disk - sometimes called a "slipped disk" occurs when soft cushioning disks between spinal vertebrae become displaced. The leaking disc material pressing on spinal nerves can produce intense back pain and numbness or tingling in arms or legs.

Among college football players, 15 percent to 50 percent of linemen suffer lower-back disk injuries including herniations.

To see how well elite NFL players fare, the researchers gathered information about linemen on team rosters between 1982 and 2009 from various sources including press reports, team injury reports, newspaper archives, team records and individual players' profiles. Only those NFL linemen diagnosed with a herniated disk in at least two independent sources and one official league injury report were included.

Of the 66 players included in the study, 14 were treated non-surgically and 52 treated with surgery. Of those treated surgically, 42 (81 percent) returned to play in at least one game, although most played an average of 33 games over 3 years.

The success of surgical treatment in NFL linemen was "significantly better than we expected," the authors write.

"What's remarkable is that many of these players not only returned to play, they returned to starter positions," Weistroffer said.

Of the players treated with surgery, 36 had been starters before their herniated disk diagnosis and 33 of them returned to that status after surgery.

In contrast, only four of the 14 players treated non-surgically returned to play. Weistroffer cautions against reading any significance into that fact. "The numbers are too small to draw conclusions from," he said.

Nonsurgical treatment for herniated disk usually includes muscle relaxers, pain killers and anti-inflammatory medications, and may involve cold compresses applied several times a day.
Surgery to open the back, clean out leaked disc material and stabilize the spine is a treatment of last resort, Weistroffer said.

"No surgery is the best option for everyone, including elite athletes," he said. "But if a herniated disc doesn't heal naturally, surgery may be an option" without branding a lineman as damaged for good.

The results of this study, the authors point out, cannot be generalized to the population at large.

Elite athletes have strong incentives to return to play including in some cases multi-million dollar contracts. In addition, elite athletes have significant resources available to help in rehab including "focused, well-trained professional staff dedicated to strength and conditioning."

Nevertheless, "if a NFL lineman can return to full activities, the average Joe has a good chance to get back on with their life if they don't heal naturally and decide to turn to surgery," Weistroffer said.