Lumbar Disc Herniation in an Amateur Tennis Player

The patient is a 32-year-old attorney and ranked amateur tennis player who came to my office in 1994 with a severe flare-up of right sciatic pain. He had a prior history of low back and right sciatic pain for the past year. He had been under the care of a chiropractor, and an LS spine scan showed 2 lumbar herniated discs: a small L5,S1 to the right, and one to the left at L4,5. He had a long course of chiropractic treatment, including electrical stimulation and manipulation. Subsequently, he consulted an orthopedic spine surgeon who advised him to have physical therapy, which he had, including electrical stimulation, trigger point massage and lumbar exercises, including William’s flexion and McKenzie extension exercises. Despite these various courses of treatment, he had persisting right sciatic pain which significantly flared up 2 days prior to presentation, associated with night pain and difficulty walking. He was having problems sitting, standing, bending and walking, and he could not participate in tennis at all.

The physical examination showed a significant right-sided limp. In the lumbar spine he has marked decreased lumbar flexion fingertips to the distal patella and extended with low back pain on bilateral hip extension. Straight-leg-raise on the right 30ø with right buttock pain, on the left 70ø with left buttock pain. There was trigger point tenderness in the lumbar muscles, especially the iliopsoas muscle. He was intact neurologically, except for a decreased right ankle jerk reflex.

He was diagnosed with lumbar herniated disc and right S1 radiculitis. He was treated with once-week trigger point treatments decreasing to every other week, with a specific stretching exercise for the lumbar muscles. Within 5 weeks the patient was playing tennis, and within 2 months he began a tennis tournament. By the end of that summer he was competing at full function. During the 2 week tournament, there was a flare-up with a mild lumbar spasm. He was then treated with a lumbar epidural corticosteroid injection and subsequently resumed playing. He was able to continue to play tennis and competed into the finals of the singles bracket, but eventually lost in the finals.

During the fall and winter of the 1994-95 season, he was treated in this office every 3-4 weeks with trigger point injections to the lumbar muscles and started on an aerobic maintenance program on a bicycle and Stairmaster as well as specific stretching exercises for the lumbar muscles. By the summer of 1995 he played and won in the singles tennis tournament. Early in the season in 1996 there was a mild flare-up, treated with a series of 4-5 trigger point treatments. In 1996 and 1997, he again won the singles tennis tournament. However, in 1997, while competing, there was a mild flare-up of the right sciatic pain, necessitating a series of 5 trigger point treatments spread out over a 5-month period of time. He continues to compete at high-level tennis, with no evidence of slowing up. If a periodic flare-up of lumbar tightness persists more than a week, he is again treated with trigger point treatments and a review of his lumbar exercises.

If you have a similar or any other sports medicine problems and would like to compete at your optimum without having to resort to surgery or other invasive treatments, feel free to contact this office.

Also view our other case reports:

Foot Pain

Low Back Pain in a
Professional Seniors Tennis Player

Lumbar Disc Herniation in an Amateur Tennis Player