Disk Herniations in the NFL

Disk Herniations in the NFL

Disk Herniations in the NFL

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Football season is starting NOW!     Whenever I watch the game,  even as an orthopaedic spine surgeon,  I am amazed there are not more injuries.    Considering the size and speed of those players,  you would think there would be an injury with every play.  Sometimes I am asked to consider the bio mechanics of injury.  Back when I was an orthopaedic resident,  we did have training in the biomechanical stresses to the bones,  joints,  and ligaments.  Engineering concepts and force analysis are necessary in developing our instruments and surgical implants.  We all know  mass times velocity = momentum.  Now imagine the effects of 300+ lbs bodies crashing at full speed,  often at awkward angles.  I have heard the arguement about how the NFL athlete’s bodies have been conditioned to accept the hits.  Still,  the tissues,  ligaments and bones are subject to the rules of physics and biomechanics.  Those forces are significant,  yet  the injury rates are surprising less than what I perceived it to be.

In October of 2013,  in Spine,  Dr. Benjamin Gray published an epidemiology paper titled “Disk Herniations in the National Football League”. It was a retrospective review on all disc herniations to the spine from 2000-2012.  The NFL has a surveillance database, and collects information such as location of injury,  player position, activity at the time of injury, and playing time lost due to injury.  It is great information that can be used in Fantasy Football,  only in reverse.

To summarize,  in those 12 years,  there was 275 documented disk herniations.  To put matters into perspective,  there are 32 teams,  with a roster of 53 player each.  At any one time,  that means a total of 1,696 players per year.  Over twelve years,  that turns out to having 275 herniations for 20,352 player-years.  Now,  I know many of the players come back season after season,  but there are statistics on the average length of career in the NFL.  If you are a rookie making the roster,  it is 6 years.  But,  if you include everyone who shows up for training camp,  it is 3.2 years.   If we give it the best case scenario,  where ever player is rookie that makes the roster,  then it means over a 12 year time period,  each position will have only 2 players during that time.  so the player-years calculation becomes 3,392 player-years.  To then calculate the frequency of disk herniations,  it would be  275/3392,  or about a 8.1 % chance that a player in one season will have a disk herniation.  Bear in mind these are my calculations,  and not the ones in the study.   That is a pretty large number.  But,  then  we need to know what happens to these players after they sustain a documented disk herniation.

The data indicates 76% of the HNP’s were located in the lumbar spine,  with the most frequent level being L5-S1. Offensive linemen was the most frequent position injured, with the blocking the most frequent activity.

On average,  there was an approximately 12 game loss ( of a 16 game season)  due to HNP’s,  but even there the statistics were interesting.   If you take the average of all players  (including those who permanently left the game after HNP),  there is an average of  12 games lost to a HNP .  But,  if you take the median,  in other words, of all the players who had a disk herniation,  if you take the player exactly in the middle of the pack of all those with HNP’s,  in terms of time off,   it was only 2 games.  From the players perspective,  if you have a disk herniation,  at least half of the players returned back to play after missing a maximum of  two games.  The players who developed the more significant disk herniations skewed the average to a much higher time away from the game.

Other studies demonstrates 82% of the players return to play for an average of 3.4 years post injury.  And,  in terms of management of disk herniations,  80% of players return to play after surgery,  while 59% of players treated non-surgically returned to play. Peyton Manning is a prime example of a player returning to excellence after neck discectomy and  fusion surgery. 

The authors of this epidemiologic studies acknowledge that the diagnosis of disk herniations on MRI studies may in fact be red herrings and may have been asymptomatic of the disk herniation when presenting with pain.  The 275 herniations may not have been acute, or the cause of the pain on initial presentation.    The database also did confirm that there is an increased risk of degenerative disk disease in high performance athletes.  I will add,  that is consistent with the added biomechanical stresses experienced by these athletic activities.

But,  I find the take home message is that disk herniations occur less commonly than I would think for such activities.  Also,  it is helpful to know that despite finding disk herniations on NFL athletes,  most return back to a high level of competitive activity.  It makes you wonder why some people are so debilitated by disk herniations,  while others can return back to high levels of  activities.  There is a non physical component.  And yes,  I am sure it has to do with compensation (money, fame, ego, etc) and the resulting motivation.

 

Citations

  • Schroeder GD, Lynch TS, Gibbs DB, Chow I, LaBelle MW, Patel AA, Savage JW, Nuber GW, Hsu WK. The impact of a cervical spine diagnosis on the careers of National Football League athletes. Spine (Phila Pa 1976). 2014 May 20;39(12):947-52. PubMed PMID: 24718072

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

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2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

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The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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