A new study has come out showing that epidural steroid injections work well for lumbar disc herniation in professional football players. This recent study was presented at the American Academy of Orthopedic Surgeons and looked at twenty seven athletes with disk herniations receiving 37 injections.
The average age of the professional athletes was 25 years and most commonly the participants in the study were either defensive lineman or offense linemen. The anatomic areas most commonly affected were L4 or L5.
The success rate noted for an epidural steroid injection by pain management doctor in this situation was 89%. Once the pain management effectiveness was looked at, the return to play rate was an excellent 79% at an average of about 5 months. These success rates are similar to those seen by pain management doctors in Arizona.
The authors looked at success with surgery for a lumbar disc herniation and noted that it was between 74% and 90% return to play rate for professional football players.
The rate of nonoperative treatment in this study was comparable to effectiveness as surgery but with a much lower risk profile. While looking at the return to play rate, 89% of the participants were deemed fit to return to play in those individuals continued for an average of 3 more years with approximately 1/3 of the individuals still playing at the conclusion of the study.
Four players needed repeat injections and 3 players required surgery for their disc herniations. When looking at the failures in treatment, the researchers noted that if the athlete had lower extremity weakness such as a foot drop or a disc herniation that appeared to be sequestered on MRI had a higher incidence of failure for treatment with injection.
We know that epidural steroid injections can be actually effective as a nonoperative treatment option for lumbar disc herniation. If the patient has a pinched nerve such that the foot drop has developed or a sequestered disc herniation is causing persistent pain and sciatic, then both in this study as well as outside of athletes surgery may be necessary in a higher percentage of patients.