Disc Herniation in a 14 year old

Posted On: May 26, 2017

This is the tenth case review from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I have practiced chiropractic and physical therapy on Chicago’s North Shore for almost 30 years. I started as a chiropractor in Lake Forest, Illinois in 1987. I integrated physical therapy into my practice in 1990.

This is a case of a 14 year-old basketball player who came to my Highland Park office complaining of lower back pain with right sciatic type symptoms. He was referred to our practice from a local orthopedic surgeon in Highland Park. He came with an MRI, which revealed a very large L3/L4 disc herniation.

I examined the patient. He had a positive straight leg raise response on the right. He did not have any other frank neurologic deficits. He had no strength loss or frank sensory loss. His range of motion was limited with forward bending going about half of the normal range with this motion reproducing the sciatic pain. Backwards bending (extension) caused the pain to become more intense in the lumbar spine (centralization the pain).

The orthopedic surgeon was wisely hesitant to do surgery in someone so young. The patient’s mother was very concerned. She understandably had questions on how physical therapy could help such a large disc herniation. I told her that her son indeed did have a large disc herniation. I told her that my examination findings suggested that he would respond to physical therapy. The fact that he had little in the way of neurologic findings and that his pain centralized with spinal extension were good signs he would respond.

He responded magnificently and was able to make it back into training for basketball in one month. This is not the norm. Usually a disc herniation that centralizes will take 3-4 months to rehabilitate but in this case we got lucky.

The patient kept up with his home exercises and came in for chiropractic adjustments on a monthly basis. He had an occasional flare up, which we helped him through. I coached him on how to safely integrate into higher-level training as he developed over the years. I have some basketball knowledge as I was a coach, played JV ball and took care of a few of the Bulls during the Jordan years. In the end he was a starter on his high school basketball team. When he went to college he chose academics rather than basketball. The case was a winning one all around.