Lumbar SpineLumbar Spine Disc Bulge/Disc Bulge/HerniationHerniation
Low back pain is the second most common reason for doctor visits in the USA, after
the common cold. Eighty percent of American adults will experience low back pain at some
point in their lives. Disc bulges and disc herniations cause significant pain, time away from work, and of course, time away from the pickleball courts. Pickleball and low back pain are closely related because of the nature of the movements seen in pickleball. Repetitive dinking at the non-volley zone (kitchen) means players are often bending forward in order to hit the ball. This, over time, can place a lot of stress on the spine and lead to disc problems (or exacerbate existing/underlying problems).
First, let’s describe the difference between a bulge and a herniation. Spinal discs are like jelly donuts lodged in between each vertebra. They provide shock absorption, and ensure that the load of the spine is dispersed evenly. A disc bulge is when the disc is pushed (most commonly posteriorly and laterally, back and to one side) out of place. This often leads to nerve roots being compressed as they exit the spine, and can create radiating pain, numbness, and tingling in the lower extremities (known as radicular pain). A disc herniation occurs not only when the disc is pushed out of place, but when a tear in the disc is also present. This leads to the gel-like substance within the disc being extruded (think of squeezing the jelly out of a donut). This, again, can lead to nerve compression and pain felt in the lumbar spine and lower extremities.
The most common mechanism of injury for a lumbar spine disc bulge (or herniation) is a combined spinal motion of bending and twisting. This unfortunately is seen all the time in pickleball due to the nature of the dinking game (not seen in other racquet sports). It is well-known that the majority of pickleball players are older than 50, and therefore their quickness, agility, and footwork may not be as good as younger players. This leads to a lot of reaching (often outside the base
of support) in order to return certain shots, and
places these individuals at higher risk for lumbar disc problems. Improving your footwork and agility at the kitchen line can lead to better positioning to hit the ball, and therefore decrease the repetitive stress placed on your spine over time.
How does a lumbar spine disc bulge or herniation present? Usually, people will report bending over to pick something up or reaching down for something, and then a sharp pain is felt. This is followed by significant stiffness, inability to move, pain in the lower back, and possibly pain in the lower extremities. In addition, a positional shift can often be seen, called a lateral shift (if you look in a mirror, your shoulders are no longer lined up straight above your hips). This is a normal response our bodies have in order to avoid compressing nerves and to decrease the pain. Unfortunately, if left untreated, this can lead to longer-term disability and keep you off the court (or even from returning to work).
The best thing to do when injuring your lumbar spine is to consult a health care professional (ideally a physical therapist) as soon as possible. Research has shown
that the quicker acute low back pain is addressed by a physical therapist, the better the outcomes. Physical therapists will be able to perform a full examination and determine the cause of your pain. From there, they can devise an individualized program to correct your problem and return you to the courts as soon as possible. There is a specific sequencing that needs to be followed in order to correct lumbar disc bulges/herniations. Positional shifts need to be corrected, then a progressive exercise sequence is put in place to correct the disc protrusion, followed by a progressive strengthening program in order to get back to all activities.
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