J.J. WATT AND HOW HERNIATED DISCS CAN REOCCUR [2019 UPDATE]
An almost audible groan rose from the plains of Texas when Bill O’Brien, head coach of the Texans NFL team, told reporters that their three-time defensive end of the year, J.J. Watt, would be out the rest of the season due to necessary surgery on a herniated disc in his back.
Herniated discs can occur in athletes who engage in contact sports, like football, where repetitive stress is put onto the discs in the spine.
J.J. Watt is not the first professional athlete to suffer from a herniated disc, nor will he be the last. As a matter of fact, one study found that between 1979 and 2013, 53 NFL players underwent surgery for a herniated disc.1
That number has assuredly increased over the past several years.
What makes a herniated disc so painful, why does it take so long to recover from and why is it that, after surgery, athletes like J.J. Watt experience a second herniation of the same disc?
We'll explain what science and medicine has to say about all that, but first, let's start with the basics and get a clear understanding of what a herniated disc actually is.
WHAT IS A HERNIATED DISC?
A disc herniation occurs when the gelatinous inner material of a spinal disc presses through a crack in the tough, rigid outer layer. This can create a bulge in the disc or a rupture that can put pressure on the sensitive nerves that exit the spine, causing pain.
It can be helpful to imagine that the discs providing shock absorption and cushioning between the vertebrae in your spine are designed a lot like jelly donuts — a strong outer ring (known as the annulus) of fiber with a softer, more gelatinous substance in the center (known as the nucleus pulposus).
Over time, these discs experience what is called natural degeneration, meaning that they simply start to wear down after years of being exposed to repeated stress and duress.
Think about it like the shocks on a car. These shocks help you avoid discomfort as you drive around town. But years of daily driving, hitting potholes, jumping curbs, slamming on your breaks and flying over speed bumps takes its toll.
It's pretty similar for the average person. Most of our bodies are equatable to a daily driver. We don't do anything too dramatic, but throughout the course of our lives we walk, we run, we fall off bikes, we jump out of trees, we carry heavy things and more. All the pressure and weight you put on your spine naturally causes degeneration to the discs.
For most people, this degeneration is relatively minor and never causes any serious problems. There may be some back pain from time to time, but it's nothing that impacts your daily life in any significant way.
DEFINITION OF A HERNIATED DISC:
“A disc is considered herniated when the inner, gelatinous material has squeezed through or caused a bulge in the rigid outer layer. This can cause pain, numbness or tingling if it presses up against the sensitive nerve roots exiting the spine.”
WHY HERNIATED DISCS ARE MORE COMMON IN ATHLETES
To put it quite simply, herniated discs are more common in professional athletes because they're allowing their discs to endure more stress and trauma than they would naturally.
This may come as a bit of a surprise because athletes are typically in much better shape than an average person but they're also putting much more stress on their spine than the average person. Lifting weights, twisting the body while swinging a golf club, getting tackled, jumping off the uneven bars, running a marathon, sprinting on a bike along with hours and hours of training all put pressure on the spine.
Think about your car and your poor shocks again. Now imagine that, instead of it being your daily driver and you accidentally hit a pothole from time to time, you consistently subject it to harsh treatment. You hit every pothole you see and you seek out speed bumps to hit at full speed. Those shocks are going to wear out a lot faster, right?
That's essentially the same thing an athlete is doing when they engage in contact sports. Several times a week they're subjecting their spine to significant stress and forcing it to bear more load than it naturally would in a typical person.
Just how much is that load? Research into football tackles from the University of Nebraska has found that the average football tackle can create up to 1,600 pounds of tackling force.2
All that energy has to go somewhere. Most of it is absorbed by the padding that athletes wear, but it is inevitable that the spine will take some of the load.
This being the case, the odds of a professional athlete experiencing some sort of spine problem due to degeneration is much higher than an average person. One study of Olympic athletes found that 85% have either lumbar (lower back) disc degeneration or herniations.3
Now does this mean that every athlete is going to develop a herniated disc? Absolutely not. While disc degeneration is natural, it's rarely painful and it doesn't always result in disc herniation. This is because a slipped or compressed disc doesn't always put pressure on the nerve roots exiting the spine. If it doesn't, it's almost impossible to tell there's even degeneration without an MRI. One study found that 73% of adults have degeneration in at least one level of their spine, but remain asymptomatic, or symptom-free.4
That said, it does pay to protect your spine at every possible avenue by wearing the proper protection while competing, making sure that your form is correct while performing exercises that can put stress on the back, strengthening the muscles and structures that support the spine and knowing your own body. If you recognize that you're starting to feel back pain as a result of your athletics, it's well worth your time to get it examined by a neurosurgeon.
Most importantly, if your spine doctor recommends that you take a break from a particular sport for awhile or encourages you to stop altogether, you need to take that advice seriously. Most disc damage can heal on its own with time, rest and perhaps a little physical therapy. But not giving yourself enough time to recover can make the injury worse or, in the case of J.J. Watt, cause it to reoccur. Many doctors speculate that his re-injury occurred because there was simply too little time between his original surgery to fix his herniated disc and him going back onto the field to play.
Damage to the discs in the spine is not irreversible, but it can have significant impacts on your life so taking care of your body in the short-term can have long-term impacts.
ATHLETES ARE MORE LIKELY TO EXPERIENCE A SINGLE, TRAUMATIC INJURY TO THE SPINE
Now, to this point we've talked about how playing a contact sport can speed up the natural rate of degeneration in the spine. But, while J.J. Watt might have been experiencing advanced degeneration to his spinal discs, his injury occurred as the result of a single, traumatic event to his spine. Playing contact sports, especially at a professional level, increases your risk of instantly rupturing a disc as a result of an injury.
As we've discussed before, disc herniations typically occur over time as a result of natural degeneration. However, it is possible to rupture a disc in a moment due to a high-stress, traumatic event; think a car accident or a severe fall.
Now typically, disc herniations in daily life are the exception as opposed to the rule. Car accidents and traumatic falls that cause disc herniations are relatively rare. However, professional athletes willingly put themselves into situations that make them more likely to get injured on a consistent basis. By simple probability, a professional athlete is more likely to experience a herniation is a result of strain than an average, everyday person. As a matter of fact, research has found linebackers have somewhere between a 65-70% chance of finding their way onto the injury report; the highest of all football positions.
J.J. Watt, a defensive end, is no exception.
He initially herniated his disc during the 2016 season and had what is known as a microdiscectomy to help correct the problem.
WHAT IS A MICRODISCECTOMY?
“A microdiscectomy is a surgical procedure that helps relieve back pain caused by herniated disc by removing the disc fragments that are putting pressure on the sensitive nerve roots.”
He underwent the procedure and fans were told that he was going to be ready to get back onto the field the next season. Unfortunately, while the surgery was claimed to be successful, J.J. Watt was placed on the Texan's injury reserve roster just three games into the 2016 season due to another back injury; a reoccurring disc herniation.
IF J.J. WATT’S ORIGINAL MICRODISCECTOMY SURGERY WAS PROCLAIMED AS SUCCESSFUL, WHY DOES HE NEED TO UNDERGO THE PROCEDURE AGAIN?
There are several factors that can play into a recurrent disc herniation, or a herniated disc that returns even after surgery.
For anyone with a disc herniation, there is a slight chance (5-10%) that they will develop another herniated disc at some point in the future and this number is significantly higher for athletes who engage in contact or high impact sports.
One of the main reasons for this is that many athletes are so eager to get back into the game that they often don’t give themselves adequate time to recover. Several prominent world class athletes including Tiger Woods, Peyton Manning and now most recently J.J. Watt have tried to come back too quickly after a microdiscectomy surgery and have caused the problem to recur.
The incision size for a microdiscectomy surgery in the neck or the back is minimally invasive, usually requiring an incision of an inch or less, so the pain associated with this surgery is often minimal. As a matter of fact, the procedure itself only takes about an hour to complete and patients can typically walk out of the hospital the day of their operation. This being the case, the athlete can be fooled into thinking that he or she is able to return to play after only a month or two.
Additionally, the painkillers and medication frequently given to players by team doctors can help eliminate or mask the pain that is coming from the spine, allowing them to return to the field more quickly than they probably should.
What most players don't often don’t realize is that they still have a disc that is worn out or has a hole, regardless of their procedure. A microdiscectomy surgery is designed to remove a disc fragment away from the affected nerve to relieve pressure, but the hole in the disc annulus (the belt of fibers surrounding disc) cannot be repaired surgically. Time needs to pass for the body to seal the hole on its own with scar tissue. This process takes months and does not mature fully for up to 1 year.
Additionally, even after this full healing time, the disc remains weak, much like a worn-out tire with a hole that has been patched. This is the reason that Peyton Manning ultimately had to have an anterior cervical discectomy with a fusion that addressed the weak disc by removing it entirely. J.J. Watt will likely require a similar surgery if he continues to play before his disc has fully healed or is too weak to support the spine.
References:
1. NFL Players Get Back in the Game after Upper Spine Surgery. (2016, October 4). Retrieved March 28, 2019, from https://wolterskluwer.com/comp...
2. Higgins, M. (2017, November 14). Football Physics: The Anatomy of a Hit. Retrieved March 28, 2019, from https://www.popularmechanics.c...
3. Dodson, C. C. (2015, September 3). Back injuries in athletes are common, but treatable. Retrieved March 28, 2019, from https://www.si.com/edge/2015/0...
4. Centeno, J., & Fleishman, J. (2003, April 01). Degenerative disc disease and pre-existing spinal pain. Retrieved March 28, 2019, from https://ard.bmj.com/content/62...