Question: Should a Teenager Be Allowed to Play Sports After a Sports Injury?

My son is a 14-year-old high school freshman. He is a stellar athlete in both football and basketball. He is 6'2” and 200 lbs. In June 2002, he crashed into another basketball player and began experiencing significant back pain.

Chiropractic care led to an MRI, which showed mild degenerative disease with a mild central disc protrusion at L4-L5. This led us to see an orthopedist in July 2002 and he had an unremarkable x-ray. The orthopedist’s recommendation was physical therapy 3x week and to “play to tolerance.” My son was diligent about therapy and pain was intermittent throughout the summer with the ultimate goal of starting football camp mid-August. He began double sessions and handled the pain with OTC (over-the-counter medications) and PT.

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Then came the first game - he played the whole first half, both ways, and I ended up taking him to the ER because of the pain. The subsequent MRI showed no changes whatsoever. An epidural was recommended and given 8 days ago. Pain has reduced to a 2-3 level. He is very depressed about missing a sport that provided much to his life. I subsequently saw a neurosurgeon who reviewed his case. He told us there should be no surgery because there is nothing to operate on, he is only 14 and he will heal.

OK, as a mom I don't know if I should again let him “play to tolerance” once he gets pain free, or insist he never plays football again and watch the depression and “funk” in his heart. All the MDs have said there is nothing structurally wrong and that he should take up swimming. What should I do?

Doctor’s Response: Playing to Tolerance is a Reasonable Option

I would agree with the opinions you have gotten to date. It does not sound as though there was any structural damage to the spine, so it should heal. Playing to tolerance is a reasonable option, and if he can go back into sports in a more gradual fashion, then his return should not be as traumatic. Remember that pain does not equal tissue damage.

He should also be on an active exercise program, as the better conditioned he is, the less likely it is that he will develop recurrent pain. He should do daily stabilization exercises, and also stretch his hamstrings. Aerobic conditioning is also very important. Lastly, try to be patient, as it can take a long time to rehab from a back injury. Based on the findings of your physicians and the MRI scan, I personally would not hold my child out from football if they were feeling better.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.