A 20-year-old Division I soccer player was referred to me from her university’s athletic trainer. She had a nine-month history of low back pain radiating down her left leg to her heel and bottom of her foot, especially when sitting and standing up. In spite of her treatment with a chiropractor for an SI (Sacro-iliac) joint dysfunction and physical therapy for pyriformis syndrome, she was unable to play her junior year.
Once I heard that the pain heightened when sitting and rising, I suspected the underlying cause was a lumbar disc herniation instead of an SI Joint dysfunction or pyriformis syndrome, as those conditions are generally worse with walking activities. Since it was May and the patient was headed home for the summer, I sent her for an MRI scan of her lumbar spine, which confirmed the L5-S1 Focal Disc Herniation (FDH). The disc was pressing directly on her left S1 nerve root, explaining the left lower extremity symptoms down to her heel and bottom of her foot.
Since she did not have a directional preference exercise that could centralize her pain, I offered her an S1 transforaminal epidural steroid injection (TFESI) under fluoroscopic guidance with contrast enhancement. This provided her 80% relief of the left leg symptoms and she responded to extension in standing and prone press-ups. She continued these exercises every two hours per day for 10 repetitions. Fortunately, a Buffalo-based PT group had an office in Syracuse near where she lived. I saw her at four week intervals in June and July, and we advanced her from bridges and planks to more stability and motor control exercises to eventually soccer-specific skills.
Eight weeks after her TFESI for her FDH treatment for her herniated lumbar disc, she was able to start practices with her university soccer team. For maintenance, she continued her extension and standing between classes, as well as prone press-ups twice per day as needed. Not only was she able to play out her senior year without back problems, she was named a team captain.