Case Report: Synchronizing Performance Training and Rehabilitation for a Triathlete with an L5-S1 Disk Herniation: Combining Rehab and Performance

Background: The situation of rehabilitating an athlete while in a training or competition cycle presents a unique challenge. The treatment of the injury requires decreasing potential training stress on the injured area, but the athlete’s competitive goals requires mitigating the detraining effects that come with resting the injured area. With upper or lower extremity injuries, physical therapists have modified training interventions to allow for concurrent training with rehabilitation of the injured limb. However, this is not yet commonly practiced when an athlete is rehabilitating an injury associated with the spine. Case Description: A multi-sport athlete in his twenties, training for an Iron Man triathlon, is seeking treatment for a L5-S1 lumbar disk herniation with the intention to continue training alongside physical therapy interventions. Intervention: The patient’s extension-based program to centralize the radicular symptoms was combined with early initiation of aerobic and resistance exercises. The choice of aerobic and resistive exercises did not cause an increase in radicular symptoms. Outcome Measures: Patient progress was measured using the Oswestry Disability Index, Manual muscle tests of the lower extremity, and lumbar range of motion. Discussion: This case report provides an example of a highly active patient, who was successfully treated using early introduction of performance training concurrently with his extension based physical therapy program. While this intensive of a rehabilitation protocol would not be appropriate for every patient, it does demonstrate the potential for earlier introduction of functional exercises in athletes returning to sport from a lumbar disk injury.