Back pain coming to fore in NFL
Back injuries like the one that could have ended Steelers linebacker James Harrison's career are becoming an increasing pain for NFL players and teams.
Harrison, a Pro Bowl pass rusher who is entering the fourth year of a six-year, $51.75 million contract, had two surgeries in 2011 to repair a herniated disc in his lower back.
Spine (back), head and neck injuries accounted for 10 percent of all reported NFL injuries between 2004-09, according to an NFL Players Association report released last year.
“I believe that back injuries are more common now than they used to be in the NFL population,” said Dr. Wellington Hsu, an assistant professor in the Department of Orthopedic Surgery and Department of Neurological Surgery at Northwestern University's Feinberg School of Medicine. He co-authored a study of NFL linemen's back injuries that appeared in 2010 in the American Journal of Sports Medicine.
Returning to the lineup six months ahead of projections in 2011, Harrison tied for the team lead with nine sacks. But he acknowledged that he briefly considered retirement because of post-surgical pain.
“During training camp last year, it was like, ‘I don't know if I can continue to do this,'” said Harrison, 34. “It could have actually ruptured to where I may not have been able to play again.”
Former Steelers offensive tackle Marvel Smith wasn't as fortunate. He retired at 31 after undergoing two surgeries to repair a herniated disc in his lower back.
“I was fighting through it, trying to continue to play. But I didn't have to play financially,” said Smith, who completed a six-year, $26 million contract in 2008, his final NFL season. “I was playing because I wanted to, but it wasn't to a point where I could play pain-free.”
The Steelers have experienced more than their share of back injuries, say officials inside and outside the organization. Since 2007, Harrison, Smith and former fullback Frank Summers had surgeries performed for a herniated disc in their lower back.
Smith, who joined the San Francisco 49ers after not re-signing with the Steelers, retired before the start of the 2009 season — eight months after his second surgery. Summers, a member of the San Diego Chargers practice squad last season who has yet to sign with a team for 2012, has not played in an NFL game since his rookie season in 2009.
“The numbers that we had in a relatively short time, I think, is a little unusual,” said Dr. Joseph Maroon, a UPMC neurosurgeon who has been the Steelers' team neurosurgeon since 1981 and performed the surgeries on Harrison, Smith and Summers. “I don't think there's anything about the Steelers and the way they practice or anything else. It's each individual's body.”
St. Louis Rams team physician Dr. Matthew Matava, also the team physician with the St. Louis Blues, said that many back injuries with one NFL team in a relatively short span is not common. “We've probably done less than five (back surgeries),” he said of his 11 years with the Rams.
With the recent emphasis by the NFL on preventing concussions, no one is sounding the alarm on debilitating back injuries.
“I don't think back pain conditions are going to explode like concussions since the diagnostic methods are already pretty accurate and sophisticated. However, back pain will always be a fact of life for the NFL,” Matava said.
The basics behind a back injury seem fairly simple: massive linemen often weighing more than 300 pounds slamming into each other with the intent of blocking for or attacking the quarterback and running backs.
There were 176 back injuries among 4,450 NFL player injuries in 2011, according to the official weekly report released by the league office. But back injuries and related problems have increased significantly enough over the past several years that medical experts are examining their origins in greater detail.
The 2010 study in the American Journal of Sports Medicine examined NFL linemen on active rosters from 1982-2009.
Of 66 players studied, 14 were treated without surgery and returned to play. Of the 52 players in the study who underwent back surgery, 42 returned to play in at least one NFL game.
Among the 42 who returned to play, seven players underwent a second surgical procedure, with six players again returning to action.
The Steelers' Smith is the only player among the seven who did not return to play after a second surgery.
“Offensive linemen are often in a two-point stance — they're in a squatting position. They put a lot of pressure on their disc,” said Northwestern's Hsu.
The most common back injury is degenerative disc disease.
“It's a breakdown of the disc in association with arthritis in the lower back,” Matava said.
The spinal column is made up of 26 vertebrae. Between each vertebra is a disc, a jelly-like substance that serves as a shock absorber.
A disc herniation occurs when pressure causes a disc to break, and a jelly-like substance squeezes out and sticks in the nerve.
“It causes intense pain and weakness. All the force is directed to those two discs at the base of your spine,” Maroon said.
Harrison underwent his first magnetic resonance imaging in October 2010. He was diagnosed with a herniated disc in his lower back, and Maroon presented him with two options.
“Our first look, (Maroon) said he would have to do surgery because you could see on the screen the bulge was so far out,” Harrison said. “The option was to get the surgery and be out (for the remainder of the season) or continue to go until you can't go no more and then hope everything holds up and get the surgery afterward.”
Harrison played in every game in 2010 and led the Steelers with 10 1⁄2 sacks.
On Feb. 21, 2011 — 15 days after the Steelers' 31-26 loss to the Green Bay Packers in Super Bowl XLV — Harrison underwent his first discectomy to surgically remove herniated disc material pressing against a nerve.
“Surgically, you do the best you can to decompress the nerve, then hope the rest of the disc stays intact,” Maroon said.
Nine days after the surgery, Maroon performed a second discectomy on Harrison.
“The second operation is unusual, but it's dictated by the MRI and the patient's complaint,” Maroon said.
“He didn't get it all the first time,” Harrison explained. “Too conservative.”
Maroon said he cautioned Harrison that the recovery following double back surgery would be 12 to 18 months. Yet Harrison returned to play in the 2011 season opener in six months.
Coach Mike Tomlin limited the star linebacker's workload in training camp and preseason games.
Smith said he wishes the Steelers had been as patient with his rehabilitation as they were with Harrison's.
He said he reported to training camp in July 2008 — seven months after his first discectomy — and was a full participant in drills.
“One thing I noticed with James, he didn't come right back doing everything,'' Smith said. “They brought him along gradually.”
The Steelers would not make their training staff available for comment concerning Harrison and Smith.
Smith said his back problems may have begun in 2003, his fourth year in the league, when he missed 10 games because of a pinched nerve. He wore a neck support, which he suggested forced him into a lower blocking stance. That resulted in more strain on his lower back and less flexibility in his ankle, he said.
In 2005, Smith missed four games with two separate high-ankle sprains.
“The high ankle sprains are what I felt like led to my back problems,” said Smith, who played the first 12 games in 2007 with a herniated disc.
After undergoing his first discectomy in December 2007, Smith missed the final 11 games in 2008 and underwent his second discectomy the December before the Steelers' 27-23 win over the Arizona Cardinals in Super Bowl XLIII. Smith got a second opinion from a California doctor who agreed with Maroon's recommendation before undergoing surgery.
“Marvel needed another operation because the disc wore out,” Maroon said. “He had subsequent problems. There's always a risk.”
In hindsight, Smith, who started 108 of 111 NFL games, won two Super Bowls and played in a Pro Bowl, said he would handle his situation differently and not be among players who played hurt as part of an unwritten team code.
“I tell guys all the time, ‘To hell with the team,' ” said Smith, who lives in Los Angeles and trains college linemen for the NFL Draft. “I would make sure I'm healthy before I go back on the field.”
John Harris is a staff writer for Trib Total Media. He can be reached at firstname.lastname@example.org.