Return to sport after lumbar disc herniation surgery: a narrative review of surgical techniques, rehabilitation, and outcomes
DOI:
https://doi.org/10.12775/QS.2026.61.72974Keywords
return to sport, lumbar disc herniation, discectomy, athletic rehabilitationAbstract
Background. Lumbar disc herniation (LDH) is prevalent among elite athletes, reaching up to 75% in high-impact sports. Extreme physical demands accelerate spinal degeneration, making the choice between surgical and conservative management critical for rapid return to play (RTP).
Aim. This review evaluates the impact of surgical techniques, phased rehabilitation, and sport-specific factors on RTS rates and timing after surgery.
Material and methods. A qualitative synthesis of 23 sources was performed, including meta-analyses, systematic reviews, and league-specific cohort studies.
Results. RTS rates after discectomy are high (75%–100%). Minimally invasive procedures, particularly transforaminal endoscopic discectomy (TELD), offer shorter recovery times (avg. 4 months) and less back pain than microdiscectomy. Recovery is optimized through structured, four-phase rehabilitation focusing on core stabilization and "hip hinge" motor control. While surgery provides faster short-term relief, long-term functional outcomes often align with conservative management.
Conclusions. Surgery effectively enables rapid symptom resolution in elite athletes. Long-term success depends on adherence to phased rehabilitation. Endoscopic techniques represent a promising advancement in reducing morbidity and shortening recovery time in the athletic population.
References
1. Albertazzi, E. (2025). Return to sport after lumbar spine surgery: a comprehensive review. International Journal of Research in Orthopaedics, 11(6), 1611-1616. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253443.
2. Ambrosio, L., Vadalà, G., de Rinaldis, E., Muthu, S., Corluka, S., Buser, Z., Meisel, H.-J., Yoon, S. T., & Denaro, V. (2025). Discectomy versus sequestrectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis. The Spine Journal, 25, 211-226. https://doi.org/10.1016/j.spinee.2024.09.007.
3. Calikoglu, C., & Cakir, M. (2018). Open Discectomy vs. Microdiscectomy: Results from 519 Patients Operated for Lumbar Disc Herniation. Eurasian Journal of Medicine, 50(3), 178-181. https://doi.org/10.5152/eurasianjmed.2018.18016.
4. Goto, K., Kawasaki, Y., Hirota, J., Yamamoto, N., & Seichi, A. (2023). Return-to-Sport Rate, Type of Sport, Frequency of Participation, and Patient Satisfaction After Elective Spinal Surgery in the Elderly Population. Orthopaedic Journal of Sports Medicine, 11(5). https://doi.org/10.1177/23259671231169936.
5. Iwamoto, J., Sato, Y., Takeda, T., & Matsumoto, H. (2011). Return to play after conservative treatment in athletes with symptomatic lumbar disc herniation: a practice-based observational study. Open Access Journal of Sports Medicine, 2, 25-31. https://doi.org/10.2147/OAJSM.S17523.
6. Kapetanakis, S., Chaniotakis, C., Koukos, C., Tsioulas, P., Charitoudis, G., & Gkantsinikoudis, N. (2026). Surgical Management of Lumbar Disc Herniation in Elite Athletes: A Comparative Study of Microdiscectomy and Endoscopic Lumbar Discectomy. The Orthopaedic Journal of Sports Medicine, 14(4). https://doi.org/10.1177/23259671261431841.
7. Kögl, N., Petr, O., Löscher, W., Liljenqvist, U., & Thomé, C. (2024). Lumbar Disc Herniation: The Significance of Symptom Duration for the Indication for Surgery. Deutsches Ärzteblatt International, 121(13), 440-448. https://doi.org/10.3238/arztebl.m2024.0074.
8. Lurie, J. D., Tosteson, T. D., Tosteson, A. N. A., Zhao, W., Morgan, T. S., Abdu, W. A., Herkowitz, H., & Weinstein, J. N. (2014). Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Eight-Year Results for the Spine Patient Outcomes Research Trial (SPORT). Spine, 39(1), 3-16. https://doi.org/10.1097/BRS.0000000000000088.
9. Ma, Z., Yu, P., Jiang, H., Li, X., Qian, X., Yu, Z., Zhu, Y., & Liu, J. (2021). Conservative Treatment for Giant Lumbar Disc Herniation: Clinical Study in 409 Cases. Pain Physician, 24, E639-E648. https://pubmed.ncbi.nlm.nih.gov/34323452/
10. Minhas, S. V., Kester, B. S., & Hsu, W. K. (2016). Outcomes After Lumbar Disc Herniation in the National Basketball Association. Sports Health, 8(1), 43-49. https://doi.org/10.1177/1941738115608361.
11. Nair, R., Kahlenberg, C. A., & Hsu, W. K. (2014). Outcomes of Lumbar Discectomy in Elite Athletes: The Need for High-level Evidence. Clinical Orthopaedics and Related Research, 473(6), 1971-1977. https://doi.org/10.1007/s11999-014-3762-z.
12. O’Connor, S. B., Holmberg, K. J., Hammarstedt, J. E., Acosta, J. R., Monahan, K., Sauber, R. D., & Altman, D. T. (2023). Return-to-Play Outcomes of Athletes After Operative and Nonoperative Treatment of Lumbar Disc Herniation. Current Reviews in Musculoskeletal Medicine, 16(5), 192-200. https://doi.org/10.1007/s12178-023-09829-z.
13. Ong, A., Anderson, J., & Roche, J. (2003). A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games. British Journal of Sports Medicine, 37, 263-266. https://doi.org/10.1136/bjsm.37.3.263.
14. Oosterhuis, T., Costa, L. O. P., Maher, C. G., de Vet, H. C. W., van Tulder, M. W., & Ostelo, R. W. J. G. (2014). Rehabilitation after lumbar disc surgery. Cochrane Database of Systematic Reviews, (3). https://doi.org/10.1002/14651858.CD003007.pub3.
15. Reiman, M. P., Sylvain, J., Loudon, J. K., & Goode, A. (2016). Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis. British Journal of Sports Medicine, 50, 221-230. http://doi.org/10.1136/bjsports-2015-094691.
16. Sedrak, P., Shahbaz, M., Gohal, C., Madden, K., Aleem, I., & Khan, M. (2021). Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment. Sports Health, 13(5), 446-453. https://doi.org/10.1177/1941738121991782.
17. Sigmundsson, F. G., Möller, A., & Strömqvist, F. (2020). Surgery for Lumbar Spinal Stenosis in Patients With Mild Leg Pain Levels Is Associated With Unsatisfactory Outcome. Global Spine Journal, 11(8), 1202-1207. https://doi.org/10.1177/2192568220942510.
18. Song, K., Liang, J., Zhang, M., Cai, S., Wang, Y., & Wu, W. (2025). Comparison of different treatments for lumbar disc herniation: a network meta-analysis and systematic review. BMC Surgery, 25, 259. https://doi.org/10.1186/s12893-025-02992-9.
19. VanGelder, L. H., Hoogenboom, B. J., & Vaughn, D. W. (2013). A phased rehabilitation protocol for athletes with lumbar intervertebral disc herniation. International Journal of Sports Physical Therapy, 8(4), 482-516. https://pubmed.ncbi.nlm.nih.gov/24175134/
20. Weinstein, J. N., Lurie, J. D., Tosteson, T. D., Skinner, J. S., Hanscom, B., Tosteson, A. N. A., Herkowitz, H., Fischgrund, J., Cammisa, F. P., Albert, T., & Deyo, R. A. (2006). Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort. JAMA, 296(20), 2451-2459. https://doi.org/10.1001/jama.296.20.2451.
21. Yaman, M. E., Kazancı, A., Yaman, N. D., Baş, F., & Ayberk, G. (2017). Factors that influence recurrent lumbar disc herniation. Hong Kong Medical Journal, 23(3), 258-263. https://doi.org/10.12809/hkmj164852.
22. Yu, H., Cancelliere, C., Mior, S., Pereira, P., Nordin, M., Brunton, G., Wong, J. J., Shearer, H. M., Connell, G., Ead, L., Verville, L., Rezai, M., Myrtos, D., Wang, D., Marchand, A.-A., Romanelli, A., Germann, D., To, D., Young, J. J., Southerst, D., Candelaria, H., Hogg-Johnson, S., & Côté, P. (2024). Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review. Brain & Spine, 4, 102806. https://doi.org/10.1016/j.bas.2024.102806.
23. Zhang, J., Zhang, W., Yue, W., Qin, W., Li, Z., & Xu, G. (2025). Adolescent lumbar disc herniation: etiology, diagnosis, and treatment options. Journal of Orthopaedic Surgery and Research, 20, 605. https://doi.org/10.1186/s13018-025-06024-3.
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Copyright (c) 2026 Karolina Korowaj, Aleksandra Gadzielik, Kinga Zofia Papciak, Maciej Piotr Dercz, Klaudia Woźniak, Jakub Paweł Palacz, Alicja Fitas, Michał Radliński, Urszula Zofia Jabłońska, Michał Głaszczka

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