Return to Sport after Disc Herniation: A Comprehensive Review of Conservative and Surgical Treatment Approaches

Abstract

Introduction

Back pain (BP) is a globally prevalent musculoskeletal disorder, affecting up to 85% of individuals at some point in their lives. It significantly affects quality of life and productivity, with a particularly high prevalence in athletes due to the high physical demands of their activity. This review examines the comparative effectiveness of conservative and surgical treatments for patients with disc herniation (DH), focusing on their return-to-sport (RTS) outcomes.

Methods

A systematic review was conducted of studies evaluating RTS following conservative or surgical treatment of patients with DH. Databases including PubMed, MEDLINE, and EMBASE were searched for studies reporting RTS rates, recovery times, and long-term performance outcomes, with a focus on adult athletes.

Results

A total of 16 studies were included in this systematic review, consisting of retrospective and prospective cohort studies, randomised controlled trials, and case-control designs. These studies were specifically selected for their relevance to RTS outcomes following conservative or surgical treatment of intervertebral disc herniation in athletes. Collectively, the studies included approximately 2,500 athletes across various sports, such as football (NFL), soccer (Serie A), basketball (NBA), baseball (MLB), hockey (NHL), rugby, tennis, and rowing. Both conservative treatments (e.g., physical therapy) and surgical interventions (e.g., microdiscectomy) demonstrated high RTS rates, ranging from 78.9% to 97%. Athletes treated conservatively typically returned to play faster (4.7 months on average), whereas surgical treatment was associated with a slightly higher long-term RTS success (up to 97%) and recovery times ranging from 5.2 to 5.8 months. Notably, no significant long-term performance impairments were observed.

Discussion

Both treatment modalities were effective, with surgical approaches offering particular benefits for patients with neurological deficits or severe disc degeneration. Conservative treatment was associated with faster recovery, supporting its use as a first-line approach for patients with mild symptoms or athletes requiring rapid RTS.

Conclusion

While both conservative and surgical treatments yield high RTS rates, the decision must be individualised based on the patient’s symptom severity, neurological status, and sport-specific demands. Future studies should focus on optimising treatment protocols and developing standardised RTS criteria tailored to elite athletes for improved long-term functional outcomes.

Zusammenfassung

Einleitung

Rückenschmerzen (RS) sind eine weltweit verbreitete muskuloskelettale Erkrankung, von der bis zu 85 % der Menschen im Laufe ihres Lebens betroffen sind. Sie beeinträchtigen die Lebensqualität und Produktivität erheblich und treten insbesondere bei Athlet:innen aufgrund der hohen physischen Belastungen häufig auf. Diese Übersicht analysiert die vergleichende Wirksamkeit konservativer und chirurgischer Behandlungsansätze bei Patient:innen mit Bandscheibenvorfall (BSV) unter besonderer Berücksichtigung der Rückkehr-zum-Sport (RTS)-Ergebnisse.

Methoden

Es wurde eine systematische Übersichtsarbeit zu Studien durchgeführt, die die RTS nach konservativer oder chirurgischer Behandlung von Patient:innen mit BSV untersuchten. Relevante Datenbanken wie PubMed, MEDLINE und EMBASE wurden nach Studien durchsucht, die Angaben zu RTS-Raten, Erholungsdauern und langfristigen Leistungsparametern bei erwachsenen Athlet:innen machten.

Ergebnisse

Insgesamt wurden 16 Studien in diese systematische Übersichtsarbeit einbezogen, darunter retrospektive und prospektive Kohortenstudien, randomisierte kontrollierte Studien und Fall-Kontroll-Studien. Die Studien wurden aufgrund ihrer Relevanz für die RTS-Ergebnisse nach konservativer oder chirurgischer Behandlung von Bandscheibenvorfällen bei Athlet:innen ausgewählt. Zusammenfassend umfassten sie ca. 2.500 Athlet:innen aus verschiedenen Sportarten, darunter American Football (NFL), Fußball (Serie A), Basketball (NBA), Baseball (MLB), Eishockey (NHL), Rugby, Tennis und Rudern. Sowohl konservative Behandlungen (z. B. Physiotherapie) als auch chirurgische Eingriffe (z. B. Mikrodiskektomie) zeigten hohe RTS-Raten zwischen 78,9 % und 97 %. Konservativ behandelte Athlet:innen kehrten im Durchschnitt schneller zum Sport zurück (im Mittel 4,7 Monate), während chirurgische Interventionen eine etwas höhere langfristige RTS-Erfolgsquote (bis zu 97 %) bei einer Erholungszeit von 5,2 bis 5,8 Monaten aufwiesen. Langfristige Leistungseinbußen wurden nicht beobachtet.

Diskussion

Beide Behandlungsansätze erwiesen sich als effektiv, wobei chirurgische Verfahren insbesondere bei Patient:innen mit neurologischen Defiziten oder schwerer Bandscheibendegeneration vorteilhaft waren. Konservative Behandlungen ermöglichten eine schnellere Genesung und werden daher als Erstlinienoption für Patient:innen mit milden Symptomen oder Athlet:innen, die eine rasche Rückkehr zum Sport benötigen, empfohlen.

Fazit

Sowohl konservative als auch chirurgische Behandlungsansätze führen zu hohen RTS-Raten. Die Behandlungsentscheidung sollte jedoch individuell in Abhängigkeit vom Schweregrad der Symptome, dem neurologischen Status und den sportspezifischen Anforderungen getroffen werden. Zukünftige Studien sollten auf die Optimierung von Behandlungsprotokollen sowie die Entwicklung standardisierter RTSKriterien für Leistungssportler: innen zur Verbesserung langfristiger funktioneller Ergebnisse abzielen.

Keywords

Return to Sport (RTS) - Disc Herniation (DH) - Conservative Treatment - Microdiscectomy - Athlete Rehabilitation

Schlüsselwörter

Rückkehr zum Sport (RTS) - Bandscheibenvorfall (BSV) - konservative Behandlung - Mikrodiskektomie - Rehabilitation von Athlet:innen

Publication History

Received: 17 April 2025

Accepted after revision: 16 July 2025

Article published online:
25 September 2025

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