Breaking Down Tony Romo's Back Injury, Recovery Timeline from a Herniated Disc

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Breaking Down Tony Romo's Back Injury, Recovery Timeline from a Herniated Disc
Patrick McDermott/Getty Images

Seemingly out of nowhere, Dallas Cowboys quarterback Tony Romo may miss the rest of the 2013 season due to a back injury known as a herniated intervertebral disc.

ESPN's Adam Schefter broke the news first. His colleague Chris Mortensen soon provided more details:

Herniated lumbar discs are a relatively common injury throughout the NFL—and life in general. In fact, low back pain—with or without herniation—represents one of the most frequent of all chief complaints at doctors' offices.

Unfortunately, Romo's came at one of the most inopportune times imaginable.

Furthermore, the entire story still remains unclear—at least partially. According to Pro Football Talk's Curtis Crabtree, neither owner Jerry Jones nor head coach Jason Garrett are throwing in the towel:

Perhaps the injury is not as severe, after all.

Or perhaps Jones and Garrett are merely posturing leading up to the Week 17 matchup with the Philadelphia Eagles—a game that will decide the NFC East champion.

To attempt to make sense of what's going on—and what's not—it helps to take a look at the injury itself.

 

What Are Intervertebral Discs?

The human spine functions as a flexible but strong bony casing that houses and protects the spinal cord. Many different vertebrae and intervertebral discs allow it to do so.

Wikimedia Commons.
Intervertebral discs, seen here in red, cushion the spine and allow for flexibility between vertebrae.

For a better picture, imagine cylindrical blocks stacked on top of one another. Now—bear with me here—gently place a round, flat bit of clay in between each. The blocks are the vertebrae, and the clay represents the discs.

From a functional standpoint, discs help cushion and stabilize motion between each vertebra, providing spinal flexibility.

 

What Is a Herniated Disc?

Two types of material make up an intervertebral disc—the nucleus pulposus and annulus fibrosus.

The nucleus pulposus resides in the center of the disc and carries a jelly-like consistency. Conversely, the annulus fibrosus serves as a tough outer covering.

A disc injury occurs when a sharp, forceful bend or twist of the back applies pressure to the area of a disc. If the pressure is great enough, the annulus fibrosus tears open and allows the nucleus pulposus to leak out. Long-term, age-related annulus fibrosus degeneration and weakening can also contribute to the problem.

Wikimedia Commons.
This diagram depicts the basic concept behind a herniated disc.

In other words, and continuing with the above metaphor, pressing two blocks together—either suddenly and briskly or gradually over time—squeezes out the clay from between them.

Why does that become a problem?

Simple. Immediately adjacent to the intervertebral discs lie spinal nerve roots—the bases of every nerve in the body. As the nucleus pulposus leaks out—or "herniates"—it compresses those roots.

 

How Does a Herniated Disc Produce Symptoms?

If the spinal cord is the body's nerve highway, the roots are on-ramps and off-ramps.

For example, in order for the brain to tell the knee to straighten, a signal must travel from the brain, down the cord, out the root, into smaller nerves and to the destination muscle—in this case, the quadriceps.

When the signal reaches the quadriceps, the muscle contracts, and the leg straightens.

Conversely, sensory input from the legs and arms must travel from the skin in question, into smaller nerves, back through the spinal root, up the spinal cord and into the brain for processing.

Any interruption on that path—such as compression of a root from a substance that isn't supposed to be there—leads to symptoms like pain, weakness and numbness.

For example, a compressed root in the lower back may not only cause low back pain, but also an intermittent shooting pain down the leg or hip and into the foot.

If downward-moving nerve signals cannot bypass the compression and leave the spinal cord, weakness results.

Similarly, the interruption of sensory signals traveling back into the cord from the periphery can lead to numbness.

 

What Effects Does a Herniated Disc Have on an NFL Player?

Should a severe herniation occur in the lower back—or the "lumbar" spine—walking can become difficult or nearly impossible, not to mention running and cutting.

Scott Halleran/Getty Images
Peyton Manning suffered from a herniated cervical disc in his neck. While lumbar discs in the lower back affect the legs, cervical discs affect the arms.

An analogous situation in the neck—or "cervical" spine—yields symptoms in one arm or shoulder. Peyton Manning battled back from a cervical disc herniation in 2011—one many thought would leave him with permanently decreased arm strength—only to return to record-breaking form this year.

Importantly, the longer nerves are out of commission, the harder it can become for them to resume full function.

 

How Are Herniated Discs Treated?

Usual first-line therapy includes icing, relative rest and anti-inflammatory medication.

If pain persists after a few weeks, doctors may decide to proceed with a spinal steroid injection. Steroids serve as more potent and longer-lasting anti-inflammatories.

Nevertheless, these interventions represent mere stopgaps until weeks of physical therapy hopefully relieve stress on the spine.

If therapy fails, spinal surgeons can physically remove either all or the offending portion of a disc.

Without the presence of the intruding disc, the affected nerves can start to recover.

Surgeons may also decide to use hardware to fuse the two vertebrae above and below the removed disc, offering increased spinal stability at the expense of a small degree of flexibility.

Recovery times from surgery usually come in the form of months, not weeks, and exact timetables depend on the extent of symptoms and amount of function lost prior to going under the knife.

 

What Happened in Tony Romo's Case?

Romo's injury came a bit out of left field, but recall that he underwent surgery to remove a cyst in his back earlier this year.

Tom Pennington/Getty Images
Tony Romo may be forced to watch Week 17 from the sidelines.

Whether or not this latest development relates to the cyst is anyone's guess, but from a medical standpoint, it very well could if the cyst—or the surgery to remove it—invaded or weakened tissues in or around his spine. Football Guys' Dr. Jene Bramel wrote about such a possibility shortly after the news broke on Monday.

Then again, over two dozen intervertebral discs populate the human spine, so the injury could involve a different spinal level altogether.

It's also very possible—perhaps even likely—a minor, minimally symptomatic disc bulge acutely worsened on Sunday and became a frank herniation. At this point, only Romo, his medical team and the Cowboys truly know.

 

What's the Bottom Line?

All told, the Cowboys signal-caller will almost certainly need surgery at some point in the future—as numerous reports suggest.

Why?

As an NFL quarterback, the hits to Romo's back are not going to stop any time soon.

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While steroid injections and core strengthening may briefly stem the tide by reducing inflammation—and therefore symptoms—removing the troubled disc represents the only real long-term solution.

Even then, non-surgical treatment can only do so much, and efficacy varies widely from case to case.

That said, the mere possibility of non-surgical treatment likely already took its toll in the form of Monday's conflicting reports.

On the one hand, the excellent Cowboys medical staff surely has or will explore all potential options to prolong their star's season.

On the other, no owner nor coach would rule out his starting quarterback a full six days before a division-deciding game—even if the decision has already been made internally.

After all, when it comes to injuries in the NFL, leaving an opponent guessing as long as possible might be the only silver lining to be had.

 

Dr. Dave Siebert is a Family Medicine resident physician at the University of Washington in Seattle, Wash. He plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.

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