Dallas Cowboys: An In-Depth Look at Tony Romo's Rehabilitation

David Pratt, DPT@@PFF_DavePrattContributor IIIFebruary 10, 2014

Dallas Cowboys quarterback Tony Romo flashes a thumbs-up as he walks off the field after the Cowboys defeated the Washington Redsksins 24-23 in an NFL football game in Landover, Md., Sunday, Dec. 22, 2013. (AP Photo/Evan Vucci)
Evan Vucci/Associated Press

Dallas Cowboy quarterback Tony Romo underwent a discectomy to repair a herniated lumbar disk in late December. A few days ago, it was reported that Romo has been progressing well from his surgery, and has now started the first phase of his therapeutic exercise program.

Romo’s regular season was cut short as he began to display symptoms that were consistent with a lumbar disc herniation: low back pain and radicular pain traveling into the leg (e.g. sciatica).

His symptoms must not have resolved with conservative interventions, so his next best course of treatment was surgical resection of the herniated material (i.e. discectomy).

Dr. Drew Dossett, spinal consultant for the Cowboys, performed a discectomy to repair Romo’s herniated disc on December 27, 2013, as reported by ESPN's Calvin Watkins.

Romo was released from the hospital on the same day as surgery, so the surgery was likely a microdiscectomy.

A microdiscectomy is a less invasive discectomy procedure. With this procedure, the surgeon makes a smaller incision and uses a special microscope to enlarge the tissue visually. The smaller incision decreases the magnitude of damage to the surrounding tissue.

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The surgery consists of the surgeon removing bone lying over the nerve root or removing portions of the intervertebral disc from under the nerve root in order to reduce the neural impingement. The resultant decreased pressure on the nerve would allow it to heal over time.

On February 7, ESPN’s Calvin Watkins reported that Romo is now performing core strengthening and core stabilization exercises, a beginning phase of his rehabilitation process.

This is encouraging news regarding Romo’s recovery. It shows that he has not had any significant complications with the surgery.

After all, research has shown that the early success rates of a lumbar discectomy range from 65 to 91 percent. This means 9 to 35 percent of surgical cases have unsatisfactory outcomes.

Although it’s encouraging that Romo has begun to perform core strengthening and core stabilization exercises, he has many milestones still left ahead of him.

Typical rehabilitation protocols for patients following a microdiscectomy involve an intense 12-week strength and endurance training program of the trunk and lower-extremity muscles.

In particular, Romo will need to begin exercises focused on strengthening his spinal extensor muscles. Following this surgery, these important postural muscles often atrophy, weaken and have higher fatigability with activity.

Variable-angle Roman chair. Levels of difficulty of the Roman chair, from easiest (level 1) to most difficult (level 6).
Variable-angle Roman chair. Levels of difficulty of the Roman chair, from easiest (level 1) to most difficult (level 6).Kulig K, Beneck GJ, et al. Physical Therapy Journal November 2009 vol. 89 no. 11 1145-1157

For example, a proven way of strengthening these muscles is to have the person isometrically hold a neutral spine position in varying angles against gravity; this can be performed using a variable-angle Roman chair.

If these essential trunk muscles are not strengthened adequately, then increased stresses will be put on the intervertebral discs, and other spinal structures, during football activities. That would in turn increase Romo’s chance of having further damage to his low back in the future.

Romo will then likely be introduced to a progression of strengthening exercises from the supine position, to quadruped and then finally to upright standing. These exercises would be targeted at progressively strengthening the abdominal muscles, lower-extremity muscles and the spinal extensor muscles. 

Romo will also likely also be reintroduced into throwing and footwork drills in the coming weeks. This is a slow and gradual reintroduction to sport-specific activities, and his tolerance will dictate the speed of activity progression.

However, he will not be allowed to perform heavy lifting (20 lbs or over) until approximately 12 weeks post-operation. This means he will spend a lot of the early offseason in the training room and less of it in the weight room.

He will also be forbidden from participating in contact activities until three to four months post-operation or until the surgeon otherwise gives permission. Fortunately for Romo, he is still more than six months away from the beginning of training camp.

All of these precautions are made to allow time for the disc to heal and to allow the neural sensitivity to diminish. Full recovery from this procedure can take up until 18 months post-operation, so expectations from the Cowboys organization need to be realistic.

Throughout this whole rehabilitation process, Romo will need to continue strengthening his core, so that he can support his spinal structures adequately during football activities. Simultaneously he will also need to sufficiently strengthen his lower extremities enough to regain his maximal mobility and push-off during throwing.

If Romo is able to successfully reach all of his rehabilitation milestones, he should be ready to practice—in a limited capacity—in the spring OTAs.

However, if he does not regain enough core strength and stability, not only will his performance on the field be diminished, but he will also have a higher likelihood of having further low-back injuries in the future. And that would compromise the future of the Cowboys' franchise quarterback.

Dave Pratt, DPT, is a licensed physical therapist focused on orthopedic and sports-related injuries. All information given is for educational purposes only.

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