Combat Arts Lower Back Injuries Overview
Jet Li has spoken openly about the toll a lifetime of martial arts and film work has taken on his body, including a serious spine injury suffered on set, a broken rib, a fractured ankle, and a long list of smaller injuries along the way. The details that circulate about that fall vary from telling to telling, so treat them as the legend they have become.
Now he’s dealing with heart issues and hyperthyroidism, as well. Li said, ‘I’m in pain but I’m not in a wheelchair yet.’
Lower Back Injury Causes
There are several physical issues that can cause problems: Weak lower back muscles, weak abdominal muscles, overly tight or weak psoas muscle, overly tight or weak hip flexor muscles, and/or overly tight or weak hamstring muscles.
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Overworking these muscles through fights, five-round training camps, and heavy training can also injure the spine via vertebral fractures. Additionally, kicks, punches, and chokes that cause the back to hyperextend can damage the ligaments. Submission moves like the swim move in jiu-jitsu where the back is mounted and stretched can strain the back.
Lower Back Injury Symptoms
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Types of Lower Back Injuries
Injuries to the spine are common due to the constant wear and tear on the spine and its muscles and ligaments. Left alone they can get worse: a disc can herniate and press on nerve roots, and the damage that follows can be permanent rather than a passing ache. Other back injuries like herniated discs and fractured vertebrae have been covered in the neck area. In this section, we focus on back injuries specific to the lower back like sciatica and cauda equina syndrome.
Overly Tight or Weak Psoas Muscle? Weak Hip Flexor Muscles?
What's Causing Your Back Pain? We Can Help!
Related Injuries
Sciatica plagues many fighters. MMA great Cain Velasquez battled sciatica for years. In his case, the sciatic nerve was being compressed by bony spurs. Even standing for fifteen minutes was painful, and he could barely manage everyday physical tasks. His first surgery did not work. A second operation to make room for the nerve was successful and led to his return to the Octagon.
Symptoms
Causes
The sciatic nerve is formed from the L4 to S3 nerve roots. Those roots fuse into the large sciatic nerve, which leaves the pelvis through the sciatic foramen, runs down the back of the thigh, and divides into the tibial and fibular nerves behind the knee in the popliteal fossa. Any problem along that path can cause sciatica. Injuries to the spine like a herniated disc, bone spurs, or spinal stenosis narrowing the canal can compress the nerve roots. The injuries could be due to overuse or blunt trauma from high-velocity kicks or punches.
To learn how Sciatica is diagnosed Click Here
Cauda Equina Syndrome happens when a ruptured or herniated disc compresses the nerve roots at the bottom of the spinal canal and the problem is left untreated or poorly managed. UFC veteran Angela Magana had surgery after her disc ruptured and suffered serious complications afterwards that put her career on hold. Accounts of what happened vary, and cauda equina syndrome itself does not cause a coma. What it does cause, if it is not decompressed quickly, is permanent damage to the nerves that run the legs, bladder and bowel.
Cauda equina syndrome is compression of the bundle of nerve roots that hangs below the end of the spinal cord, which itself finishes around the first or second lumbar vertebra. The cord is not the structure being squeezed, and that is the anatomical difference between this and a spinal cord injury higher up. It usually follows a herniated or ruptured lumbar disc. The disc could be damaged acutely during a fight or a crush, or give way after years of accumulated stress.
To learn how Cauda Equina Syndrome are diagnosed Click Here
Common Injuries
Learn more about other common lower back injuries in our Common Injuries section.
Lower Back Injury Diagnosis
Lower back injuries are often put through a gamut of tests because spinal injuries can cause life-altering damage: paralysis, weakness that never fully recovers, and loss of bladder and bowel control. Imaging and physical exam form the cornerstone of diagnosing these injuries.
Injury Specific Diagnosis
Physical Exam
Sciatica is a clinical diagnosis. A good physical examination is needed to evaluate pain and symptoms. Sciatica demonstrates unilateral pain. On examination of the lower back and leg, pain radiates to the affected extremity.
Doctors must examine sensation and muscle strength in the buttocks and lower limbs. A straight-leg raise test is done. It is a passive examination. The fighter lies relaxed and supine while the doctor lifts the leg and flexes it at the hip, keeping the knee extended and the leg straight. Pain that shoots down the leg in the early part of that arc suggests nerve root irritation from a lumbar disc. Back pain on its own does not count as a positive test, and a positive test points toward the diagnosis rather than proving it.
Imaging
Routine imaging is not needed for straightforward sciatica in the first few weeks, because it rarely changes what gets done. It is worth getting when a fighter has taken real trauma, when symptoms drag on past six to eight weeks without responding to treatment, or when there are red flags. Plain films of the lumbosacral spine show fractures, spondylolisthesis and other bony problems, and a non-contrast CT scan is an option if the plain films are unremarkable. For any neurologic deficit, an MRI must be done to rule out spinal pathology.
Lab Tests
Blood tests are not necessary to confirm sciatic unless surgery is warranted.
To learn how Sciatica is treated Click Here
A thorough neurological examination is paramount when it comes to cauda equina syndrome. Any motor or sensory deficits in the legs whether bilateral or unilateral and asymmetrical raise a flag for spinal pathology.
Doctors look for signs like areflexia, hypotonia and atrophy, which point to longer-standing compression from a herniated disc. Additionally, saddle anesthesia in the buttock and groin area, absent or decreased rectal tone, and impotence in men will also be checked. Doctors will also palpate the bladder to see if there is urinary retention.
The gold standard is an urgent MRI with sagittal and axial sequences, and it needs to happen without delay, because the sooner the compression is relieved the better the chance of keeping bladder, bowel and leg function. Cauda equina syndrome is not usually fatal, but left undecompressed it causes permanent paralysis, saddle numbness, and lasting bladder, bowel and sexual dysfunction. Neurosurgical or orthopedic consultation must follow. A CT myelogram is an option for those with metal implants who cannot have an MRI. A bladder scan is also done to check post-void residual volume and look for urinary retention.
Blood tests are done in preparation for surgery. A lumbar puncture is not the test for cauda equina syndrome. It samples cerebrospinal fluid to look for bleeding or infection, which is a different workup entirely, and where cauda equina compression is suspected it is the wrong move: it risks delaying the MRI that decides whether the fighter reaches the operating room in time.
To learn how Cauda Equina Syndrome is treated Click Here
Common Diagnoses
Read our Common Diagnoses section to understand how doctors diagnose injuries in the lower back through various tests and modalities.
Lower Back Injury Treatment
Lower back injuries are treated based on the injury. Most lower back injury management involves strengthening the core muscles and practicing good technique to prevent them. Injuries to the back are dangerous because they can compress nerves and, in the case of cauda equina syndrome, leave permanent loss of leg, bladder and bowel function if they are not decompressed quickly. That one is treated surgically, and urgently.
Injury Specific Treatment
Emergency
Cauda equina syndrome is a surgical emergency. Go to an emergency department now, not to a clinic appointment, if you have numbness in the groin, buttocks or inner thighs, if you lose control of your bladder or bowels or cannot pass urine, or if weakness or numbness in the legs is getting worse. Those symptoms mean the nerve roots are being crushed, and an urgent MRI and decompression within hours is what protects walking and continence. Ordinary lower back pain and sciatica are not emergencies, but they are not something to quietly train through either, whatever the room expects of you.
Medical
Pain is usually managed with a short course of oral NSAIDs, with muscle relaxants sometimes added for spasm. Stronger painkillers, oral steroid courses, localized corticosteroid injections and any nerve-pain medication are prescribing decisions for a doctor who has examined you, and gabapentin and pregabalin in particular are no longer well supported for sciatica. Keep in mind that masking the pain lets a fighter keep loading a compressed nerve, which is how a bad back becomes a permanent one. Deep tissue massage and physical therapy help the surrounding muscles, and surgery is considered for disc herniation and spinal stenosis that will not settle.
Home
At home, fighters are advised to use hot or cold packs to ease pain and inflammation. They should avoid activities that trigger or incite the pain, and avoid sitting or standing in one position for long stretches. Get straight to an emergency department if numbness appears in the groin or inner thighs, if bladder or bowel control changes, or if leg weakness is getting worse.
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Practice good posture. Develop core strength and back muscles. Warm up before all workouts, and bring stretching for the lumbar spine and hamstrings back into your routine gradually. If you lift weights, learn proper lifting techniques. Light exercise like swimming, walking and aquatherapy can ease the tension in the muscles, and yoga may help low back pain as long as you modify the positions that aggravate it.
Suspected cauda equina syndrome goes straight to hospital: an immediate neurosurgical consult, orthopedics alongside it, and an urgent MRI. Surgery follows as soon as the scan confirms the compression. Trauma protocols such as ATLS apply when there has been major trauma, but a disc-driven cauda equina is a race to the scanner and the operating room.
The treatment is surgical decompression via laminectomy. This could involve subsequent discectomy or not, or via sequestrectomy. A laminectomy is where the back portion of the vertebra is removed to ease the pressure on the spine. A discectomy is where the disc is completely removed and replaced with a synthetic disc or it could be partially removed.
Post cauda equina syndrome surgery, the recovery is long. Ice the incision area for 20-30 minutes several times a day. Always wrap the ice in a towel. Keep the incision clean and dry.
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Change position every 45-60 minutes while awake. Walk three times a day or as permitted. Don’t do any strenuous activity. No sports or aerobic activity that involves lifting, bending, and jarring the spine. Don’t limit movement either.
No lifting more than 10 pounds are permitted. No driving until all reflexes have returned. Sex is not permitted for two weeks after surgery. Sleep on the side.
Place pillows behind the knees if lying on your back. Alternatively, place pillows behind the back and between the legs when lying on one side. No swimming, hot tubs, or lakes until 6 weeks post-surgery, to keep the incision dry and uninfected. Wear compression stockings and elevate the legs to increase circulation. Take pain medication only as your surgeon prescribes it, and follow the discharge instructions you were given ahead of anything you read here.
Common Treatments
Read through our Common Treatments section to understand how various back injuries are treated through conservative and alternative therapies.
