Disc-related low back pain (lumbar disc injury, with or without nerve root irritation)

What it is

Between each pair of vertebrae sits a disc, a tough fibrous ring around a gel-like centre, which spaces the bones and spreads load. Repeated bending and rotation under compression can irritate or tear fibres in the ring. If the gel pushes outward far enough it can press on, or chemically irritate, a nearby nerve root, and that is what sends pain, pins and needles or numbness down the leg. Disc bulges also show up on scans in plenty of people with no pain at all, so the scan alone is not the diagnosis.

How volleyball causes it

This is the one volleyball back injury the arch does not cause. It comes from the other half of the sport: the hours spent in a flexed passing posture, the low lunging digs, and the compression of landing, which runs several times body weight through the spine on every jump. Hitters compound it in the transition from full extension in the air to a flexed, rotated landing, so the disc absorbs the whole reversal. Beach players get more of it from unstable sand landings and low digs, and the gym adds risk when heavy deadlifts or cleans get done with a rounded back after a hard practice.

PassingDefenseAttackingBlocking

What it feels like

• A deep ache or band of pain across the low back, sometimes more on one side
• Worse with sitting, and much worse after a long drive to a tournament or a set spent on the bench
• Worse first thing in the morning and when bending forward to put shoes on
• Coughing, sneezing or straining increases it
• Pain, pins and needles or numbness into the buttock, back of the thigh, calf or foot
• Leg pain that is worse than the back pain, following a clear line down the limb

Stop and get it seen if

• Numbness in the groin, inner thighs or saddle area, loss of bladder or bowel control, or difficulty starting or feeling urination. This is a medical emergency and needs an emergency department the same day, not an appointment.
• Weakness in the leg or foot: a dragging toe, foot slapping when you walk, or being unable to rise onto toes or heels on one side
• Symptoms in both legs at once, or leg symptoms that are getting steadily worse over days
• Fever, recent infection, or unexplained weight loss with back pain
• Severe pain starting immediately after a fall, a collision or a heavy landing gone wrong

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Settle the irritation

   1 to 4 weeks

   Reduce the nerve irritation and find the positions and movements that ease symptoms rather than provoke them.

   • Leg symptoms retreating up towards the back rather than spreading further down, which is the single most useful sign things are moving the right way
   • Can sit for twenty minutes or so without symptoms building
   • Sleep is less broken
   • Coughing no longer sends pain down the leg

2. 2. Rebuild tolerance to bending and load

   3 to 8 weeks

   Get bending, hinging and sitting back to normal, and restore any strength lost in the leg.

   • Can hinge and squat to depth without symptoms
   • Can sit through a class, a bus ride or a long match without a flare
   • Calf and foot strength are symmetrical again if they had been affected
   • No leg symptoms with normal walking distances

3. 3. Rebuild landing and passing tolerance

Ready to play again when

• No leg symptoms, or only occasional symptoms that stay above the knee and settle quickly
• Can sit through a full journey or a full match on the bench and stand up without stiffness or catching
• Leg strength symmetrical: single-leg heel raises and heel walking equal both sides
• A full passing and digging session with no increase in symptoms the following day
• Repeated jump landings at practice volume with no flare

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Romanian deadlifts and kettlebell deadlifts to groove a hip hinge, so digging low and picking balls up is driven by the hips instead of a rounded lower back.
• Goblet squat holds and 90/90 hip switches for hip mobility, because a stiff hip forces the passing posture to be created by bending the spine.
• The trunk endurance staples, side plank, bird dog and curl-up, which build stiffness and endurance without repeatedly bending the spine to end range under load.
• Box drops and controlled landing practice to land hip-hinged with knees bent, plus calf and quad strength so the legs absorb the landing rather than the spine.
• Move heavy loaded lifting away from the first hour after waking, when discs are at their most swollen and least tolerant of bending under load.
• On long tournament drives, stand up and walk every thirty to forty-five minutes rather than sitting the whole way and then warming up cold.