Some sports are commonly associated with spinal injury and pain.  These include tennis, golf and horseback riding, among others.  Athletes, whether they be amateurs or professionals, may suffer sudden severe injuries to the spine or may suffer spinal pain caused by the repetitive spinal stress of sports participation.  While most patients improve with non-invasive conservative care and injections, some athlete patients require more invasive treatment.  NeuroEndospine surgery is an important option for those patients.


Tennis players may suffer from sports induced back pain.  One study showed that 39% of players had to leave a tournament because of back pain.  Among tennis players with low back pain, 29% may develop chronic low back pain.  

There are several reasons why tennis can lead to back pain.  Forehand and back hand shots require a large amount of trunk rotation and twisting of the spine.  This twist can lead to torsion of the disc, making it more susceptible to tearing.  The serve requires a hyperextension of the back, potentially pinching a disc between vertebra or jamming spinal joints together.  


Golf is commonly associated with back pain and back pain is one of the most common injuries in golf.  Up to 24% of professional golfers suffer from low back pain.  For amateurs it is worse; as high as 34%.

Golfers tend to injure their backs by a combination of bending forward and twisting their backs.  Bending forward stretches the back of the disc, rendering it vulnerable to the torsion that comes from the twisting associated with the swing.

Horseback riding

Horseback riding is another sport where back pain is common.  While up to 48% of riders suffer back pain, there is wide variation based on riding type and sex.  English style riding is associated with a 66% incidence of back pain.  This drops to 23% in Western style riding.  Women are more susceptible to riding induced back pain than men.  Back pain occurs in 58% of female riders versus 27% of male riders.

Rider’s bodies must absorb repetitive forces generated by the horse in all directions, resulting in front to back, side to side and up and down forces acting on the spine.  These forces can be of large magnitude depending on the activity of the horse.

Unique qualities of the athlete

Because an amateur or professional athlete’s spine is regularly subject to intense forces, normal spinal stabilizing structures take on added importance.  These stabilizing structures resist excessive bending and twisting that can lead to chronic injury and pain.  The spine is surrounded by muscles that provide stability by resisting forces placed on the spine.  Many athletes work hard to strengthen these muscles (called core muscles) to prevent injury and perform well at their sport.  The spine also possesses ligaments that connect bones and joints.  Like muscles, these ligaments provide significant stability to the overstressed spine.  Lastly, the annulus is a bandlike structure that encloses the disc and connects two vertebra together.  When healthy, the annulus can resist the repetitive torsion and compression of many sports.  

After an injury, an important factor in an athlete’s recovery and return to their sport is the strength of their spine, as determined by stabilizing structures like core muscles, ligaments and joints. Athletes with injury or weakness to these components of their spine often need to undergo extensive rehabilitation before returning to their sport. Athletes who have traditional spinal surgery often suffer injury to some of the key spinal stabilizing structures during surgery, further necessitating rehabilitation.

NeuroEndospine surgery for the amateur or professional athlete

NeuroEndospine surgery allows the effective treatment of spinal disorders while maintaining the key spinal stabilizing structures that lead to a strong back.   Athletes rely on these key structures for athletic performance and to avoid injury during sports.  The most important components of these stabilizing structures are the multifidus muscle, the facet joint and the ligamentum flavum.  Together these structures maintain spinal stability and strength by resisting injury causing hyper-motion.  This leads to a strong back.

By maintaining the key spinal stabilizing structures, NeuroEndospine surgery also facilitates an athlete’s recovery and return to their sport.  This can often occur without extensive therapy or rehabilitation.  The lack of surgical injury to these key spinal structures during NeuroEndospine surgery means that the athlete can often self-recondition to return to their sport.

NeuroEndospine surgery avoids injury to important spinal core muscles.  In conventional surgery the multifidus muscle, the most important stabilizing muscle in the spine, is either cut or is split by a 22mm tube (about an inch).  Injury to this muscle weakens the spine and makes future disc or joint injury more common.  NeuroEndospine surgery can, in many cases, spare the multifidus muscle completely.  When the muscle does need to be traversed, NeuroEndospine surgeons can pass through the muscle with a tube 3 times smaller than in conventional surgery, resulting in minimal or no injury.

NeuroEndospine surgery avoids injury to stabilizing spinal joints.   After cutting or splitting the multifidus muscle, typical spine surgery enters the spine by drilling through the facet joint, an important spinal joint.  The facet joint is a joint on either side of the disc.  The joint and its capsule is important in resisting undo torsion and flexion on the spine.  NeuroEndospine surgery often avoids this joint completely by using a tube small enough to pass through natural spinal openings.

NeuroEndospine surgery avoids injury to important stabilizing ligaments of the spine.  The ligamentum flavum is a very elastic and strong ligament that resists undo flexion forces on the spine.  In many cases, NeuroEndospine surgery avoids passing through this ligament completely.  When the ligamentum flavum does need to be traversed in a NeuroEndospine operation, it can be done with a tiny 2-3mm incision in the ligament, thus maintaining much of its strength.

While hyper motion of the spine may cause injury, normal motion is essential to an athlete’s performance.  NeuroEndospine surgery is effective at treating spinal pain without resorting to fusion, thus maintaining an athlete’s normal spinal motion.  Besides limiting motion, fusion may increase the risk of future injury. Because a fused spinal segment cannot move, normal motion is maintained by over-compensated motion above and below the fused segment.  This causes extensive forces on the spinal segments adjacent to the fused segment of the spine.  This results in accelerated wear and tear and an increased likelihood of injury above and below the fusion site.  Thus, an athlete who strives to maintain performance after a fusion is at risk of additional injuries.

In addition to the benefits of maintaining key spinal stabilizing structures and avoiding fusion, athlete’s undergoing NeuroEndospine surgery have the same benefits as anyone else who undergoes NeuroEndospine surgery.  These include a fast recovery, the ability to permanently treat injured spinal joints and the smallest incision of any effective spinal surgery.


  • The repetitive stress to an athlete’s spine can cause injuries leading to pain.
  • Amateur and professional athletes participating in tennis, horseback riding and golf have high rates of backpain.
  • An athlete relies on stabilizing spinal structures, like core muscles, ligaments and joints to avoid injury.
  • Athletes rely on a strong spine to return to their sport and continue their sport without re-injury.
  • Key spinal stabilizing structures, often injured in traditional surgery, include the mutifidus muscle, the ligamentum flavum and the facet joint.
  • NeuroEndospine surgery avoids injury to spinal stabilizing structures by bypassing them all-together or using miniature instruments to avoid injury.
  • NeuroEndospine surgery can effectively treat athlete injuries while avoiding fusion, allowing an athlete to maintain normal motion in their spine.