You are what you eat: How Philip Rivers’ disc bulge resembles a hamburger!

With the conclusion of week 16, there is only one week left in the regular season! Yes, only one more Sunday packed full with 16 NFL games! The bad news is the 2014-15 season is nearing its close but the good news is the playoffs are just around the corner! Now let’s take you (incredibly attractive) readers through week 16 by the numbers:

60 = Number of players who missed game time due to injury.

8 = Number of players placed on season-ending IR.

6 = Number of concussions.

19 = Number of injuries sustained on the two Saturday games this week (5 from the San Diego Chargers, 8 from the San Francisco 49ers, and 6 from the Washington Redskins).

Remember DeMarco Murray who was our guest star last week? The running back for the Dallas Cowboys? The guy who fractured the fourth metacarpal in his hand and had surgery to fix it? Yeah, that dude! The last time we left off, his playing status on Sunday was listed as questionable. According to the NFL, a player who is considered “questionable” has a 50% chance of playing. Well, as Murray’s close personal friend, I’m pretty sure he was more confident about playing than his injury report disclosed. Actually, the proof is right here:IMG_7915

289186-330-0And sure enough, Murray was ready for his game against the Indianapolis Colts. He rushed for 58 yards and scored one touchdown while playing with a padded glove that had a hard plastic shell protecting his left hand. With one game left in the season, Murray only needs 29 yards to break the Cowboys’ franchise record for total rushing yards in a season. Go get that record, boo!

There were a stunning 19 injuries in only two games on Saturday. That’s a third of all the injuries that happened this week! Ouch! Clearly, the football gods were busy Christmas shopping and forgot about this random pair of Saturday games.

One of the unlucky teams playing on Saturday that felt the sting of the injury bug was the San Diego Chargers. But in a shocking turn of events, I’m going off the beaten path this week and highlighting a player who isn’t accounted for in the injury total and didn’t miss any playing time (*gasp*). Who is this mystery man? He was drafted fourth overall in the 2004 NFL draft. He is a 5-time Pro Bowl selection. His parents’ names are Steve and Joan. He has 7 kids! And his life is on Wikipedia. Aand thank you, Wikipedia, for providing these fun facts.)

phil buzzLadies and gentlemen, I present to you: Philip Rivers! Please do not mix him up with Buzz Lightyear.  Because apparently, this comparison has been made in the past… Um, right. He might not be a badass space ranger but Rivers has the second coolest job in show biz. He is the franchise quarterback for the Chargers. He’s been first string for the Chargers since 2006 and has led them as far as the AFC Championship game (aka the one game away from the Super Bowl).

Disk-DegenerationWith only one game left in the season, the Chargers are going to need Rivers to have a great performance to clinch a spot in the playoffs. The only problem is that he’s been experiencing some back pain over the last three weeks. Sources are saying that Rivers is dealing with a bulging disc in his lower back. According to these reports, the team’s medical staff is concerned that the disc is on the verge of herniating.

We chatted about the back before when we examined Tony Romo’s transverse process fractures. We even chatted about disc injuries briefly! As a quick review, your spine is made of bones called vertebrae. Between each vertebrae is a water-filled cushion called an intervertebral disc. (Speaking of which, the Intervertebral Discs have released their second single since the last time I mentioned them. It’s called “None of Us Want to Bulge (But Physio Can Help If We Do)” – you can find it on iTunes!) Your discs are meant to absorb shock so that your bones don’t crunch on top of one another when you walk around, climb stairs, or jump on your bed! Discs are made of a tough outer layer of fibrous cartilage (called the anulus fibrosus) that surrounds a gel-like centre (called the nucleus pulposus). JellyDonutsThink of them like jelly donuts where the dough is the anulus and the jelly is the nucleus. You’ll never look at jelly donuts in the same way… You’re welcome!

We encounter disc injuries when the nucleus finds a way out of its usual home and pops into the spinal canal. And yes, it’s called your spinal canal because it houses our spinal cord as well as the nerve roots that branch off the cord. Before I go any further, let’s run through the terminology of disc injuries because there are many types that all seem very similar.

  1. Disc herniation = when the nucleus pushes past the interverteral disc space and enters the spinal canal. A herniated disc may or may not be contained in the anulus. Herniations involve less than 25% of the circumference of the disc. Think about the jelly coming out of the donut.
  2. Disc bulge = when the nucleus pushes past the intervertebral disc space but is still contained within an intact anulus. Typically, bulges imply that 50-100% of the disc is squished out. Think of a burger patty that is too big for the bun.
  3. Disc protrusion = a type of herniation where the base of the escaped nucleus is wider than the portion of escaped nucleus. On imaging, it looks like a dome.
  4. Disc extrusion = a type of herniation where the base of the escaped nucleus is narrower than the portion of escaped nucleus. On imaging, it looks like a balloon. With extrusions, the herniated portion may also migrate either up or down in the spinal canal and cause further damage.PicMonkey discs

484063951We’re going to hone in on disc bulges in hopes to educate Rivers on what exactly is going on his back. If the sources are correct, Rivers’ spine resembles hamburger patties that are too big for their buns. In other news, I just spent about 5 minutes googling “hamburger stack”, “hamburger tower”, and “hamburger pile” to find the picture on the left and am now craving a hamburger.

Thankfully for Rivers, there is only one bulging disc in his low back. With the amount of stress and strain football players put on their body, it’s no surprise that some will have disc-related injuries. In Rivers’ case, he does a lot of twisting when he throws footballs. Kamerion+Wimbley+Philip+Rivers+Oakland+Raiders+xL9Ej4wygSQlCombine that with the number of hits he takes from the opposition’s defense in games and it’s almost a wonder that he’s lasted this long without any severe back issues.

But even so, one aggravated disc is enough to produce various symptoms that can have a big impact on Rivers’ performance. The first and most obvious symptom is pain. Depending on the severity of the injury, pain can be localized in the back or can radiate down into the leg. If the bulge hasn’t pushed up against a nerve, the pain will tend to stay centralized in the low back. But if the bulge is in contact with a nerve, there’s a good chance pain will refer from the back to the thigh, calf, or even as far as the foot!

disc bulgeIf Rivers has a disc bulge that is pressing on a nerve, then he might also have some nerve-related symptoms. He might report that his leg feels like it’s always falling asleep or that pushing off his foot feels weaker than before. Here’s where the team physio swoops in to perform a lumbar neurological scan to determine the extent of the injury. The purpose of the scan is to figure out if the nerves in the low back are being compressed. The nerves from the spine provide our muscles with strength, skin with sensation, and tendons with reflexes. A disc bulge that applies enough pressure on a lumbar nerve root can affect the nerve’s ability to properly send signals to our legs.

Screen Shot 2014-12-23 at 2.41.49 PMSo let’s say Rivers is complaining about pain down his leg, weakness when he’s pushing off his foot, and occasional numbness in his heel and toes. When the medical staff scans him, they find weakness in his calf and duller sensation in his foot. And finally, when they test his Achilles reflex, they notice a weaker response to being smacked with a reflex hammer. These are signs and symptoms of nerve impingement!

If you have pain, weakness, and numbness in your leg, it would be hard to walk your dog let alone play in a game of football. Sources have noted that Rivers had epidural injections to relieve the pain. PE-ESI_Figure3The injection might help with his current symptoms but it won’t improve the injury itself.

Rivers’ main goal is to win on Sunday. A win locks up a playoff berth for the Chargers. Leading up to the game, epidural injections might be enough to keep Rivers’ pain tolerable. The team physios will also prescribe strengthening and stretching exercises to reduce pain and help prevent the disc injury from worsening. But in the long term, his back might not thank him for putting that extra stress and strain on it while it was hurt. Only time will tell!

Best of luck to you and your Chargers in this last regular season game, Phil! You’ll be receiving a Christmas card along with a framed copy of your appearance on this week’s blog in the mail soon!

orig-21139635And in the spirit of the holidays, I hope you all have a fantastic time with your family and friends. Did you forget to buy a present? Read them this delightfully corny and informative blog! You can call me emergency Santa! Merry Christmas to all and to all a good night!

– Santa Chris (6-10)


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