Fast comeback for a quarterback with a bad back - science behind the news - Joe Montana

News item: On Sept. 7, star quarterback Joe Montana, 30, of the San Francisco 49ers twisted his back in his team's NFL season opener against Tampa Bay. X-rays revealed that he had ruptured the lowest movable disc in his spine. Montana had played with a back injury the previous season, aided by painkillers. But this time the pain was so severe he couldn't raise his legs or stand up, and there was speculation he might never play again. But 63 days later, after an operation by San Francisco orthopedist Arthur White, Montana led the 49ers to a 43-17 rout of the St. Louis Cardinals.

Each of the 30 discs -- the shock absorbers between vertebrae --consists of a cushion of gelatinous tissue surrounded by a hard protective shell of fibrocartilaginous material called an anulus. When the anulus breaks, as Montana's did, some of the inside of the disc oozes out from between the vertebrae and presses against nerves in the spinal cord. Montana's soft tissue pushed on his sciatic nerve, radiating pain and numbness down his lower back and into his legs. Though surgery is seldom required for a ruptured disc, White says that ''in Joe's case we had to remove it or there would have been extensive nerve damage.''

White took out a third of the disc, leaving it, he said, ''like a hard Model T tire, without any tube inside.'' Then he was faced with a decision: to fuse or not fuse. ''Fusion is like welding or soldering two vertebrae together,'' says White. Since you lose one disc out of 30 in the process, ''you lose one-thirtieth of your flexibility. Without fusion, you keep that flexibility and recover faster, but you sacrifice some of the protection o the spinal cord.''

White asks himself in such cases: Can we rely on the man, with his life style and his coordination, to hold those vertebrae himself, or do we have to hold them for him? In the case of a football player, is he a lineman or a quarterback? ''As a quarterback, Joe gets hit maybe once every five or six plays, and not very hard,'' he says. ''He's very coordinated and very well trained to protect himself.'' Also, after his previous back injury, Montana had gone through stabilization training, learning how to walk, bend, fall, and rise without straining the spine. White's verdict: no fusion.

Montana's postoperative therapy was based on moderate exercise. But Montana had his own idea of moderation: he was jogging within two weeks of surgery, swimming within three weeks, and throwing a football within four. Then, eight weeks after surgery, Montana took the step that White says he would have been crazy to recommend. The rest of the story is in the sports pages.

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