Objective To describe clinical outcomes and return-to-play following multimodal chiropractic management of an elite speed skater with acute L5-S1 disc protrusion and S1 radiculopathy. Clinical Features A 20-year-old male elite speed skater presented with sudden-onset severe lumbosacral pain and S1 dermatomal symptoms during ice training. Assessment revealed positive straight leg raise at 40 degrees, diminished reflexes, and motor weakness consistent with S1 radiculopathy. Day 3 MRI confirmed mild L5-S1 disc protrusion with S1 nerve root impingement. Intervention McKenzie-based directional preference exercises with lumbar extension movements demonstrating centralization phenomenon. Treatment included progressive loading rehabilitation with sport-specific movement patterns through structured phases, McKenzie exercises performed 3-4 times daily (3-5 sets of 10-12 repetitions), and coordinated multidisciplinary care with physiotherapy, massage therapy, and strength coaching. Outcome Complete return to competitive speed skating within 4.8 months with sustained participation without symptom recurrence at 12-month follow-up. Notable 5-second personal best improvement in week 9 of rehabilitation. Conclusion Conservative chiropractic management utilizing McKenzie-based protocols within a coordinated multidisciplinary framework achieved excellent outcomes in this elite athlete with lumbar disc herniation and radiculopathy, including successful return to competitive performance with enhanced outcomes.
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