Gaining strength after injury

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    Gaining strength after injury


    So I been dealing with some neck pain for about 5 months. In January had an mri. I have three bulging and bone spurs. My c5c6 disc is bulging but also have a bone spur right were the nerve root branches to my left arm. So now the nerve is getting pinched between the disc and the spur. I been on max dose oxycontin for a week cuz the pain was unbearable. Had a epidural steroid injection about 2 Weeks ago and going for the second next week. This has helped a lot along with physical therapy. I want to start working out again to build up my strength. My left arm has zero strength I curled 10 lb dumbbell for 5 reps then It just couldn't do any more. I have no idea where to start or even start gaining back what I have lost. So any ideas would be great. I know I need to start light but not sure how to go about this.

    Any ideas?
    Thanks

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    What is your pdoc going to do about the spurs? nothing? Are they having you do cervical extension exercises at PT? You need to get that disc material "sucked back in" with cervical extension. The nerve compression/neural tension will get better when the disc material gets back in line. Hows your deltoid, bicep and wrist ext pain/strength at this point. The main important thing and they should have told you this at therapy is pain free exercise, pain free range of motion. As your disc bulge improves so will you referred pain. Since you didn't suffer any structural damage to your arm, I think you could leave it up to your own discretion, you don't have any restrictions, Id go maybe 2-3 sets of 15 dumbbell curls for a couple of weeks, ease into it. Remember pain free ROM, pain free exercise.
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    They told me the spurs need to be removed eventually. Right now we trying to get the bulging reduced with cervical traction. Sometimes I feel better but other times my neck hurts and feels like i was punched in the arm. My gripping strength is pretty much gone same with my bicep strength. They said once the bulging is reduced the strength should come back. I'm afraid though that I have nerve damage. If i can figure out how to upload my mri results I will and it explains better

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    Yeah, with a cervical disk, I'm not sure you should really be doing anything until your doc knows exactly what he/she is dealing with. I give you props for wanting to get going and everything, but let's not risk it at this moment in time.

    I didn't quote your post and will have to go back and read, but if the problem is where the nerves branch off from the spinal cord, a whole hell of a lot can go wrong there. I think you mentioned you haven't got the MRI yet, let's wait for now.

    Have you spoke with your neurosurgeon about wanting to start training again?

    EDIT: just let us know what the diagnosis is on the MRI...
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    Quote Originally Posted by witt51 View Post
    They told me the spurs need to be removed eventually. Right now we trying to get the bulging reduced with cervical traction. Sometimes I feel better but other times my neck hurts and feels like i was punched in the arm. My gripping strength is pretty much gone same with my bicep strength. They said once the bulging is reduced the strength should come back. I'm afraid though that I have nerve damage. If i can figure out how to upload my mri results I will and it explains better

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    Yep eventually so it must not be critical, usually thy will treat you with conservative treatment first. Your pdoc should give you a range how long before surgery as an educated guess. I suppose you have numbness and tingling in your arm also. Nah not nerve damage basically the protruded disc material (nucleus propulsis is bulging out through the annulus fibrosis) and is touching a spinal nerve, once it's not "touching a nerve" anymore your symptoms and strength should be back to normal. Hope this helps ease your mind a bit. Traction will help, as will cervical ext exercises
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    Quote Originally Posted by KimChee75

    Yep eventually so it must not be critical, usually thy will treat you with conservative treatment first. Your pdoc should give you a range how long before surgery as an educated guess. I suppose you have numbness and tingling in your arm also. not nerve damage basically the protruded disc material (nucleus propulsis is bulging out through the annulus fibrosis) and is touching a spinal nerve, once it's not "touching a nerve" anymore your symptoms and strength should be back to normal. Hope this helps ease your mind a bit. Traction will help, as will cervical ext exercises
    Not to be the harbinger of bad news, but let's not get ahead of ourselves. If the compression was bad enough for a long period of time, there could very well be damage.

    And unfortunately, insurance coverage has a lot to do with initial treatment. Not saying it's right, but it is a reality. So lack of aggressive tx off the bat isn't really an indicator of anything...
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    Quote Originally Posted by napalm View Post

    Not to be the harbinger of bad news, but let's not get ahead of ourselves. If the compression was bad enough for a long period of time, there could very well be damage.

    And unfortunately, insurance coverage has a lot to do with initial treatment. Not saying it's right, but it is a reality. So lack of aggressive tx off the bat isn't really an indicator of anything...
    I am a DPT, I know a little bit about what I'm talking about. He is not my patient so I can only speculate, and there is a lack of details so speaking somewhat generally. Of the cases ive seen of people with disc problems it is with referral patterns there are very very few with nerve damage with this type of disc displacement with referral pattern.

    The worst case scenario with a disc herniation is when the disc material gets into the spinal canal. I'm sure you can look this up on pubmed or google thanks

    Medically, when I say "conservative tx" I mean PT, ie not surgery or other invasive means...I know about insurance and you are right the insurance companies are the doctors now. I imagine he went to see his doc, then doc wrote a PT or traction script. Generally if 6 tx on traction are not effective the pt is returned to the doc for further assessment in this case MRI..I see this over and over all the time..
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    Quote Originally Posted by KimChee75 View Post
    I am a DPT, I know a little bit about what I'm talking about. He is not my patient so I can only speculate, and there is a lack of details so speaking somewhat generally. Of the cases ive seen of people with disc problems it is with referral patterns there are very very few with nerve damage with this type of disc displacement with referral pattern.

    The worst case scenario with a disc herniation is when the disc material gets into the spinal canal. I'm sure you can look this up on pubmed or google thanks

    Medically, when I say "conservative tx" I mean PT, ie not surgery or other invasive means...I know about insurance
    duly noted, i have an ms in anatomy and 10 yrs of spinal cord injury and rehabilitation clinical research experience. i'm also a published author (as i'm sure you are too) in the area of spinal cord injury, so i know a little about what i'm talking about as well.

    my point is, let's not get ahead of ourselves...
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    Well, I'm not educated on this from the medical standpoint, but I am from the patient side.

    I had the same issues, along with a fractured vertebrae. I elected to have the surgery-ended up replacing the discs between c3-c5 and I had a 2 level fusion.

    Upon waking, the nerve pain was all but gone, I was back in the gym doing PT in 10 days, back to work in 5 weeks, and fully recovered in about 6 months. By fully recovered I mean strength back to pre-injury levels, zero nerve issues, etc.

    It never bothers me, I had the surgery at 34 and would do it all over again.
    Don't worry, man, someday I'ma be nobody too.
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    Quote Originally Posted by Swanson52 View Post
    Well, I'm not educated on this from the medical standpoint, but I am from the patient side.

    I had the same issues, along with a fractured vertebrae. I elected to have the surgery-ended up replacing the discs between c3-c5 and I had a 2 level fusion.

    Upon waking, the nerve pain was all but gone, I was back in the gym doing PT in 10 days, back to work in 5 weeks, and fully recovered in about 6 months. By fully recovered I mean strength back to pre-injury levels, zero nerve issues, etc.

    It never bothers me, I had the surgery at 34 and would do it all over again.
    that's awesome swanson. i use to do some work with a neurosurgeon whose sole practice was fixing fusions gone wrong.
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    I did have an mri. If i can figure how to upload the results of it I will. I been doing traction for 6 weeks. Abut 2 Weeks ago it was excruciating so my doc wrote a referral for the epidural steroid injection. It helped some with the pain shooting down my arm. But the neck still hurts with occasional arm pain. My arm still goes numb some.

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    what kind of doc are you seeing?
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    I'm seeing a primary care but have an appointment with a nuero surgeon

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    That's my mri. Don't know why it looks like that but you have to click in it and will have to zoom in to read it

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    dude, i'm not a doctor, but i've read literally hundreds and hundreds of mri results over the years:

    i've seen a lot worse. i can see how any neurosurgeon would be treating this conservatively.

    just keep doing what the doc has you doing in pt and listen to your therapist. no need to push it.

    hopefully kimchee will have an opinion

    good luck...
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    Quote Originally Posted by witt51 View Post
    I'm seeing a primary care but have an appointment with a nuero surgeon

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    ahh, i see. i would venture to guess the neurosurgeon will initially treat this conservatively as well.

    good luck...
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    Ok thanks. Just frustrating not able to workout and always in pain with no arm strength

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    I appreciate you taking a look at this and helping me out

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    Quote Originally Posted by witt51 View Post
    Ok thanks. Just frustrating not able to workout and always in pain with no arm strength

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    patience my friend...
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    Ahhh yes very familiar situation.
    I have the same problems in my c2-c1 , l4-l5, l5-s1 discs. Basically bro you need to change your life around your vertebrae's. quit dead lifting and squatting, that is a must.

    Essentially this is a herniation you can fix this via diet and therapy and proper exercise. It will take many years bro but its worth it. My best friend is 40% paralyzed cuz of a spine surgery to remove these pieces of herniated tissue that pinches our nerves. Before I did my first session of therapy I couldn't walk(2 years ago) now I'm hiking the Rocky Mountains in 4 ft of snow.

    Any specific questions? Non surgical therapy is your main thing.
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    I do owe you an apology napalm, I was posting that from my phone, and when I re-read my response I didn't like the way it came off. I know there are plenty of pretentious *******s on message boards and I don't want to be one of them. Again apologies.

    Quote Originally Posted by napalm View Post
    duly noted, i have an ms in anatomy and 10 yrs of spinal cord injury and rehabilitation clinical research experience. i'm also a published author (as i'm sure you are too) in the area of spinal cord injury, so i know a little about what i'm talking about as well.

    my point is, let's not get ahead of ourselves...
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    Quote Originally Posted by KimChee View Post
    I do owe you an apology napalm, I was posting that from my phone, and when I re-read my response I didn't like the way it came off. I know there are plenty of pretentious *******s on message boards and I don't want to be one of them. Again apologies.
    no problem at all, what do you think of his mri?
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    Interesting, so it looks like you have a disc bulge (duh lol), but imho the tingling and numbness is being caused by the foramina stenosis (narrowing of the spinal canal) with myleopathy ("nerve pinching", numbness). No foramina stenosis, narrowing around nerve root and spinal canal. No spondylolisthesis backward or forward slipping on lower vertebrae bc of interarticularis. No encroachment in VTS. You're MRI looks pretty "good."

    Treatment wise there's nothing that can be done in PT to "unnarrow" the canal, really what we do is stretch the muscles, try to increase the ROM, and work on your functional day to day level. I don't see you mention any neck movement limitations or problems with daily activities having to do with cervical movement, just the complaints of the nerve compression through dermatone C5 and C6. I would recommend you talk to your therapist and doctor and have them come up with a treatment plan based on 2 or so months, check the results, and then decide if surgery is a feasible option. Each clinic is different but generally we discontinue cervical traction if it isn't working after 6 treatments. Surgery is always a last option..

    I'm really not much of a fan of cervical/lumbar PT patients, it just seems like it's such a mixed bag of results. Our boss has another clinic in a doctors office that does mostly spinal surgeries, fusions, cervical etc I think it would drive me nuts. If you did get surgery they will probably clean those bone spurs out while they're in there.

    Again take what I say with a grain of salt, I'm not your pcp, neurosurgeon or PT, anything they say should supercede what anyone on a board thinks. The unfortunate part about healthcare is that we providers really don't have the time to sit down and talk things out like we would with our patients, and sometimes I'd really like to but can't...
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    Quote Originally Posted by KimChee View Post
    .I'm really not much of a fan of cervical/lumbar PT patients, it just seems like it's such a mixed bag of results. Our boss has another clinic in a doctors office that does mostly spinal surgeries, fusions, cervical etc I think it would drive me nuts. If you did get surgery they will probably clean those bone spurs out while they're in there.
    this is a common theme in this area, and part of the reason i got out of research and went to the business side. the problem is that you have a fair number of pts that just don't want to get better. there are a lot of auto accident/workers comp pts in this population who have a monetary interest in not getting better. it's a big frustration in trying to do research in this area. a lot of the neurosurgery stuff i did were device trials, ie artificial disks, hardware used in fusions etc...

    i can remember a number of trials that had a really good device from a safety/phase 1 trial standpoint, really good results. as they rolled the device out to a larger population in the phase 3 trials, these auto accident/workers comp pts end up in your study and confound the results.

    <---not even kidding...
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    Guy if you want your life back there is a specialized hospital, it's called 1st State Hospital. Only 1 of its kind in Europe, (STRICTLY NON SURGICAL!!!) it's in a Eco-tourist city in Taganrog Russia. The head doctor is an acquaintance of mine, to get a 21 day hospitalization it will cost 35k roubles (1300$). 3 time a day diet food, medication, good 3 person suit. It's worth just to fly there for the treatment.
    There is a huge waiting list though, ppl wait for years to get their turn to go there. I on the other hand know the head doctor. 1300$ into his pocket and your hospitalized.

    The procedure I underwent where:
    Underwater spinal stretching (15kg first two days then went 16, 17, and 19)
    Dead salt water mud @ 42*c on the whole spine
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    Basically I would recommend this to any of my buddies who where ever injured in war or tournaments.
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    I do actually have neck pain. It really hurts when I move my head and neck back. I can tilt just my head if that makes sense. Side to side and forward don't hurt. It is actually getting better than it was a couple weeks ago. It hurts the most when I get up in the morning along with my arm hurting. Once I move around it gets better. When I met with the pt he said it will take 12 weeks or so to get better. I can honestly say it is better than when I started. My main concern was that I just woke up one morning with so much nerve pain I pretty much couldn't move my head,neck and arm. Then got the shot and its getting better. I wanted to start some exercising mainly to get my arm strength and grip strength back. I know I can't get after it right now like I used to though. Thanks for all the help from eveyone


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    Quote Originally Posted by napalm View Post

    this is a common theme in this area, and part of the reason i got out of research and went to the business side. the problem is that you have a fair number of pts that just don't want to get better. there are a lot of auto accident/workers comp pts in this population who have a monetary interest in not getting better. it's a big frustration in trying to do research in this area. a lot of the neurosurgery stuff i did were device trials, ie artificial disks, hardware used in fusions etc...

    i can remember a number of trials that had a really good device from a safety/phase 1 trial standpoint, really good results. as they rolled the device out to a larger population in the phase 3 trials, these auto accident/workers comp pts end up in your study and confound the results.

    <---not even kidding...


    I know what you mean about the people wanting to get on dis, motor vehicle accidents, comp patients that don't want to return to work. I've even had a few of these pts lose their hearings and try to either come back on me or the doctor, these the people who it was pretty obvious they were faking it anyways.. Really kills your want to want to help people at all...the research with hardware sounds interesting.
    PT,DPT,OCS
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    Quote Originally Posted by KimChee75 View Post
    the research with hardware sounds interesting.
    it was, but like i said, very frustrating. the most fun i had was early in my career working with quads. i worked for/with a rehab guy that had a big nih grant. it was when the 2nd generation spasticity drugs came out and we were involved in the early clinical trials because of a device the guy i worked for/with designed to measure spasms by inducing them. once baseline is established, you can look at drug effect. nothing earth shattering but it was pretty cool...
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    Quote Originally Posted by witt51 View Post
    I do actually have neck pain. It really hurts when I move my head and neck back. I can tilt just my head if that makes sense. Side to side and forward don't hurt. It is actually getting better than it was a couple weeks ago. It hurts the most when I get up in the morning along with my arm hurting. Once I move around it gets better. When I met with the pt he said it will take 12 weeks or so to get better. I can honestly say it is better than when I started. My main concern was that I just woke up one morning with so much nerve pain I pretty much couldn't move my head,neck and arm. Then got the shot and its getting better. I wanted to start some exercising mainly to get my arm strength and grip strength back. I know I can't get after it right now like I used to though. Thanks for all the help from eveyone

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    Don't mess yourself up more accidentally. Even if your a pro lifter. The hospital docs told me to forget about lifting heavy things, also to quit weight lifting at the gym as well.

    Doesn't mean I don't lift though. Rehab works miracles.
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    Ya I guess I'm going to have to take it easy for now on. I have a feeling without surgery to remove the spurs this will more than likely come back at some time.

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    Quote Originally Posted by witt51 View Post
    Ya I guess I'm going to have to take it easy for now on. I have a feeling without surgery to remove the spurs this will more than likely come back at some time.

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    Lol surgery is very extreme. Id never risk that far. There's natural non surgical methods that triumph today's bull**** medicine and surgery.
    的deas are far more powerful than guns. We don't let our enemies have guns. Why should we let them have ideas?" - General Secretary of The Union of Soviet Socialist Republics, Joseph Stalin.
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    Always consider surgery as your last option in all scenarios. Especially when you're talking about things to do with the spine. I've had more than one patient have spinal surgery and come back with some form of paralysis post surgery. I've never had surgery but the threshold to me seems to be when a person is not doing things out in the community due to pain and when they can't sleep at night due to pain. I always in a somewhat round about way remind my patients that a surgeon wants you to have surgery! I've had several of my own patients talked into getting surgery done when conservative treatment would have been just fine...I'm going off on a tangent but you get the idea..
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    I agree with you. I want that to be my last resort. So if the spurs will not go away is this something I would be going through forever. I just been so miserable for so long. Also with the pt will I just wake up one morning and not be in pain? Or just gets gradually better?

    For some reason I can't rep you

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    I agree with what your pt says its going to take 2-3 months of treatment..our goal in PT is to reduce your pain as much as possible, but unfortunately it may not be all the way in all cases. I feel like since we are online I can be frank with you, normally I would say something like we'll do the best we can and see how it goes..The goal is strengthen the neck muscles, stretch, ROM and your level of functionality, I can't tell you to take things, but are you on any fish oils? They seem to greatly reduce inflammation and help with joint pain in my own experience, NSAIDS will also help.

    I guess the bone spurs arent rubbing on any of the tendons bad enough that they want to do surgery right away? That's the other thing to think about bone spur removal shoulder scope is op procedure and not very invasive..Im getting ahead of myself due to lack of sleep, but we'll see how you do with conservative tx ...
    PT, DPT, OCS Clinical Residency
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    If you guys can please advice me as well.
    的deas are far more powerful than guns. We don't let our enemies have guns. Why should we let them have ideas?" - General Secretary of The Union of Soviet Socialist Republics, Joseph Stalin.
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    This is a little outside of the scope of my knowledge. The only input I can give is to maybe think about some Estim on the muscles of the forearm and wrists to keep them active and maintain some level of muscle mass.

    Jason Cholewa, Ph.D., CSCS
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    I like the others applaud your enthusiasm to get back to lifting! But these guys have a HUGE point in taking it slow and getting all your PT done and listening to your Doc. DON'T RUSH ANYTHING !!!!
  

  
 

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