Question
QUESTION: Hello Doctor! I am male, 29 years of age and had been doing
gym workouts regularly for more than six years before this
injury happened almost 6 months ago. My workouts have always
been moderate, not heavy (lifted a maximum of 45 Kilograms
on bench press and my workout never lasted for more than 1
hour. I had not made any sudden or abrupt change in my
workouts just before the problem occurred. Also, I work as a
Television Producer and my profession never required me to
sit on the computer for long hours.

On the night of June 9 2010, I felt a sudden and extreme
pain in my left shoulder in the middle of night and woke up
from my sleep.

In the first few days after the pain started, I tried to not
push myself and took as much rest as possible by working for
only a few hours in the day and returning home early from
office to just lie down and rest. I used hot water bottle
fomentation and applied topical pain reliever on the
affected area three to four times a day. By the second
or third day, the pain gradually spread to the left arm with
numbness in the top part of the index finger of left hand.

The doctor initially diagnosed cervical spondylosis as the
cause of nerve pinch after examining me externally. I took
physiotherapy for three days (June 14 to 16) continuously
(diathermy, some massage and TENS) and got some relief from
pain. But at this point I had to discontinue physiotherapy
for 15 days since I was busy with something. But during this
period, I took rest mostly and didn抰 over exert myself.

After a gap of 15 days, I continued to get physiotherapy
treatment everyday regularly for 17 days(a combination of
diathermy (heat), cervical traction, IFT for initial few
days only, TENS, Ultra Sound and some Isometric exercises at
home).

Very slowly, the numbness and radiating pain in the left arm
went away. But after this, whenever have been sitting for
long hours on the computer etc, I start to feel slight
uneasiness and pain around the spinal thoracic region in the
back. This never happened before this problem started.

I got an MRI done recently, on October 10, 2010 and this is
the MRI report:
MRI CERVICAL SPINE & SCREENING DORSAL AND LUMBAR SPINE

IMAGING PARAMETERS: AXIAL T1 & T2 WIs.; SAGITTAL: T1 & T2
WIs.; CORONAL: STIR.

MRI study shows mild focal syrinx from C3-4 to C5 level
without intermedullary mass lesion.

Straightening of cervical lordosis. No lyses/ listhesis/
scoliosis noted.

Mild disc bulge with posterior annulus fibrous tear at C5-6
level without significant canal stenosis/ neural foramina
narrowing/ myeloradiculopathy.

Mild disc bulge with left paracentral disc herniation at C6-
7 causing ventral thecal sac flattening, mild encroachment
of left neural foramina & minimal indentation over left
exciting nerve root.

Mild degenerative changes in form of disc dessication,
marginal osteophytes & marrow changes.

Rest of vertebrae and IV discs are unremarkable.

Posterior bony elements, facet jointsand rest of B/L neural
foramina are normal.

Spinal canal diameters (in mm) at dosc levels are:

C2-3 : 13.0
C3-4 : 12.0
C4-5 : 13.0
C5-6 : 11.0
C6-7 : 10.0

No primary or secondary canal stenosis. Rest of thecal sac
with spinal cord is normal.

C.V. junction & cervico-medullary region with visualized
intra cranial contents normal.

Pre and para vertebral soft tissues are normal. No
infective/ mitotic lesion.

Screening dorsal spine reveals no significant abnormality.

Screening lumbar spine reveals mild disc bulge at L5-S1
level without significant canal stenosis/ neural foramina
narrowing/ rediculopathy.

Kindly suggest, should I completely stop any weight training
or gym workouts? Not even light weights? Or would you
suggest some precautions/ special workouts? I am losing my
physique and want to get back to shape. Plz help


ANSWER: Kushal,
 I would continue to workout, but with a change in focus.  For the next couple of weeks, stay away from the bench press, incline press, biceps curls and any other chest and biceps activities.  Your MRI shows some changes in your vertebrae along with a straightening of the cervical spine.  Since you sit for long periods of time and you work on the computer, that is causing the pecs and biceps to shorten.  When those two groups shorten, the shoulder blade gets tipped forward causing increased neck pain.  Continue this for some time and it will also change the angle of the cervical spine.  Work on strengthening your back muscles and posterior shoulder muscles.  Try some stabilization activities, Y's and T's.  Whenever you do some cardio exercises, make sure to stretch your pecs because they are involved in breathing and can get tight if you are breathing heavy with your exercise.

---------- FOLLOW-UP ----------

QUESTION: Thanks for your reply Doctor. As I can guess from my case
history and MRI report that I have already sent you in my
last question, 4th June 2010 (the first instance when I
experienced acute pain) is the date on or before which I
developed the mild disc bulge with posterior annulus fibrous
tear at C5-6 and mild disc bulge with left paracentral disc
herniation at C6-7 causing ventral thecal sac flattening,
mild encroachment of left neural foramina & minimal
indentation over left exciting nerve root.
My MRI image was taken recently, on 10th October 2010, that
is 4 months or more after the disc bulge conditions
developed in my cervical spine.
You have asked me to stay away from the bench press, incline
press, biceps curls and any other chest and biceps
activities for the next couple of weeks. Do you mean to say
that in this couple of weeks time, the disc bulge that has
been there for 4 months would disappear and get ok and so I
can continue usual gym workouts and weight training like
bench press inclined bench etc? The physiotherapist and orthopedic doctor whom I initially consulted when the
problem had newly started had both suggested me to
discontinue these weight training gym workouts for a period
of 3-4 months, which is over now. So how can I be sure that
after a few more weeks time the disc bulge would get ok
enough for me to restart these workouts?
Or is it so that I might have to stop doing any such weight
training exercises for the rest of my life?
Also, please suggest me what precautions/ measures I need to
follow in common daily postures like sitting, working on a
computer, traveling in a bus/ motorcycle on a bad, bumpy
road, sleeping posture, whether to use pillow or not,
whether or not to carry a reasonably heavy bag containing a
laptop etc. I'm a lot distressed, thanks for your help.

Answer
Kushal,
 By having you stop your weight training of the pecs and biceps, it will not make the disc bulge disappear.  What it will do is give your posterior scapular muscles time to gain some strength to help restore balance to your body.  Like I was telling you before, any pectoralis activity and biceps activity causes your scapula to tip forward and you will compensate with your neck position.  When you strengthen you scapular muscles, you pecs and biceps will not be able to pull the scapula forward as easily.  The worst position for your neck if forward flexion with a twist or turn.  Than will make the disc bulge more.  When sleeping, try to make sure your neck is in a neutral position, meaning that your head is not tilted back or forward too much.  I would not recommend that you carry a heavy bag, it would be better to use a backpack to evenly distribute the weight.  When you are sitting at your computer, take a break every 60 minutes and get up and stretch your pecs and biceps to help break the position you are sitting in for hours.  I know you are distressed, but if you workout smarter, watch your sleeping position and avoid situations that causes your head to be bend forward with a twist, your symptoms should subside.  I hope this help alleviate some of your stress and help you to have some direction.

Martin