Hurting My Neck at the Gym - Part II

I would venture to say that the most common disc related neck injuries occur at C5 - C6.  That is the area between your 5th and 6th cervical vertebrae.  I have been seeing quite a few people with problems in this area in my practice lately.  This is a continuation of my blog from last week.  If you are interested you can review that here.

The nerve that is affected by a cervical disc herniation is the one that exits the spine at that level.  In this instance it is the C6 nerve root.  C6 is a major nerve root in the brachial plexus and joins C5 to make the upper trunk.  In this picture below, the blue color represents the C6 nerve root involvement. 

Without risking the likelihood of boring you to death you can see the involvement of C6 in the musculocutenous nerve, the axillary nerve, the median nerve,  radial nerve as well as the long thoracic nerve, upper and lower subscapular nerves, medial and lateral pectoral nerves, and thoracodorsal nerve.  WOW!  Such an important job in your entire shoulder and arm.  The muscles that C6  innervates are the deltoids, biceps,coracobrachialis, supraspinatus, pectoralis major, pectoralis minor, infraspinatus, serratus anterior,  latissimus dorsi, teres major and minor, subscapularis, the wrist extensor group, your triceps, and wrist flexor group.  Like I said, pretty much your entire arm, rotator cuff, chest, shoulder, and upper back.  

So what does this mean to me in the gym?  If there is an exercise that you want to do that involves your arms, shoulders, elbows and hands...I guess that there are many of those, then C6 had better be working correctly.  So if you are stuck in this position, and can't seem to make it to the top of the movement,  maybe it is because C6 just isn't 100% of it's capacity.  Consider the possibilities!

How do you know if this might be the case for you?  If you experience any numbness in your index finger or thumb, generalized weakness or pain anywhere in your arm,  then you should probably have this checked out.  Imagine how easy some of the exercises and movements you perform daily will be when the nerves are functioning correctly.  You know what I am going to say..."Everyone deserves a good mechanical assessment and treatment plan!"  Visit grimmpt.com  or call 504-228-0524 to set up your evaluation today. 

If you want you can check out a great book called Treat Your Own Neck by Robin McKenzie that I have linked to Amazon for your convenience.  I recommend this book to most of my cervical patients for their libraries. See you at the gym for some PR's!

Hurting my neck at the gym?

I have seen several patients in my practice who have had neck problems and didn't even know it.  I feel they have done something at the gym that actually revealed an underlying problem that did not show symptoms until it was provoked.  I thought I would take the time today to discuss a few movements that are exposing these underlying pathologies.

First -  Take a look at this video where I evaluated a patient for severe pain in her left elbow.  Believe it or not, this is a somewhat common presentation.  She had a rapidly reversible condition that was primarily based in her neck.

The movements (among others) that I hear "cause" patients injuries in the gym include the "Snatch",  Clean and Jerk, and Kipping Pull Ups.

The Jerk

The Kipping Pull Up

Now these are not pictures of perfect technique, because we know if you practice these movements with perfect technique we would not get hurt... 

Look at the last picture in each of these series and see if you can see what I see.  In the Snatch, the Jerk and Kipping Pull Up you can see a significant amount of cervical protrusion (forward head) which is where the lower cervical spine flexes and the upper cervical spine extends and probably to their end ranges.

 In a neck with no underlying pathology this generally wouldn't be a problem, but for those who have underlying derangements this repeated protrusion or the prolonged forward head posture as you can see here can exacerbate the underlying problems giving you symptoms of pain and limited range of motion in your neck, shoulder, elbow, wrist, hand or all of the above!

This is getting long but I wanted to show you the pathway of symptoms that may be cervically based.  If you have any symptoms in your arms or shoulder blades like this, chances are it is coming from your neck until proven otherwise.  I will continue this thread next week and discuss how this prolonged forward head or repeated protrusion can actually cause weakness in your arms.  Weakness in the gym is never a good thing!

You know what I am going to say now...if you have pain in your arm, shoulder, elbow or neck when performing these movements or sitting at your desk "You Deserve a Good Mechanical Assessment and Treatment Plan!"  Visit grimmpt.com  or call 504-228-0524 to set up your evaluation today! Then get back to the gym and workout without pain for a change!

MRI's, Peyton Manning and Herniated Discs

Continuing on my MRI theme...so what if you go as far as to have surgery on a herniated disc based on MRI findings and you aren't any better after surgery.  We all know people who have had spine surgery and are not any better afterward.

One of my mentors in the MDT world Dr. Yoav Suprun, tweeted this Sports Illustrated article about Peyton Manning.  You know we all love the Manning family here in New Orleans.  It was especially hard for me to hear that Peyton had a herniated disc in his neck.  I always think "What If?"  What if Peyton had seen a MDT credentialed or diplomaed therapist before he had his surgery.  What if he saw one today?  What if he came to see me?  What if?

So let's talk a little about herniated discs.   It would probably be a good place to define what a herniated disc is.  A herniated disc is an MRI finding.

A disc has two main jobs:  one is to allow movement between the vertebra or bones in your spine and two they act as a shock absorbers.

The nucleus pulposus, or center of a disc,  is the consistency of jelly in an old jelly doughnut.  It is gel-like to absorb shock so that every time you move or are touched by something you don't "zap" your spinal cord.  That would be debilitating.  The nucleus is surrounded by several layers of ligaments known as the annulus fibrosus to keep the nucleus pulposus in place.  These are very strong ligaments but would leave an indentation if you touched one with your finger.  It is designed this way so it can allow movement.  An interesting fact is that there are no pain sensitive structures or nociceptors in the nucleus of the disc.  However, there are many in the annulus. Your symptoms will vary depending on where you touch the annulus.  

When you age, beginning around the ripe old age of 12, you begin to develop little cracks and fissures in your discs.  They are all over the place.  You will hear it termed degenerative disc disease, but really it is just normal aging.  With prolonged sitting or other repeated postures the jelly-like nucleus will find one of these cracks or crevices and can cause a bulge (See A.).

A herniated disc (See B)  is a bulge that changes the shape of the disc leaving the annulus (or ring of ligaments) intact. This doesn't necessarily cause pain or weakness.  In fact, many people have herniated discs and disc bulges on their MRI's that they didn't know they had! I bet that if you took an MRI of my discs, they would look like old rubber gaskets that have been left out in the sun.  I would have bulges and herniations all over the place.  However, they aren't touching anything painful or blocking motion so what do I care?  However, if your herniated disc is causing you problems and the annulus is intact, McKenzie MDT physical therapy can generally help.  If the disc ruptures and breaks the annular wall as in picture C, this is a surgical problem.  However, your body has a tremendous way of healing itself, so if you elect not to have surgery your body can absorb this in about a year. 

Again,  your treatment at Grimm Physiotherapy is based on your symptoms such as pain, weakness, loss of proprioception...that you show in your evaluation, not on your MRI.  I always tell potential patients, I am different.  MDTor the McKenzie method is different.   "Everyone deserves a good mechanical assessment and treatment plan!"  Check out grimmpt.com or call 504-228-0524 to set up your evaluation today.

What about MRI's?

I was reading this article the other day and it made me think a little bit more about the type of practice that I have.  It is not unusual for patients to tell me what their MRI (Magnetic Reasonance Imaging) scan showed or what they think their diagnosis is based on their MRI findings.

 I have never ever treated an MRI and really hate to even see the reports until I am done with my assessment and have made a classification and treatment plan.  Of course, I am a huge fan of anatomy and love to compare my findings with an image. I believe that if you took an MRI of everyone in the greater New Orleans area ages 25 - 55,  the majority of them would show bulging discs and degenerative disc disease, what I like to term "normal aging."  Some of these people would actually have pain complaints that corresponded with the MRI findings, but the majority would not.  The problem seems to be that my "bulging" or herniated discs aren't touching anything painful, while yours might.  I just want to treat what is actually painful, blocking motion or reducing strength and not what is on an MRI.

I used to work editing medical textbooks back in the day for a prominent medical book publisher.  After 4 hours of reading the same text over and over and over, in a small cubicle,  looking for mistakes, it wasn't unusual for my cohorts and I to be convinced that we had the rare maladies we were working on by the lunch hour.  Kind of like what you think about you'll bring about...  Even though it would be implausible to get Beri Beri,  Pica syndrome or Malaria in such a short time.  So I do understand when patients have results of their MRI that they suddenly can feel their bulging discs or degenerative disc disease.  The question remains though, are these findings the pain producers or not?  Only a good mechanical assessment can tell for sure.  Does it really matter what the MRI says if you are able to rapidly reverse and treat your symptoms in your spine or extremities?  My guess is not.

So if we really want to cut health care costs, maybe we should start with our mentality about MRIs.  You can see the Article I read about MRI's  here.  Do you really need to pay an average of $1,950.00 for a cervical MRI for this information?  Just food for thought.  Don't get me wrong, I am not saying to get rid of MRI's...they definitely have their place in diagnosis. As a Physical Therapist, do I really want to see what an MRI will show me?  Well, yes, I kind of do, but then an MRI will do nothing to fix your problem.  A mechanical diagnosis on the other hand will lead the treatment of your painful condition.    
Not to worry, if I suspect sinister pathology such as a tumor, cancer, infection, fracture or other life threatening red flags, I will be the first to recommend getting imaging.

You know what I am going to say.  "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Call 504-228-0524 or visit grimmpt.com to set up your evaluation today.