T Nation

Cervical Stenosis and Grappling?


#1

Hey guys, I’ve been a long time lurker of this sub-forum, really just trying to soak up all of the knowledge from the more experienced members. I’ve trained in different martial arts (muay thai, bjj, judo) over the past few years, although it’s been on-and-off, since I haven’t been able to stay in one place for very long due to military service. I’d really like to get back into them, however I’m not sure what, if any, I should stay away from. The VA’s diagnosed me with cervical stenosis (C2-C3 and C5-C6) as a result of my service, so I’m really wondering if grappling is out of the question.

If there’s any help or advice you all could give, I’d greatly appreciate it. I’m planning on doing muay thai this evening.


#2

First the disclaimer.

Online is advice is a poor substitute for medical evaluation, diagnosis, and treatment/advice. I am not YOUR doctor. Nothing above or below should be misconstrued as establishing a doctor patient relationship. Superseding a your clinician’s orders based on the words of some chimp on the internet would be stupid. Like smoking in the magazine stupid. Like telling the NCO to stick it up his ass stupid.

Can I get an age and approximate date of injury/onset of symptoms? Do you have any indication of what tissue is creating the stenosis?(I am really asking about disk herniation vs “boney” canal changes that tend to be common in older patients)? What, if any, advice did your medical team give you about activities/limitations?

Answering the above would allow for more meaningful responses.

Thank you for your service.

Regards,

Robert A


#3

It is very unlikely that he got any useful information out of the VA. No respected neuro would bother working there.

If you have digital MRI copies I can take a look at them for you and let you know what is going on exactly. I am a neurophysiologist, btw. I can have the neurosurgeon take a look at them as well.


#4

Robert and Loftearmen, I’m 28 years old, but onset of symptoms began in 2010. I’ve found the medical records from the VA and I may have misstated some things, so I sincerely apologize. I have no idea how to interpret this information, nor did the doctors do much help in explaining everything for me. I’m sure it’s all fine, but it’s just the lack of explanation and information that is making me second guess some things.

Here’s the information from the file:
“Mild multilevel cervical spine degenerative changes with disc osteophyte complex at C4-C5 and C5-C6 mildly effacing the ventral system and resulting in mild central canal stenosis, with facet arthropathy and uncovertebral spur, as above. There is straightening of the cervical spine lordosis.”

Thank you both for your responses. I understand that neither of you are my doctors, but I still appreciate any help with at least answering a few questions.


#5

Reion2005,

First, I would strongly consider taking Loftearmen up on his offer. A second read of your MRI and any other relevant (if you had any electrodiagnostic testing like EMG or nerve conduction velocity) testing is always a benefit. Sometimes new eyes find things. This is especially true if you think you may not have been given a ton of consideration previously.

Thank you for giving your age, that can be a factor in what specifically is likely to re-injure or not. It also helps with making any kind of predictions about what is likely to aggravate your condition.

Now, lets translate the report you gave in case any of the wording is leaving you behind. I hope you don’t take this as being condescending, I just don’t want clinical language to be a barrier. My comments/translation will be in italics.[

"Mild multilevel cervical spine degenerative changes-Degenerative changes happen over time. Usually they get described as age or overuse related. If you think of it as wear and tear you aren’t that far off. Severe degenerative changes are to worn out what severe traumatic injury is to busted up. Stenosis and arthritic changes are often described this way.

disc osteophyte complex at C4-C5 and C5-C6 mildly effacing the ventral system
disclaimer, I have never seen the term ventral system show up on a cervical MRI report, at least that I can recall. I am going to lean or Loftearmen for an actual explanation here. Effacement is basically being blotted out or obliterated. Don’t freak out by that language because we need to remember this is small stuff and using radiology/imaging terms. It doesn’t mean hulk smash, it just means something is in a space where we would expect to see something else. Usually I read “effacement of the thecal sac” and it means that something is taking up part of the space that should be the exclusive stamping grounds of the spinal chord, cerebral spinal fluid, nerves, etc. Osteophytes are bony spurs that grow out from the normal anatomy. A disc osteophyte complex indicates that these spurs are involved at multiple levels, and involve cervical discs as well. Think calcification of tissue or new hard/calcified tissue developing in what should just have the softer(by comparison) intervertebral disc there. So bone is growing where it shouldn’t be. This is often a finding when there are issues with stability or chronic overuse. One of the issues this can cause is that it takes up space, which can lead to

resulting in mild central canal stenosisStenosis implies a narrowing or decrease in space. The central canal is the space the spine that contains the chord, cerebral spinal fluid, etc. and it is formed by there being a “hole” for all that to run through in each vertebra. So from your report we learn that bony spurs/calcified tissue is getting in the way of “other stuff”.

with facet arthropathy and uncovertebral spur, as above.The facets refer to the articular joints of the spine. They are also called zygapophyseal joints. It is worth knowing that these are pretty much normal synovial joints. Cartilage articular surfaces, synovial fluid lubrication, joint capsule around them, likely everything you think of when I say joint. Unless you post in the Bad Ideas thread. Then you would think Probable Cause. Arthropathy means that things are going on that are interfering with the normal, smooth movement of the joint. Because of the degenerative change language earlier we should probably think of an “over worn” joint. Like an 85 year old woman’s hip. An uncovertebral spur is one of those damn bone spurs happening in the uncovertebral joint. This is an articulation between what is sort of a lip on the sides/lateral part of the lower vertebra and and the side of the vertebral body of the superior vertebra. This articulation helps limit movement/brings stability two the cervical spine. The spur means that lovely osteophytic thing is happening here as well.

There is straightening of the cervical spine lordosis.Lordosis refers to the inward/concave looking curve normally present in the neck and low back. The outward curve you notice in the thoracic spine is called a kyphotic curve. Your necks doesn’t curve as much as “normal”.

I am also going to translate the report into my native tongue of P.I.B.(Pennsylvania InBred)

The joints in yer neck is all wore out and they creek and they don’t slide so good. Also some stuff is poking where all kinds of important wires, and tubes, and fluids, and such are.

Alright, so I was just having some fun there at the end.

Was any of that helpful?

Are you having any symptoms currently? If not what were they, and how did you treat them? If your VA medical team has you cleared for work/duty/didn’t put any limitations on you there may still be some better and worse ways to approach what you do in training.

Again, I realize the above was likely all things covered previously or that you already knew. I sincerely hope I didn’t cause any offense with the above. I just wanted to make sure “the report” was transparent for you as a starting point.

Regards,

Robert A


#6

We wouldn’t likely find anything on EMG or Nerve Study because the spinal cord is what is being affected. SSEP’s may show some manifestation but would still be of limited value conaidering that we already know the source of his symptoms. Any involvement of the nerve root would be an underlyimg issue, albeit a very plausible one.

OP, the arthrogenic changes in your cervical spine are still somewhat mild but they will get worse with age. Seeing a COMPETANT Chiropractor would probably be a good idea; unfortunately, competant Chiros are in ahort supply these days. When you do find a good one they are worth their weight in gold. Your stenosis will eventually get worse and will likely require surgery. This will probably be down the road quite a way so don’t start freaking out about it.

Even though surgery is years and years away (if at all) now is the time to start taking preventive measures to help push that day further and further away. The lordosis may be the cause or a symptom of the osteophyte formation and degenerative changes in your spine. Either way, it does need to be corrected so definitely speak about exercises, stretches and at home traction techniques you can utilize to restore your natural cervical curvature. It would also probably be a good idea to purchase a cervical decompression device which is a harness for your head attached to a string you load with a weight nd toss over a door. It basically lifts your head up a little bit and allows better blood flow to the discs. At your age, discs can still heal and correct themselves pretty well so this could help (it could also be a waste of time and money but there is only one way to find out).

For the rest of your life you should pay attention to your hands and arms. If you start feeling numbness, tingling, burning, electric sensations or muscle weakness then it is time to see a neurologist for an exam and Neurodiagnostic testing.

If you have any questions or need any help with this don’t hesitate to contact me at norsemanpowerlifter@yahoo.com. If you have those MRI images handy you can send those to that email as well.


#7

Robert A

By ventral system they were referring to the anterior corticospinal tract, anterior spinothalamic tract and the anterior horn of the gray matter. Basically, this indicates 2 things: 1) his symptoms are likely to manifest in motor deficits and 2) there is an increased probability of compression of the anterior nerve roots should the issue progress (which really just reinforces the first point although through a different etiology).

I did find it odd that the interpreting physician didn’t measure the depression in the spinal cord. Usually an MRI report would say something like “3-4mm spinal cord compression from osteophyte formation and posterior disc herniation of 5mm at the such and such spine levels”.

It was a poorly written impression and interpretation, I assume it was written by a doctor at the VA.


#8

I missed it if he stated he had or did not have any upper extremity issues as well as or secondary to the stenosis. I am thinking different possible advice for a hx of pain primarily vs one that had peripheral neuropathy as well. Not in a Red Flag sense but in a training considerations sense.

Ok, that makes quite a bit of sense. I was inferring ventral chord, but I honestly never saw the term used. It was always ventral chord/anterior spinal canal/anterior spinal chord often with a hefty dose of “please correlate with symptoms/pt presentation” The use of “system” had me questioning if I knew what I was reading or if I was wrong. The motor deficits angle has me asking about symptom presentation as well. Also a big question about modifying factors if we get there.

Now that you mention it that is a bit irregular as well. They only graded it as “mild”. I have seen sparser reports from regular hospitals or radiology clinics though so it may not have been the special VA level of don’t give a fuck. Just the regular amount.

So, given your size and muscle how many people assume you are an Orthopedic surgeon?

Regards,

Robert A


#9

Hahahaha, people think I am an ortho all the time. It’s funny you brought that up.


#10

Finding a good chiro is definitely going to help stave off symptoms… especially if they are an ART practitioner. I also have cervical stenosis and degenerative disks, but probably a bit worse off than you since I’m a bit older.

I’m a very active person, and have been doing judo and jiu-jitsu for almost 10 years. While on the mat, I never really experienced any symptoms. And if I did, I chalked it up to taking a bad fall or getting my foot stomped. But I’ve recently had to take some time off (fire academy and had a kid). I still lift daily, but I don’t get the same level of neck work as when I’m on the mat.

One morning about a year ago, I woke up and thought I’d had a stroke. My entire left side was numb and very weak. After I realized that I in fact did not have a stroke, I figured it was something with my neck. In the days leading up to this, my neck had been getting progressively stiffer and on this day, I was virtually walking around like Frankenstein because I couldn’t turn my head/upper back.

I found a hospital based chiro office that specializes in ART, and after the first session I had all feeling back and about 90% mobility. I went 3 times a week for about 6 weeks and did mobility exercises on the days I didn’t go. Now I only go when absolutely necessary, but when I do they’re able to fix me up pretty quick.

I know I’m going to need surgery, probably sooner rather than later, but there are some things other than ART that have really helped.

  1. I stopped popping my neck.
  2. I try to drink a lot of water. On days where I don’t get enough, or I have a few beers, I tend to get really stiff. If I go much more than a day like that, then the numbness starts creeping back in.
  3. I have to do mobility work daily. Head turns, chin tucks, head slides, figure 8’s, etc.
  4. I do some sort of SMR every day, whether it’s on the foam roller, using a lacrosse ball, or The Stick, keeping the surrounding musculature free has helped.

I recently got back on the mat after a longer layoff than usual, and oddly enough, my neck felt great in spite of taking some hard throws and chokes.


#11

Robert and Loftearmen, I appreciated the simple explanation. Haha, no offense taken at all. Some of the symptoms I’ve experienced have been stiffness throughout my neck, almost like it was locked in place for a period of time, soreness of course, and a slight tingling at times down to my right hand. I would send out the MRIs if I could, but I don’t have them, nor can I find them in my service file. I have requested a visit with a chiro (denied by the VA), but have started taking preventive measures through the use of a traction device and massage. It helps a lot.

Steve, thank you for telling me all of this. Shows I should still be able to do it a bit, and congrats on the return to the mat. I’ll do my best to take it easy and get on top of seeking out some preventive measures to slow down some of the degeneration.

Thanks again everybody!


#12

Reion2005,

Again, full disclaimer here. Obviously specific advice is impossible without a history, testing, physical exam but I am just going to mention a few things that patients with similar injury histories have benefited from.

The advice to get a good/qualified eval and treatment from a chiropractor is spot on. I would be especially willing to seek out someone who would be looking at overall motion and stability of your cervical and thoracic spine. It is not at all uncommon for upper thoracic and shoulder issues to cause increased wear and tear in the cervical region. In fact upper cervical and jaw/TMJ issues can be related as well. If you have been at the mercy of Tricare Dentistry for a while fillings/dental work can also be part of the overall picture. Addressing these things can go a long way in making sure you don’t work your way into a surgical condition before absolutely necessary.

If you end up having to go out of pocket for a chiropractic or physical therapy evaluation than the upside is that you get to pick who you go to. So be selective.

Next, give yourself permission to pay attention to your body, and try to avoid any unnecessary provocative actions. Decide right now to tap early and often to neck cranks or “chokes” that have a high degree of crank going on as well. Gutting out a bunch of “bad” submissions" may have impact on how long you can keep training without having to pay for new tires for the surgical team. Be cognizant of things that suck and bring on an increase in your stenotic symptoms, vs the normal suck of combat sports/martial arts training. Consider any upper extremity symptoms as a red/yellow flag and figure out the difference between injured or “just hurt” before throwing yourself back into rough training. If you notice your neck “getting tired” with movements like crunches or just having to keep your head up/moving than that is a huge signal to dive into the stability/motor pattern end of the prehab game.

If you already have prehab/rehab drills that you know benefit you, find a way to make them part of EVERY training. If you check FightinIrish’s log for “High Mileage Warm Up” you can find something I wrote up for him that did a bit of good a while ago. I hope some of this helps.

Regards,

Robert A


#13

Robert,

Thank you very much for that write up. I think I’m going to simply step away from it, since that is the best way I know to self-regulate. I was hoping to do at least one competition, but that could potentially do more harm than good. I do plan to continue my training in Muay Thai and Boxing however. I’ve found that I don’t feel any issues with my neck/back while studying those arts (no sparring).

I will find his log and take a look. Thank you again for all of your help. Hopefully I can stay a little more active here.

Respectfully,

Reion2005