T Nation

Nerve Impingement help


#1

"Another possible cause of your arm development woes may be in your neck. Have a qualified health practitioner look at it, as a small narrowing of the intervertebral space can limit your nervous system from firing effectively, thus hampering growth." (from : Final Solutions for Frustrated Lifters: Arms by Charles Poliquin http://www.tmuscle.com/free_online_article/sports_body_training_performance/final_solutions_for_frustrated_lifters_arms)

I came across this (quote above) and similar statements in the past. Knowing I have some neck damage from and accident, and noticing that I was having difficulty increasing 1RM in all my upper body pressing movements (current 1RM lower than before accident), I had an EMG and imaging done. I have a nerve pinched between bulging discs (C6/C7) and bone spurs. The EMG 'chart' for my left arm was erratic with large troughs well out of range of the screen.

Any suggestions about routines/style of lifting/program designs that could help in getting around the degraded nerve signal or somehow improving it. Or, am I just stuck?

Thanks.


#2

What's your primary goal, muscle development or pressing strength?

My opinion is that the effect on lifting is not so much from the nerve signal being degraded, but that the CNS limits force output when spinal support is compromised. I think it's the instability around the vertebra that reduces force output. And that instability is totally fixable.

I had a nerve pinched between bulging discs at C7/C8 and C8/T1 back in 2001 or so. I had nearly no sensation in 4th and 5th fingers and no grip strength at the time. I eventually recovered, and my upper body strength is greater than before the injury.

However, I learned that the key is rock-solid spinal support. At first after my injury, I couldn't even assume a proper plank position. But I did a ton of that stuff and eventually it paid off.

I also believe that explosive stuff with a tight core is extremely helpful, like medicine ball slams and explosive stuff with bands. (But you may want to consult the professional of your choice for advice.)

When I was injured, I read and heard doctors saying that nerve damage is permanent, that I shouldn't use my affected arm or I could permanently lose the use of it. . .

After a couple months of not using my right arm for anything that hurt (which was EVERYTHING, including picking up a fork), it occurred to me that what is the point of voluntarily giving up the use of my arm, so that I wouldn't lose the use of my arm? I quit worrying about it, rehabbed like mad, got a few ART treatments, and got better.

Take your fish oil and plenty of fat-soluble antioxidants because oxidative stress is high in pinched nerves. R-ala and CoQ10 are antioxidants that might help nerves heal. I took plenty of those myself, so they might have helped.


#3

Thanks for the input. I am much better than I was following the accident surpassing the doctors expectations. I went back to the doctors because my progress has stalled so much. When pressing I lose connection with my left arm, it is not so much numbness but rather the right arm seems active and the left just following along - this is even when I focus on the left arm. When attempting max weights the arm shuts down. This has lead to strains in my opposing shoulder. Unlike with my right arm when approaching failure it slows down- my left arm just fails without warning.

Thanks for the advice for the planks. Posture does make some difference and I could see it will help there. I am taking fish oil again and will try the R-ala and CoQ10 once I can pick them up from the store. What dosage did you take?

Primary goal would be muscle development but I realize that you need to progress in load as well as volume.


#4

The arm shuts down either because the spine does not have enough stiffness with that load at that time, or because the compressive load from the overhead press is too high for that compromised disc. Or both. Your max weight is the max your CNS considers safe for your spine during that movement.

If stiffness is the problem, you can improve that with core stability stuff. Planks are just a start. If planks are easy, then can you do explosive pushups with rock-solid spine? Stability ball rollouts. Explosive OH pressing with bands. Etc.

For the second problem, compressive load too great for the disc, be patient; disc healing is sloooooooow. Don't just keep attempting max OH presses. Switch to another movement that can overload the muscles without putting as much compressive force on the spine.

For R-ala, 300 mg/day is the dose showing improvement for neuropathy. Yes, that's a lot, and it's expensive. (I didn't use that much because I wasn't familiar with the neuropathy research at that time. I used 100mg/day.) For CoQ10, I would go with 300 mg per day.


#5

OHP, bench, triceps work - each has a fail point. I have noticed I am having trouble with bicep activation lately. I am going to do more flexing/posing to help with the mind-muscle connection.

I will add in more stability work. I got some form pointers for exercises that could help open up the area. Mainly keeping the neck neutral and keeping the scapula back and down. Explosive band OHP sounds good.

I have been working back from this injury for 12+ years. I understand slow. I was making good progress this past year and then a series of weak episodes, more progress, then weak episodes. This is when I got the tests done.

I looked at the R-ala and CoQ10 and yes they are expensive. Actually, all I could find as ALA - same thing? I think I remembering reading somewhere there is a difference.

I do appreciate your help with this.


#6

12 years! Wow.

Do you mean to say that it is harder to activate your bicep now than it used to be?

Chances are, as you were making progress you were also tearing down the disc. A healed disc (or any healed tissue for that matter) is never as strong as the original tissue, and is more vulnerable to reinjury. So you need to let the most recent reinjury heal, then modify your technique and exercise selection to stimulate muscle growth as much as possible while minimizing compressive loads on the disc.

Scap retraction is a MUST to stabilize that mid-back. There are some good articles by Cressey, Robertson, and Gentilcore on this site (and their own sites) on core stability and spinal stabilization. Cressey's blog has some good videos, too.

It's not about throwing in some planks or other movements for the core. It's about constantly assessing core stability while you work on it, progressing to more demanding loading, and making sure that the same motor control carries over to every lift.

R-ala is the active form of the isomer. Regular ALA contains the inactive form as well, so you'd have to take 600 mg to get 300 mg of the active isomer. http://www.iherb.com/R-Lipoic-Acid

If I were you, though, I would rather spend my money on a consultation with Cressey. He could assess what the weak link is in your lifts and prescribe a program to fix it.


#7

Yes, bicep activation seems to be getting harder. I can flex it easily enough but it gets harder to focus the bicep when lifting weights. Never have been a strong point for me, my back and shoulders try to do all the work.

It took four years just to be able to lift pink weights and my hands not go numb for the next week. Some of that time I spent focusing on other things - the trade-off being risk numbness or be able to work, write papers (returned to school), etc. Also, lifting too much (volume, weight, both) was real easy for me to do so taking time off periodically became necessary.

I will look at the authors you suggested. I am nursing a AC joint (other shoulder, guess how that might of happened) and need to spend some time rehabing. I will spend time working through their stuff while laying off any pressing for awhile.

Thanks again for all the explanations and suggestions. If I can get access to Cressey I will look into that. Most of the suggestions I have been getting from docs and PTs is, you are trying to lift too much weight.


#8

Take a look at Cressey's thoracic extension video:
http://ericcressey.com/exercise-of-the-week-thoracic-spine-extension-on-foam-roller

If you cannot achieve that much thoracic extension without excessively arching your low back and/or neck, there is great potential to put those discs back where they belong.

Excessive thoracic flexion compresses discs unevenly. It also stretches the scapular retractors into a weakened position. This limits force production AND stresses the shoulder joint.

Also take a look at
http://ericcressey.com/newsletter164html


#9

So, your saying I should be less flexible than the women in the video?


#10

Can you extend your mid-back as much as the girl in the video? making sure it's only your mid-back extending, not your low back or neck?


#11

Sorry for the delay. I did not think so until I looked at the video again and saw she really was not moving all that much. I will have my wife check.


#12

No, I am not as flexible.

I do have a vertebra that likes to move a bit in that area. Left over from some muscles tears when I was younger. The travel is noticeable on an x-ray. It has not done it lately but I did feel pressure there after going heavier on squats this past week.


#13

Going heavy on squats may do more harm there than the heavy pressing. How good do you think it is to put a heavy bar right on top of the disc(s) that are already injured?

You have to stop doing movements that cause the strain, or else the injured tissues will never heal.

Discs do not just randomly bulge for no reason. They bulge because of forces put on them. You have to remove/reduce the forces that cause that disc to bulge. You need to introduce new forces to squeeze it back to its ideal location (like thoracic extension).

So for example, if you're in grad school spending a lot of time hunched over a computer, the ligaments and small muscles connecting the vertebrae in the mid-back and neck get stretched away from their ideal length-tension relationships. The discs, which are viscoelastic, slowly deform. The firm jelly-like nucleus squishes out; hours and hours of pressure stress the annulus (fibrous outer container for the jelly) in that area. Then you get up, with the tissues still deformed (see McGill, Low Back Disorders), and try to lift heavy at the gym. Now you put high loads on those overstretched tissues, causing strain.

So the simple bottom line: you HAVE to eliminate the movements and postures that cause the problem so that the injury can heal. If you keep producing the forces that bulge the disc, it's not going to stop bulging.

You don't have enough thoracic extension or scapular retraction. So discs are always deformed out of their ideal position. If you can't extend as much as the girl in Cressey's video (Gentilcore extends more than that!), your muscles are currently unable to keep your thoracic spine in the ideal position, and also unable to stabilize your shoulder movements. The disc bulge and AC joint injury are related by this same underlying problem.

Nobody ever wants to hear this. But if your thoracic spine is locked into too much flexion and your scapulae are locked up anteriorly in unloaded postures, all loaded movements you do in the gym can cause further harm. Take rows for example. In theory, rows work the scap retractors and mid-back muscles, so they should be a good choice. BUT if your thoracic spine cannot extend, THEY DON'T. If you can't extend the thoracic spine over a foam roller, with gravity to help and partial spinal support in the lying position to make it easier, than how are you going to maintain safe thoracic spine positioning in loaded movements in the gym? You cannot. So even things like bent-over rows can put bulging forces on your discs.

One thing I have learned, the hard way, is that your LONG-TERM progress in bodybuilding is no better than your joints' condition right now, ESPECIALLY the spine.


#14

So this is what I understand at this point. I need more mobility in my thoracic spine (we erred on the side of not as mobile - it was close) but in doing so I aggravate a vertebra that likes to shift to the left (too much mobility, in a sense, the resulting effects I wish to avoid - pain, trouble breathing, depression). The lack of mobility is not allowing my neck to align properly for the over a decade old disc bulge to return to place (I believe what you are saying but have never had this conversation with all the back specialist I have seen). The bulge is not that bad (according to docs) but the bone spurs are the problem about which I can do nothing.

This does not sound good.

So moving forward, would you suggest focusing on posture and shoulder and upper back mobility above all else for the time being?


#15

Yes, I would suggest focusing on spinal posture and optimal mobility and ROM. You have to learn what that is and what to do to improve it. However, you may need some help from a qualified PT if thoracic extension on a foam roller causes trouble breathing and depression. (I say "qualified" because all the PTs I have seen, sucked. You have to find a good one.)

As far as the doctor's opinion as to whether the bulge is that bad...there is little correlation with how it appears in imaging and the level of pain/dysfunction. Does your doctor know that? Bone spurs are a symptom of years of excessive pressure there. If a bone spur appeared to compress the nerve root that corresponds to your exact symptoms, I would think the doctor would want to surgically remove the bone spur. But I'm not sure what the prognosis would be for such a surgery.

BTW your previous message is the first time I noticed you mention any pain whatsoever.


#16

I will try to clarify a few things.

The vertebra that moves it around the bottom of my shoulder blades - old injury (23 yrs ago). I started lifting in large part to help strengthen that area, muscles tore on both sides. I have never been able to squat over 315 without pressure/pain. Heavy, the other day, was 315 to test the area and form. Felt fine for the rep, felt a little pain hours after but was short lived. Where the foam roller was on my back to do the exercise in the video it put pressure in that area and was uncomfortable. When the vertebra is "out" is when I experience pain, difficulty breathing, and signs of depression (poor sleep, less focus, moody, etc.). 95% of the time I squat light for reps. This injury does not seem to be currently affected by deadlifting.

Neck bulge was from getting hit by a car and landing on my neck. I had been lifting just 1.5 yrs and the docs said my "nonfunctional" muscles saved my life. Imaging then is when I learned about the bulging disc (pain radiating to hands, major loss of strength - could not hold a coke can or feed myself), bones spurs and degenerative disc disease in the area. Over time and with much effort the symptoms have gotten better, well exceeding the best prognoses by the doctors, (hand pain is fairly minimal now, but I know that if I turn my head to the right and look up it puts pressure on the nerves in the spine (not the ones radiating down the arm) and will lead to a migraine). This is where the trading-off of activities has been - typing a long paper = hand pain and even loss of function for a time being. Migraine headaches have been a constant since the accident, much worse the last few years although I think I have them somewhat under control now. It has been a long row to hoe. I have yet to match some of my original top lifts, such as bench.

Now, my concern is that I cannot seem to get any stronger (in related exercises) nor my arms any bigger. In many ways a pretty minor concern considering.

[quote]But I'm not sure what the prognosis would be for such a surgery. [quote]
The risk of scaring in the region could undo any benefit from the surgery and make it worse. Since I can function pretty normally it is not worth the risk.

The only other piece of information that might be of use is it appears I have a ton of inflammation - wrists, shoulder, knees. I am hoping that reducing the inflammation will help with the pressure of the nerves. I do not know what is causing the inflammation but it has been a problem for several years. I am currently on an anti-inflammatory plus taking fish oil.

Sorry for wall of text. I do appreciate your help with this.


#17

Well, that is some rough stuff. If I stop and think objectively about it, I have experienced some similar rough stuff. I was hit by a car while riding my bike, for example, and that sucked. However, I do not know of any vertebra I have that pop out of place, so I do not know of a specific strategy to help with that offhand.

If I understand correctly, you were hit by a car 12 years ago, had severe symptoms immediately following the accident (unable to move hands), and had imaging done at that time. The imaging at that time showed a disc bulge, bone spurs, and degenerative disc disease in the area. The bulge was probably already existing, but made worse by the impact of the accident. The bone spurs and degenerative disc disease must have been developing over a period of time before that, maybe from inadequate recovery from the muscle tear 23 years ago. (Or from who knows what, since they are all extremely common findings in imaging, even in people with no pain or other symptoms.)

Then recently, with your plateau in strength and difficulty activating biceps, you had imaging done again, and the bulge and bone spurs are still there.

I know of a couple positions/movement sequences that you could try to decompress the spine and give the surrounding muscles a fighting chance to relax. They are much more gentle than the foam roller thoracic extension, which you obviously shouldn't continue to do at this time. If you PM me your email address, I will send you an invitation to view the photos and printed audio instructions I have up on Google Docs.


#18

check for PM