Shoulder pain doing dips/spinal stenosis - JP Fitness Forums

MAXX · 02-24-2007, 04:45 PM

I used to be able to do 30 dips no problem, but now I can barely do 5 due to the pain in my shoulders. I've been diagnosed with cervical spinal stenosis. Is the stenosis the source of the pain? I'm also looking for any advice for treating/relieving the stenosis which has caused a lot of discomfort in my neck and also severely affected my training.

bryanc · 02-25-2007, 01:47 PM

I think this is one issue that would probably be best addressed by your doctor. Spinal stenosis isn't always consistently the same between individuals and anything anyone is going to tell you on this forum is going to be pretty speculative anyways since cervical pathology is complicated. I think it's an important issue, and I don't to make it seem like you're getting a brush off, but treatment/therapy by someone who has significant experience in spinal stenosis would probably be your best bet.

dfpt · 02-25-2007, 05:28 PM

Maxx,
I would recommend getting a differential diagnosis as to the origins of your pain. There are specific cervical tests and shoulder tests (after the c-spine is cleared) to perform to determine the tissue(s) at fault.

MAXX · 02-25-2007, 07:28 PM

dfpt, what type of person would i go see for this. Currently I am just seeing a chiropractor who diagnosed the condition after requesting xrays and MRI's. He believes I've had the condition for quite some time, but no one had diagnosed. He uses a clicker to treat me instead of manual manipulation, but he refuses to work on the cervical area due to the bone spurs.

bryanc · 02-25-2007, 09:56 PM

So, do you have stenosis or early osteoarthritis of the cervical spine?

Stenosis generally refers to a narrowing (and in the context of "cervical stenosis", it refers to the space that your spinal cord runs through. Bone spurs are generally more associated with osteoarthritis and also spondolytis/spondolysthesis, but I'm not entirely sure what your imaging looks like.

MAXX · 02-26-2007, 06:12 AM

Here are highlights of the reports:

MRI REPORT:

C2-3, C3-4, and C4-5 levels are normal. At C5-6, the disc is degenerated and there is some uncovertebral disease projecting into the left neural foramen. This causes mild stenosis. The central canal and right neural foramen are unremarkable. The C6-7 disc is degenerated and there is moderate left neural foraminal narrowing due to uncovertebral disease. The central canal and right neural foramen are unremarkable.

Cervical spondylosis with left neural foraminal compromise at the C5-6 and C6-7 levels as detailed above. No cord compression is seen.

XRAY REPORT:

There is a tilt of the cervical spine to the right. There is straightening of the cervical lordosis with anterior carriage of the head. There is a pseudo articulation of the posterior tubercle of C1 with the spinous process of C2. This is a developmental variation. Incidentally noted is a posterior ponticle at C1. Incidentally noted is partial ossification of the stylohyoid ligaments. There are disc space changes and degenerative bone formation at C4, C5, and C6. There is hypertrophy of the uncinate processes at C4/C5, C5/C6, and C6/C7. Incidentally noted is elongation of the C7 transverse processes bilaterally.

UConnJulie · 02-26-2007, 06:35 AM

MAXX, definitely see an orthopedist ... he will be more qualified to determine if your shoulder pain is related to the cervical dysfunction or if it is a separate problem.

bryanc · 02-26-2007, 06:04 PM

And if you can, I might also suggest a referral to a rheumatologist. Given, you might not have any other joint pain, but talk with your family physician whether he/she thinks this would be a worthwhile referral to make to possibly rule out ankylosing spondylitis. Your presentation would be an uncommon one, but it would be bad diagnosis to miss.

UConnJulie · 02-26-2007, 07:34 PM

Quote:

Originally Posted by bryanc

to possibly rule out ankylosing spondylitis. Your presentation would be an uncommon one, but it would be bad diagnosis to miss.

Really? I was under the impression that ankylosing spondylitis always started caudally and progressed cephalically ... plus it is very easy to diagnose on x-ray as the "bamboo spine" is pretty hard to miss ...

bryanc · 02-26-2007, 08:19 PM

I've seen a couple of very rare cases where the spondylitis appeared not-lumbar first. Again, it would not be the stereotypical presentation, but given that it would be such a horrible diagnosis to miss and given you can slow the progress down, why wouldn't you include it on your differential? I'm not saying that it's at the top of my differential, and I would definitely go through my family physician to ask about whether or not it would even be worth doing (I've never examined MAXX, nor have I seen his films), but it's not a difficult diagnosis to rule out either.

If you're getting your diagnosis after a bamboo spine x-ray, it's because no one was thinking about it, and you're in the late stage. I've seen a lot of ank spondy, and not one bamboo spine x-ray yet--other than the textbooks.

dfpt · 02-26-2007, 11:29 PM

Maxx,
I agree with UCONNJulie to see an ortho....another option which I'm biased towards are physiatrists (M.D.'s specializing in rehab), only b/c their last resort is surgery.
I've gotta admit, that's one hellova detailed MRI and X-ray report!...I'm impressed....I've not seen many MRI or X-ray reports mention the uncovertebral joints.
Bryanc: interesting you mentioned ankylosing spondy....what was it about the imaging that "red-flagged" it for you? My typical red-flag for A.S. is a subjective report of significant stiffness very temporarily relieved by stretching.
Maxx, I'd be curious to know your age, previous traumas or previous participation in contact sports. Maybe that's in your profile.....I'll check!
UConnJulie: what year did you graduate from UConn....1997 for me!

UConnJulie · 02-27-2007, 05:23 AM

Bryan, interesting ... and I'm curious if you don't mind telling (just because we interact quite a lot on this forum and I've never asked) what kind of physician are you? I am assuming orthopedist since you talk about seeing films and your talk about other orthopedic injuries ...

dfpt, another UConn alum! Well, my first degree from UConn was in 1990 in athletic training. The program was shit and I never sat for my boards because I knew I couldn't pass them with the education I received (Ralph Mansell was the worst! The program is very good now, but it wasn't then!). Actually my senior year I decided to go into physical therapy but finished my degree first and then did prerequesites for a year or so (part time) then went back and graduated again in 1995. Were you in class with Jeff Kinsella-Shaw?

MAXX · 02-27-2007, 08:28 AM

I am 35 years old. My chiro also asked about previous trauma. He said my neck looked like a 60 year old neck, and he felt the damage had been there for quite some time. The only thing I could think of, I had a head on collision with a big guy on the football field my senior year in high school that left me with a very bad stinger--the right side of my upper body was paralyzed for about 2 minutes. Our trainer told me to tough it out.

After that, I always had trouble with pulled muscles in my neck. About 7 years ago, I had a severe pinched nerve in my back for about 2 months--nothing would relieve it. I started to do shoulder shrugs and within days, the pain went away and so did the pulled muscles in my neck--for good!

I have always been a neck cracker since high school. I can crack my neck two ways. One is general cracking that relieves stiffness in my neck. The other is more of a manipulation--I've always described the second type as bone clicking on bone. I used to do the second type a lot when I was younger, but stopped because it caused a lot of pain--it was a bad habit. I try not to do the first type much, because my neck feels a lot better when I don't crack it regularly. But when it gets stiff, I can't resist cracking it to get some relief.

I'm not sure if it is significant or not, but I also have lower back problems. I attribute them to working at a Sam's Club in college where I did a lot of heavy lifting. But my family has a history of back issues. Here's the xray report on the lumbar:

Pelvis and sacrum rotational malpositions are seen. There is a tilt of the lumbar spine to the left. The contour is flat in the upper region. There are disc space changes and degenerative bone formation at L1 thru L4. There is subchondral sclerosis of the facet joints at L4/L5. There are oseophytes seen across the margin of the sacroiliac joint on the left. The remaining osseous structures, joint spacing and articluar relationships are maintained. There is no evidence of osseous or joint pathology.

I feel great except for my lower back and especially my neck. My neck has kept me from doing serious weightlifting over the past year, which has taken it's toll on me mentally and physically. I live in a rural area, so there are not a lot of doctor options. I do not want to have surgery. But regular doctor visits or rehab would be difficult for me right now--my job really prevents me from seeing anyone on a regular basis, except during the summer months. Thanks for all of the input so far.

bryanc · 02-27-2007, 06:47 PM

So, you've lost both lumbar and cervical lordosis...

You're 35 and you have degenerative changes in both cervical and lumbar/sacral vertebrae.

You have pain that wakes you up at night, which may or may not be related to a narrowing of the space that your spinal cord travels in.

None of this would be anything I would classify as "physiological variant of normal", because it's not. You should not have these changes at the age of 35, even if you BROKE your neck in high school.

Rural area or not, it's time to see a doctor.

dfpt · 02-27-2007, 10:14 PM

UConn Julie,
Yes, Jeff the neurology teacher! Is that how you know him? Sorry to hear about the athletic training, but career wise, P.T. has a lot more doors open for it.

dfpt · 02-27-2007, 11:45 PM

Quote:

None of this would be anything I would classify as "physiological variant of normal", because it's not. You should not have these changes at the age of 35, even if you BROKE your neck in high school.

I would have to respectfully disagree with this point. Bryanc, don't take this the wrong way. I think this is a great opportunity to share our viewpoints in relation to Maxx's condition. I do respect your input and I hope there's nothing I could say that would make you think otherwise.
Maxx,this is just my thought process and a lot is speculative b/c I didn't take a detailed history and I didn't physically examine you. Make sure you get evaluate by someone thoroughly.
Maxx, given your history of what appears to be significant trauma to your cervical spine in high school, you've already begun the acceleration in the degenerative process; your cervical spine is compensating to maintain proper alignment (by the way, how tall are you Maxx?). You're basically trying to balance a bowling ball with muscles that don't know how anymore (that's revealed by your constant "pulled muscles in the neck" report). If you kept on playing, I would imagine continued contact with your "unbalanced" head. Weight training in the presence of dysfunction promotes more compensation. As far as lumbar spine, a rotation (which accompanies a tilt) is more common than uncommon as well as sacral and pelvic orientation changes. Repeated contact in football may cause forced hyperextension (trauma=compensatory changes)...weight-training with compensatory changes as I mentioned earlier promotes more compensation. I think you'd go a long way with a lot of soft tissue work and corrective exercises. It's smart of your chiro not to manip with all that's structurally going on, but also, it won't resolve the neuromuscular component. Just my 2 cents.

UConnJulie · 02-28-2007, 06:55 AM

Quote:

Originally Posted by dfpt

UConn Julie,
Yes, Jeff the neurology teacher! Is that how you know him? Sorry to hear about the athletic training, but career wise, P.T. has a lot more doors open for it.

I know Jeff because I was his clinical instructor during his first affiliation ... then we worked together for many years at Windham Physical Therapy ... he's a great guy and probably the smartest guy I know! He's now on faculty at UConn full-time ...