Pain, surgery, and athletics

For the last 5 months I have been living with pain and only for the last 3 months have I been stepping back at the gym- at least with overhead movements. Ironically, pain increased drastically with me doing this. Also, unfortunately those are the movements I need to work on most. I've been blessed with some strong legs and a decent booty, but my chest and arms are the weakest parts of my body. Consequently, I am strong at lifts that are are hip-explosive and utilize leg strength. Think cleans, deadlifts (I have a strong grip), thrusters, squats. 

While the pain in my shoulder and arm at first didn't quite stop me from hitting WODs, I soon started noticing loss of strength on my left side. At first, I explained it with being right-handed, and simply considered my left side less strong. Kind of BS, if I consider how I did extra heavy left-hand curls and focused on using my left more in training. It did not help.

Muscle weakness also caused me to not hit any more maxes and I began to stagnate and even regress. Then with my EMG and MRI results, and conversations with my doctors and PTs, I ended the cycle of denial and stopped through the pain.

Light-weight back squats, front squats, pistols, step ups, one armed curls, one armed pullups and push-ups, leg raises, one armed planks, lunges... Yep, basically lower body movements are ok, but nothing over head. Even TGUs on the left shall be avoided. The last PR in my records book was a 210# FS PR about a month ago. Since, I had to take more loads off the bar.

Focus on form. Focus on core. Focus on legs. But I it is very frustrating to feel like I am losing all my strength and fall bac behind everyone else at the gym.


So, I was seeking out data and stories about athletes returning to sports with and without back surgery.

Here are some if my finds


http://www.back-surgery.com/athletes-spine-surgery/

http://www.medicaldaily.com/pros-and-complications-microdiscectomy-and-why-tiger-woods-missing-masters-back-surgery-273900 (this one mentions Tiger Woods, who had back surgery)


http://www.michaelgleibermd.com/blog/74-professional-athletes-undergoing-cervical-spine-surgery.html (this one has short videos explaining different procedures and mentions Peyton Manning who had cervical spine procedures)


http://www.readingneckandspine.com/return-to-play-after-anterior-cervical-discectomy.html (nice read, written by a fellowship-trained orthopedic spinal surgeon named Setphen Banco (MD), citing studies and using Manning as an example as well)

http://www.orthogate.org/patient-education/cervical-spine/cervical-discectomy.html (summary)



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Today I did the following at the gym, just to keep working a bit - all very slow and controlled - watching my pain level.



1k light row set to resistance 3 for warm-up followed by some easy stretching

40/40 GHD

10rds 5-10sec Ring holds alternating high and low 

5-5-5-5 ring rows 

Working up to heavy FS

5-4-4-3-3-3-2-2-1-1-1

35-65-85-105-115-125-135-145-155-165-175 (which is 35# below my 1RM)

4 rounds Untimed

250m row

20 alternating pistols 

20 alternating curls with 25#right/15#left DB

20 alternating step ups with 10#DB on each shoulder 

Spinal Surgeon #2

I went to another surgeon in South Denver today to get a second opinion. I liked this doctor much more than the first. He was more personable and professional, took his time to explain everything to me and my husband and did not rule out non-surgical options right away.

I still have another appointment set up but kind of feel it's not necessary anymore (nor do I have time to wait any longer). As I just implied the first surgeon I saw didn't take much time to explain or discuss my case, and didn't even consider non-surgical options.

So, surgeon #2 laid out the pros and cons of possible four options that my case would allow for - in his opinion.

(1) Epidural steroid injections

(2) Anterior cervical discectomy and fusion

(3) Anterior disc replacement

(4) Posterior cervical discectomy



We logically ruled out epidural steroid injections because of (a) failure of other conservative treatment including rest, meds (anti-inflammatories, steroids, narcotics for pain), physical therapy, dry needling, chiropractic manipulation, and (b) the location and size of the herniation.



Left with the remaining hree surgical options. But which one should I do? he compared my case to Peyton Manning and his fusion and showed me X-rays of successful fusions he did on athletes. Manning had (4) done but it didn't work out so (2) was his next step. While I was set on disc replacement over fusion after having done my own research - relying more on European studies than US-based research, I began to doubt this was really the right idea. Yet, I kind of excluded option (4)posterior cervical discectomy.



Nonetheless, this procedure actually shows high success rates, yet, it still may lead to one of the other options down the road (think Peyton Manning).

So should I go ahead and do (2) anterior cervical discectomy & fusion (Manning did this after (4) failed) or (3) anterior cervical instrumentation (aka replacement).



This surgeon worked with athletes, and said (2) was the standard procedure for elite athletes in high contact/impact sports. (3) However, lacks US-based research although it appears to be the preferred procedure in Europe and South America. and research has been promising.



Thinking it over and taking to my PT, reading yet a few more scholarly articles on the topic and some rational thinking made me second-guess going for a big surgery right away.



So, option (4) is what I decided and now the insurance approval battle has begun again.

Here are the titles and authors of some of he articles I've read and found helpful

In making my decision for the less invasive surgery:





(1) Early outcome of posterior cervical endoscopic discectomy: an alternative treatment choice for physically/socially active patients

by Kim, Chi Heon / Chung, Chun Kee / Kim, Hyun Jib / Jahng, Tae Ahn / Kim, Dong Gyu; 

Journal of Korean Medical Science



(2) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. by Ruetten S, et al.
Spine (Phila Pa 1976). 2008 Apr 20;33(9):940-8. doi: 10.1097/BRS.0b013e31816c8b67



(3) Minimally invasive cervical microendoscopic foraminotomy; Initial clinical experience. 

by Fessler RG, Khoo LT 

Neurosurgery 51(Suppl 5):S37-S54, 2002.



(4) Advances in Spinal Stabilization. 

by Haid RW Jr, Subach BR, Rodts GE Jr (eds):

Prog Neurol Surg. Basel, Karger, 2003, vol 16, pp 251-265




(5) This one is open access: http://www.karger.com/Article/FullText/351887?hl=1&q=Cervical%20posterior

Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients by Dohrmann G.J. · Hsieh J.C.

Section of Neurosurgery, University of Chicago Medical Center



(6) Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes

by Hsu, Wellington K. MD

Spine Issue: Volume 36(10), 01 May 2011, p 800–805