Tuesday, September 6, 2011

Training with Herniated Discs

Last week I received an email from a blog reader with a question:

"I was recently diagnosed with herniated discs in my neck (C-3:C-7) and I am a bodybuilder. I realize that my workout must now change and am looking for a new program that can still keep me in good shape, build lean muscle, while keeping the stress off of my neck. Thanks so much for your help."
MH

Thanks for your question! First of all, I am going to assume that you have clearance from your physician to start training and don't have any neurological deficits (i.e. weakness or tingling in your arms). If you still have any neurological symptoms, consult your physician.




Herniated discs can be a little tricky, but the primary modifications with strength training would be to maintain a neutral neck (spine) and limit exertion of muscles that insert on the cervical vertebrae. If the neck is not neutral, say do to poor posture or muscle imbalances, then your training can (positively or negatively) impact your condition. Lets take a look at some of the muscles of the upper back, shoulders, and neck.

As you can see, many muscles connect to the cervical vertebrae, originating above from the scalp, and below from the scapulae and thoracic spine.

While many different types of training programs with free weights or machines may be effective in helping you achieve your goal, I am going to point out the precautions you need to take with any exercises you do perform. One of the most important things to remember is how you do the exercises is as important or more important than what you do.

1. Maintain a neutral neck with lifting- Be carefull to not hyperextend or flex your neck with exercises, such as squats, curls, presses, etc. Find a focal point to look at and keep your head "tall" as you perform the exercise. Avoid exercises in which it is difficult to maintain a neutral neck, such as a crunches.


Maintaining a neutral neck while deadlifting.
2. Limit stress on muscles that insert on cervical vertebrae-
Muscles such as the upper Trapezius, Levatator Scapulae, and Splenius Capitis all insert on the back of the cervical vertibrae and can exert a lot of stress on the cervical discs. It is almost impossible not to use these muscles, but you can limit them by using good technique. For example, with a cable row, when rowing, keep the weight at a level where you can retract the shoulder blades back and down. This motion limits tension in the upper Trapezius muscle, and stress on neck. Another example is with the bench press. Again, keep the shoulder blades back and down and be careful not to hyperextend your neck into the bench. Think of keeping your head "tall" and chest "forward."

Proper movement of the scapula, back and down, improves posture and puts less strain on the neck.


3. Balance your training so your posture improves- Imbalanced training can worsen posture. So many people, because of the vast amount of sitting, have poor alignment of the spine, shoulder joints, and rib cage. An imbalanced training program, such as one that doesn't address posture and includes a lot of "chest" or pushing exercises can create more problems. I will give a client that has posture problems a healthy amount of "corrective exercises". This will usually include stretching the chest and front of shoulder, increasing extension and rotation of the thoracic vertebrae (at the level of your chest), strengthening the upper back and hips, etc.

Normal and head-forward postures, which put more pressure on the discs in your neck.
Thoracic spine rotation to 'correct' poor posture
A properly-designed strength training program can safely be followed even with cervical disc herniation (without symptoms). While I am not providing a specific program (because I would really like to know more about you), following these three precautions should help you. Of course, if you have symptoms and/or want more specific advice about appropriate 'corrective' exercises, seek out a physical therapist or qualified trainer (hint: most trainers are not qualified in this area). Good luck!

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