Triceps weakness from cervical radiculopathy

[Mark Rippetoe]

Will- No muscle atrophy that I can see or feel and the strength is improving. Coordination has long since returned to normal. Bench strength has been equal left and right except for locking out my right elbow, hence my original, still unanswered question. And as I said, even that difference is nearly gone.

I'm not really sure how an emg/ncs (electromyelogram/ nerve conduction study) would be helpful. My understanding is that it's a diagnostic test that can be helpful when the cause is unclear. Based on symptoms and response to treatment, the etiology does not seem to be much in question.

Rip- any thoughts on the utility of accessory work to speed up the strengthening of the residual triceps deficit, or just do the program?

If it's actually healing, then the doing the program works the triceps bilaterally. If technique is correct, the weak side will be forced to catch up.

[Will Morris]

Will- No muscle atrophy that I can see or feel and the strength is improving. Coordination has long since returned to normal. Bench strength has been equal left and right except for locking out my right elbow, hence my original, still unanswered question. And as I said, even that difference is nearly gone.

I'm not really sure how an emg/ncs (electromyelogram/ nerve conduction study) would be helpful. My understanding is that it's a diagnostic test that can be helpful when the cause is unclear. Based on symptoms and response to treatment, the etiology does not seem to be much in question.

Rip- any thoughts on the utility of accessory work to speed up the strengthening of the residual triceps deficit, or just do the program?

Your understanding of an EMG / NCS is wrong, but you came here to answer your own questions.

[chaloney]

Your understanding of an EMG / NCS is wrong, but you came here to answer your own questions.

Please correct my misunderstanding, that is, after all, the reason I chose that wording.

Rip - thank you

[Mark Rippetoe]

IF you have a neurological problem, then all the assistance work in the world will not correct the neurological problem, because isolating the muscles involved depends on the ability to recruit those motor units into contraction, which is dependent on neurological mechanisms.

If exercises fixed neurological problems, then paralysis wouldn't be such an issue. Right?

When Will tells you things, pay attention, Doctor.

[chaloney]

[/B][/I]When Will tells you things, pay attention, Doctor.

I'm sorry, am I supposed to know who the fuck Will is? There's effectively no info in his profile except SSC, which gives him no qualifications to recommend medical tests to anyone. Do you take unsolicited medical advice, or any kind of advice, from random people off the internet? Of course not. So I asked for explanation/discussion, by which I could hopefully judge his knowledge and ability to give good/meaningful/useful advice. I'd argue that I did more than "pay attention." The response I got did not suggest he had any to give. Rather, the snarky, retaliatory tone suggests quite the opposite.

Regardless, I am aware that I don't know more than the basics in regards to emg/ncs and I patiently await explanation of how it is more than diagnostic. How can it change treatment? How can it alter recovery?

[Will Morris]

I'm sorry, am I supposed to know who the fuck Will is? There's effectively no info in his profile except SSC, which gives him no qualifications to recommend medical tests to anyone. Do you take unsolicited medical advice, or any kind of advice, from random people off the internet? Of course not. So I asked for explanation/discussion, by which I could hopefully judge his knowledge and ability to give good/meaningful/useful advice. I'd argue that I did more than "pay attention." The response I got did not suggest he had any to give. Rather, the snarky, retaliatory tone suggests quite the opposite.

Regardless, I am aware that I don't know more than the basics in regards to emg/ncs and I patiently await explanation of how it is more than diagnostic. How can it change treatment? How can it alter recovery?

If I had any good / meaningful / useful advice to give, I'd say something like this: a muscle undergoing a deinnervation process is at high risk of alpha motor neuron cellular apoptosis when that muscle is worked to fatigue. That is why the standard of care for any deinnervation process, whether it be ALS, cervical radiculopathy, peripheral nerve injury, or the like, is to perform exercises in a low rep range to prevent fatigue. The retrograde of waste products along the axon is impeded by the deinnervation / axonal damage, however, the neuronal cell body begins to increase the rate at which it signals for retrograde of waste products and this causes a positive feedback loop that stresses the neuron to the point of apoptosis. An EMG / NCS is the definitive test to rule out a deinnervation process, as well as providing evidence of reinnervation. A properly evaluated EMG can also determine the chronicity of the deinnervation. That is to say, a chronic deinnervation with evidence of reinnervation is less at risk of working to fatigue than a muscle undergoing acute deinnervation with no evidence of reinnervation. I'd follow that to say, for deinnervation processes, working general, compound exercises is of greater benefit / less risk than accessory movements. If the EMG came back all clear, I'd be more than comfortable with taking a look at the programming of my patient and see if there was something to add to correct the deficit. But then again, what the fuck do I know? I have no qualifications to speak on this matter, as I am not a practicing physician.

[GaryP]

Stop fucking around with this and see a neurosurgeon.

Not to hijack this thread, but I got to say I've got a similar issue. I've got an appointment with the neurosurgeon next week.

Age 64. Discectomy with fusion for c5-c6 thirteen years ago. Herniated c6-c7 about a month ago; been sitting on my ass for a month with bad pain in my right mid-trap and right arm taking strong analgesics, a series of epidural nerve blocks, and losing muscle. Actually I think I've lost around 8-10 pounds of muscle in this short time. Last night, I measured my right upper arm and it was a half inch smaller than my left arm. Boy was I pissed. It took a long time at my age to build that muscle! Now as soon as I can get under the bar again I want to blast my right arm.

Unfortunately, one thing I'll be giving up is my favorite lift, the press.

[Mark Rippetoe]

Giving it up, as in permanently? Why?

[chaloney]

If I had any good / meaningful / useful advice to give, I'd say something like this: a muscle undergoing a deinnervation process is at high risk of alpha motor neuron cellular apoptosis when that muscle is worked to fatigue. That is why the standard of care for any deinnervation process, whether it be ALS, cervical radiculopathy, peripheral nerve injury, or the like, is to perform exercises in a low rep range to prevent fatigue. The retrograde of waste products along the axon is impeded by the deinnervation / axonal damage, however, the neuronal cell body begins to increase the rate at which it signals for retrograde of waste products and this causes a positive feedback loop that stresses the neuron to the point of apoptosis. An EMG / NCS is the definitive test to rule out a deinnervation process, as well as providing evidence of reinnervation. A properly evaluated EMG can also determine the chronicity of the deinnervation. That is to say, a chronic deinnervation with evidence of reinnervation is less at risk of working to fatigue than a muscle undergoing acute deinnervation with no evidence of reinnervation. I'd follow that to say, for deinnervation processes, working general, compound exercises is of greater benefit / less risk than accessory movements. If the EMG came back all clear, I'd be more than comfortable with taking a look at the programming of my patient and see if there was something to add to correct the deficit. But then again, what the fuck do I know? I have no qualifications to speak on this matter, as I am not a practicing physician.

Thank you. That's very helpful. Answers my questions very thoroughly. I appreciate the time and effort it took. I apologize for being an ass in earlier posts-- my attempts at being polite were coming across the wrong way and I didn't see any other way to get an answer to my question. Thanks.

[Will Morris]

Not to hijack this thread, but I got to say I've got a similar issue. I've got an appointment with the neurosurgeon next week.

Age 64. Discectomy with fusion for c5-c6 thirteen years ago. Herniated c6-c7 about a month ago; been sitting on my ass for a month with bad pain in my right mid-trap and right arm taking strong analgesics, a series of epidural nerve blocks, and losing muscle. Actually I think I've lost around 8-10 pounds of muscle in this short time. Last night, I measured my right upper arm and it was a half inch smaller than my left arm. Boy was I pissed. It took a long time at my age to build that muscle! Now as soon as I can get under the bar again I want to blast my right arm.

Unfortunately, one thing I'll be giving up is my favorite lift, the press.

Pain, by itself, is not a good indication for surgery. Generally speaking, there is no good reason why you wouldn't be able to press again.

Thank you. That's very helpful. Answers my questions very thoroughly. I appreciate the time and effort it took. I apologize for being an ass in earlier posts-- my attempts at being polite were coming across the wrong way and I didn't see any other way to get an answer to my question. Thanks.

No reason to apologize brother. You just want to train, and I respect that very much. I do hope the reasoning for suggesting the diagnostic yield of an EMG makes sense. The chronicity of the lesion, and the body's healing mechanism for deinnervation are at least appropriate for evaluation in this case, in my opinion. But, then again, as stated before, I am not a physician.