Suggestion for lifters recovering from (non-lifting related) carotid dissection?

[toronto.reader]

I'm a beginning lifter. I purchased Starting Strength and had been lifting for a period of about 8 months. I incurred a carotid dissection while playing hockey about 4 months after starting weight training. The dissection injury had nothing at all to do with weight training. While I continued lifting during the time between the injury and its formal diagnosis (a period of 4+ months) I did stop lifting once the carotid dissection was diagnosed through proper MRI and CT-angiogram radiology.

Question for Rip: Once subsequent CT-angiogram scans and consults with my neurologist confirm proper and complete healing of the dissection (hopefully in November), is there any consensus on approach for a modified weight training program? Currently my neurologist has recommended I not pursue any "heavy" lifting in the future (I take that to be any weight that would involve Valsalva maneuver) but he is not averse to heavy exercise - he sees no reason I can't play hockey again. Is there any research on this topic - recurrence of carotid dissection injury from weight training? I'm not sure if it would be reasonable to exercise high reps but light weight for squat, or if I need to and replace squats with some other resistance exercise for hamstring, glutes and adductors. I'm not sure if I need to never do deadlift again and replace this with other lower back strengthening exercises.

Feedback is appreciated. Thanks Rip!

Toronto Reader

[Mark Rippetoe]

Was an explanation for the dissection offered?

[Jonathon Sullivan]

I'm a beginning lifter. I purchased Starting Strength and had been lifting for a period of about 8 months. I incurred a carotid dissection while playing hockey about 4 months after starting weight training.

I assume there was a discrete trauma preceding the dissection? Like say, a hockey puck to the throat, or a choke hold during friendly competition?

While I continued lifting during the time between the injury and its formal diagnosis (a period of 4+ months)

Everybody needs to stop and ponder the preceding statement for a few moments.

Question for Rip: Once subsequent CT-angiogram scans and consults with my neurologist confirm proper and complete healing of the dissection (hopefully in November), is there any consensus on approach for a modified weight training program?

Yes, there is a medical consensus: You should never, ever, ever lift anything again. You should take stool softeners, engage in non-contact physical activities, and avoid grunting, sneezing, coughing, and ejaculating.

Currently my neurologist has recommended I not pursue any "heavy" lifting in the future

Oh, but of course he has.

but he is not averse to heavy exercise - he sees no reason I can't play hockey again.

So. You can engage in the sport that actually caused the dissection, but you cannot engage in the training that did not cause the dissection. This underscores the simple truth that medicine in general, and neurology in particular, are impenetrable and occult disciplines, intelligible only to the initiated, encompassing mysteries and nuances beyond the ken of mere mortals.

Is there any research on this topic - recurrence of carotid dissection injury from weight training?

No. There is no controlled data on the natural history of resolved post-traumatic carotid dissection in strength training populations.

But this is not the point at issue. Your neurologist doesn't need no steenkin' research to tell you what to do in expectation of your full, unquestioning and cheerful compliance. He's a neurologist, for Chrissake. Show some respect.

I'm not sure if it would be reasonable to exercise high reps but light weight for squat, or if I need to and replace squats with some other resistance exercise for hamstring, glutes and adductors. I'm not sure if I need to never do deadlift again and replace this with other lower back strengthening exercises.

Feedback is appreciated.

Okay. Here's some feedback:

While I continued lifting during the time between the injury and its formal diagnosis (a period of 4+ months)

Hope it all works out for you.


This post is for ejumacational and infotainment porpoises only, and does not constitute medical advice for any particular person, patient, disease, or condition. Sully is not your doctor, nor anybody else's, for which he is grateful beyond expression. You should always do what a neurologist tells you, even if it doesn't make any sense to you, because it makes sense to him, and that's all that counts. He's a brain doctor, and you're not. Obey.

[toronto.reader]

Was an explanation for the dissection offered?

Hi Mark - thanks for the reply. Yes. The explanation was a sharp hit to my head (shoulder pad against my facemask) that just snapped my head to the left quickly. It was sub-concussive, I didn't see any stars or anything like that. But what I now realize is Horner's Syndrome (from the dissection) began at that time. It was like whiplash from a car crash for lack of a better explanation. It didn't occur spontaneously, and it didn't occur from deadlifts. I appreciate any views you have on the topic.

Thank you Jonathon Sullivan, Starting Strength Coach. I read your reply carefully. Thank you for the time to reply.

Of course there was a trauma preceding the dissection - it didn't happen spontaneously. Otherwise I wouldn't have mentioned hockey. It wasn't a puck to the throat - that would have caused a sore throat or bruised windpipe. Have you ever played hockey, or seen a puck?

It's true I continued to lift prior to diagnosis. That doesn't mean it was safe to do so or would be in the future.

Why do I think you work the term "ejaculation" into all of your posts on here? I haven't searched, nor do I intend to. But I'm thinking you have ejaculation on your mind.

[Mark Rippetoe]

My views on the topic are far less relevant than Dr. Sullivan's, yet you have insulted him with your criticism of his prose (a candid assessment of the treatment you have received), while pretending to thank him for his time -- for which he was not compensated and of which you have been the beneficiary. Good luck with your vascular problems. Do not post here again.

[Pluripotent]

Of course there was a trauma preceding the dissection - it didn't happen spontaneously. Otherwise I wouldn't have mentioned hockey. It wasn't a puck to the throat - that would have caused a sore throat or bruised windpipe. Have you ever played hockey, or seen a puck?

This seems like a strange objection. I would think a hockey puck would be perfectly capable of causing carotid dissection, as would any properly placed blunt trauma. These type of outbursts do tend to set the troll meter off...

[Jonathon Sullivan]

This seems like a strange objection. I would think a hockey puck would be perfectly capable of causing carotid dissection, as would any properly placed blunt trauma. These type of outbursts do tend to set the troll meter off...

Perhaps I was too snarky in my reply. I see now that OP is new to our forum.

Hockey puck to the throat seems like a perfect mechanism for initiating a dissection. We still don't know what the trauma was. And by the way, these carotid dissections do occasionally happen "spontaneously"--no identifiable precipitant, although all of the ones I've seen and treated (maybe half a dozen in my career) were from blunt neck trauma. They all had fairly benign clinical course, except one. They can definitely go sour and cause big problems.

If there hadn't been a precedent hockey-related trauma (whatever it was), the neurologist would surely have blamed the squats.