Pneumothorax (collapsed lung)

[tongzilla]

Hello folks,

I'm an intermediate male lifter in my late twenties who's been lifting on and off (mostly on) for almost a decade, using the techniques as prescribed in the Starting Strength book. I do not smoke or have any pulmonary diseases such as asthma.

Four days ago, whilst warming up with some overhead squats on my light active recovery day, I felt a sudden pain around my left back and left ribs. This happened during the squat with my breath held in. Since the pain was manageable, I went on with my workout.

I continued to experience soreness in my left rib and left back area for the next few days. I thought I tweaked something so I went to a chiropractor, who helped to relieve my pain and stiffness. However, I still experienced a strange sensation when I took a deep breath. I also noticed when I walk briskly up the stairs or jog slowly, there is this loose unstable wobbly feeling inside my left ribs.

Two days ago, instead of going to my normal training session, I decided to visit a doctor. After an x-ray, the doctor diagnosed me with primary spontaneous pneumothorax (please see http://www.medicinenet.com/pneumothorax/article.htm and http://youtu.be/i-sZzZ4TMnY for a brief explanation) in my left lung. I was then referred to a lung specialist, who told me to rest (no exercise) since the lung is only 20% collapsed. His prognosis was that the air will get reabsorbed, and my lung will re-inflate over time. I will visit him again for another x-ray in a week to see if my condition has improved, if not, I may need an aspiration (to remove gas and liquid from the pleural space).

The lung doctor said if the condition gets resolved without treatment, the chances of reoccurrence is about 30%. He said there are certain activities that may increase the chance of reoccurrence, such as flying on an airplane, or scuba diving. He did not mention anything about weightlifting, however. Nor did I ask, because I did not want to hear I would not be able to lift heavy weights again. The doc also said if I opt for a procedure where they use some powder to glue my lung and chest walls together (sorry I don't know the correct term for this procedure), the chances of a reoccurrence is minimal ("less than 1%"). However, there is still a non-negligible chance I may get spontaneous pneumothorax in my other lung. The doc said there is essentially no direct cause to my spontaneous pneumothorax (although the weightlifting exercise did trigger it)- some people just have a genetic predisposition to it, especially tall skinny people (I'm 6' and 185lb, but would probably be closer to 155lb if it wasn't for weight training).

I am writing to hear thoughts/advice/insights/experiences from anyone who has some knowledge in this area. I really hope I can lift heavy and train fully soon. Lifting weights and running is very important to me. Some of the stuff I read online is not encouraging at all- many cases of reoccurrence during exercise

Let me know if you guys need more info.

Leo

[Mark Rippetoe]

Never heard of this happening, no experience with it.

[tertius]

Happened to my cousin while he was swinging off a railing down a set of stairs, though he also somehow broke a rib at the same time.
He's also tall and thin. I think they ended up gluing his lung in place since the whole thing collapsed. The process is pretty unpleasant.
No problems since, though. He lifts some, though not very heavy.

[crunchy]

Had this happen to a friend of mine, he didn't do anything for some time, although it hurt, and continued on smoking lots of tobacco before finally having to go to the hospital to get his long perfored and the air sucked out.
He's REAL skinny too, like his arm is the same diameter from wrist to elbow.
He doesn't eat well and continued his smoking so eventually had to go back several times to stay in the hospital.

[pendaluft]

Once your lung has re-expanded...lifting weights should be fine. If you have blebs on the pleura then you are at risk for more pneumothoraces. If you wind up needing a chest tube or if you have a second pneumothorax, most people would recommend a CT scan to look for blebs (little bubbles). This will help evaluate possible risk for SCUBA or re-occurrence. Most authorities will tell you to wait at least two weeks after re-expansion before flying. Don't fly if it is not re-expanded -- that could be problematic with the air in the chest expanding and collapsing the lung more.

If your lung re-expands in less than a week, I would wait a few weeks and then get back into it. There is some debate about whether valsalva can cause a pneumo -- I personally don't think it is worth worrying about. I wouldn't consider pleurodesis (the glue in the space thing) unless you had a lot of blebs or recurrence.

Note: I am a pediatric pulmonologist so my pneumothorax experience ends a 21 years. Take this for what you will.

[Mark Rippetoe]

Your pneumothorax experience is the best we've had so far. Thanks.

[Paul1]

If the lung has completely apposed itself to the chest cavity, that does not mean that the injury to the lung that cause the pneumo has completely healed. There is always a "potential" space between the lung and the chest wall, so the real question is not has this recent pneumothorax resolved but rather has your lung healed. The issue here is that a big valsalva force, i.e. increasing intrathoracic pressure, can force air through a defect in the lung and cause the pneumothorax to reaccumulate (and these can be true emergencies if enough air accumulates -- a previous minor one will not necessarily be minor the next time).

I'm not a pulmonologist, so I am not going to say how long it would take for a spontaneous pneumo to heal. It's a good question for a pulmonologist, though and one they could probably answer very well. Pulmonologists manage ventilators in people who have had pneumothoraces, and on ventilators you are actively dialing the positive pressure that you will deliver to the patient (or you can dial the volume, but the machine tells you how much pressure that volume produces) -- so pulmonologists have a very quantitative sense of what sort of intrathroracic pressures are safe in someone with a recently resolved pneumo, and if these are likely to be exceeded with a valsalva.

I don't think the weights themselves will be an issue unless the cause of the pneumo was a displaced rib fracture. It's probably just the intrathoracic pressure differential that's at issue. Some people reaccumulate pneumos just bearing down to shit, so at the very least I'd suggest asking the specific question here before assuming all is well -- be an informed customer.

The procedure you're referring to is called pleurodesis. They infuse talcum powder into the pleural space, which basically causes an inflammatory reaction where the lung scars down to the chest wall.

[Paul1]

Didn't notice pendaluft's post.

So you'd be comfortable with a forceful valsalva as soon as the pneumo has radiographically resolved? You wouldn't let any time lapse before resuming normal activity?

I guess the big question is how close will a forceful valsalva approximate a safe intrathoracic pressure as you might dial in on a vent?

[tongzilla]

pendaluft- thank you for taking the time to make this very useful post.

I will be going for a check up (x-ray) the day after tomorrow (7 days since the collapse) to see how much my lung has re-expanded. Maybe I should ask them to do a CT scan also to check for blebs. If there are no blebs, I am pretty dumbfounded as to why such an unfortunate even can happen to a young, healthy, athletic male like me. Not being able find the movement/event that caused this is quite annoying as I don't know how it's going to happen again next time.

Using google, I found this paper which said, "It has also been theorized that primary spontaneous PTX can occur as a result of the rupture of subpleural blebs (which form by an unclear mechanism), which is caused by the increased intrathoracic pressure against a closed glottis (Valsvalva maneuver)".
But the thing is, I've been lifting heavy for so long I would expect my body to have made all the necessary adaptions to prevent this.

The only other possible explanation I can find is maybe I bounced the bar off my chest a little too hard during my bench press. But I don't think this is the case as the doctor said I have no rib injuries. I actually wish it was a traumatic case of pneumothorax since the chances of recurrence is less than the spontaneous type.

Anyway, will post my results after the check up in a few days...

[Ewan]

tongzilla,

Like you, I had primary spontaneous pneumothorax in my left lung. Happened in 1999, so yeah, it was a long time ago. I had a chest tube (not sure what it was, but it was sticking out of my chest!) for about a week and I was stuck in a hospital bed for a couple more. I'm now 34, I've logged over a thousand scuba dives, ran my fair share of marathons, been fooling around with weights at the gym for over a decade, and currently doing SS for about 9 months.

Listen to your doctors and be safe about it. I visit a hyperbaric doctor and a pulmonologist annually just to make sure everything is okay. But at the same time don't let fear stop you from doing what you enjoy.

I wish you a speedy recovery.