Neck/Spinal Strain

Hopefully anyone reading this is familiar with my current injury history. If not, I received a TBI last year which I'm still recovering from, but I have also developed neck/upper back issues as well. I probably got some whiplash when I got knocked out that didn't become apparent until my head healed enough for me to start moving about.

I've been doing rehabilitative work with a PT on my neck/back and have regained mobility in my neck. A few months ago I couldn't even look over either shoulder. This has cleared up a lot of severe tension headaches I was having too. Unfortunately last week I started trying to do other types of exercises, and I did something pretty significant to my neck/upper back while doing some light deadlifts at home.

I had a lot of disorientation/vertigo the first few months of my injury, but I seem to be developing disorientation/vertigo again ever since I did the deadlifts. I'm having a hard time seeing if this may be a symptom of neck/back/spine issues, or if I am regressing in my condition with my head as I'm getting more migraines lately and a fuzzy feel in a portion of my head. I suspect that I may be getting disorientation/vertigo from my neck/back problems, and that this is causing my head to have a hard time. My neck/back creaks and pops and aches a lot more than usual and I'm slowly working myself back into stretching, working tension points, heating/icing, and eventually I'll move back into the PT exercises.

I have a meeting with a doctor coming Tuesday, but I would like to gather as much information as possible to consider when I discuss things with him. There are a couple of new-ish tension points on my neck that when I put pressure on them run up to a spot that feels like it's in my inner ear, so I really suspect this may be assisting in the disorientation/vertigo. Has anyone ever experienced a neck/spine/back issue that causes disorientation/vertigo at all? Not looking for answers here or anything, but just ideas on where I may be having problems. I didn't start getting the disorientation/vertigo (even with a migraine) until after I did the deadlifts, so I strongly suspect I may have a neck/spine issue that relates to it. Any input is appreciated.

 

Hey man. First of all sorry to hear about your health issues. Neck/upper back tightness/strain is normal after a whiplash, as I'm sure you already know. It seems the trauma and hyperextention must have been severe based on your pain level, quite limited range of motion and cervicogenic headaches. The presence of neurological symptoms (vertigo) would tend to indicate a higher grade cervical spine injury, however if the cervical spine itself had been injured, that would have been diagnosed as I assume you underwent an MRI? My guess is that they neurological symptoms reappeared after you did the deadlifts which probably put strain on your neck/area even though they were light. Any cognitive issues like speech problems or memory loss? Any signs of depression, altered psychococial functions or altered state of consciousness? Those would be neuropsychological in nature and a direct result of the brain injury - and would need to be addressed by a neuropsych. The neck/upper strain and vertigo can all be addressed by a neurologist.

Please note that though I work with physicians, I am NOT one. Please take the advice above for what they're worth and trust your physician will know better than any MAPist Hope things go well tomorrow and wish you a prompt recovery.

 

Hey Ero, that sounds like a pain. I may have mentioned this to you before and I guess you have some exposure to it as you mentioned “working tension points” in your post, this book has a lot of good practical info on dealing with tension related muscle issues:

[ame="http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/1608824942/ref=sr_1_1?ie=UTF8&qid=1396279352&sr=8-1&keywords=trigger+point+therapy+workbook"]The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief: Clair Davies NCTMB, Amber Davies CMTPT LMT, David G. Simons MD: 9781608824946: Amazon.com: Books[/ame]


Also a little anecdote from my experience. A few years back, we had some really tough issues at work, with a lot of money on the line and working minimum 11-12 hours per day, continuously for a good half year or so. Basically very high stress, long hours and demanding work.

Normally I do quite a bit of meditation/breathing exercise, but during this tough work period I eschewed these for more physical practices as I was constantly short on time and energy to commit to longer training sessions.

Sometime during this period and presumably from the stress and lack of awareness of my breathing, I developed a habit of involving my scalene muscles (and upper chest to some extent) in the breathing process. This resulted in much the same sort of symptoms you described, tight, creaking upper back and neck, tension headaches etc.

Despite getting good relief from following the massage techniques in the above book, the problems would recur regularly. One very noticeable thing was how tight and painful my scalene muscles were when working on them, particularly the lower parts just behind the collar bones.

When things finally settled down at work and I started training the full spectrum of the stuff I normally do, I noticed that my breathing was off, and once I had an awareness of this I managed to sort it out in a few days and the back upper back/neck issues went away quite quickly.

Of course this may have absolutely nothing to do with your case, but maybe it’s worth a look. Plus, in many respects it’s useful to be aware of your breath and muscle tension and how these two are intertwined. So perhaps it’s something you can look in to. The newer editions of the book linked above have a good description of exercise for dealing with excessive and subconscious tension, mostly in the latter sections towards the back of the book. These aren’t however the methods I used, but work in a similar manner i.e. awareness of breath/tension and releasing these.

Hope you feel better soon!

 

Hey greg, thanks for the response! I'm not totally sure it was whiplash, but I have a hard time believing that I have developed such a significant problem from being incapacitated for 4 months and having to lay around from the brain injury. I'm sure that didn't help anything, but some of the symptoms (mainly listening to muscle spasms in my head) have been present since day 1.

I've been to a PT for rehabilitation exercises, but the neck hadn't been a significant issue other than the extreme tension I had in it. They only took an MRI of my head and the top upper neck, the specific area I think is the problem wasn't captured in the MRI.

Today is the first day I've really felt like I could get into moving about my home. I haven't had any strong disorientation for a couple of days which is good. It's sounding like I may need to request getting in to the hospital for another MRI or X-Ray to look at my upper spine/neck. Joy, joy.

 

That's kind of funny, the scalene muscles have been a significant problem the last few days. I was feeling so bad one night that I massaged them specifically on each side for about an hour which brought me some relief. The one that goes under the collar bone in particular was bad. I noticed when putting pressure on it that I would feel a strong pull in my ear. I'm wondering if that might have something to do with the vertigo since my ear is getting tugged about from strain or tension? Not sure if it has an effect on the inner ear though. :dunno:

I'm starting to believe a lot of tension I get is revolving around compensation for weak muscles due to injury in another area. My upper spine between the top of the shoulder blades and the scalene muscles seem to always have some sort of problem regardless of how much I work them. Sometimes I feel like it's the neck/spine issues that trigger my head having problems. I used to not feel like "me" with my head injury, with plenty of buzzing and numbness. I don't feel like that anymore at the worst of times, and the front left portion of my head is all that bothers me when thing are particularly bad. Issues with my head don't seem to happen unless I'm having issues with my neck/spine (unless I do something stupid like drink alcohol), I'm curious to know how closely related the two might be. I tend to hear spasms in my head during bad migraines. I have a lot to bring up tomorrow I suppose.

 

Got it. You mentioned a whiplash so I thought that was an assumed fact. What was the mechanism of the injury? Was there an actual whiplash motion/hyperextension of the neck of the cervical area or only a head trauma from hitting something? Any loss of consciousness at the scene? Post-traumatic vertigo is a common symptom after a head trauma. The most common type is Benign Paroxysmal Positional Vertigo. You can read more about it here:

http://american-hearing.org/disorders/benign-paroxysmal-positional-vertigobppv/

If no MRI of the c-spine was done, you definitely should get one done to rule out a c-spine though I think you'd have more severe physical symptoms if it had been touched. Take it really easy until you've had the MRI done and see what the doc says.

 

That’s interesting Ero! Yeah, see what your Dr says, maybe he/she can clarify. I've noticed a relationship between the scalenes and my ears too, though I haven’t really been able to comprehend it yet.

If you want I can give you some breathing exercises you can try out for relaxing the scalene muscles, I've been meaning to write this stuff down anyway, it may take a little while though.

 

I have a couple of threads that have documented my experience if you're interested in reading it. It's a lot of reading though so I'll just recap briefly. I had a boxing match June 1, 2013 where I got knocked out by a guy who outweighed me by a good 50lbs at least. I didn't black out, but my body wouldn't respond for a good 20-30 seconds so I couldn't get back up (which I suppose was a good thing). Although I felt nauseous immediately after, I was fine after about 10 minutes. I had no problems until a week later at a store with my wife where I started developing severe enough symptoms to have to call an ambulance. I had significant brain problems, major regions "buzzing" and feeling numb, with severe vertigo. I spent 2 weeks bed ridden (literally, I was urinating in bottles), and about 3-4 months just being able to move around the house. I also had some speech issues (slurring). My ability to think was only effected for the first month, heavily associated with the buzzing feelings.

After 4 months I started to try and get back into things, and I started noticing the extreme tension and neck issues. Some of the neck/spine issues (mainly the spasms) I'm realizing were present from day 1. After a month or two of the PT exercises I was doing a lot better, but seem to have messed myself up from the deadlifts and some of the old symptoms like vertigo have appeared again. I still have issues with severe migraines and feeling bad, but they seem to be present more because of the neck/spine issues I'm having more than my head issues. My head had been so bad I never considered my neck/spine, and I'm really wondering if my neck/spine is contributing to some of the issues I'm having with my head now.

I've regained mobility in my head movement for the most part. I think the tension I had was my neck muscles compensating for some injured area in my neck/spine, as I've started getting tense again and developing the kinds of tension I had before. I've been able to stave off the mobility issues for the most part by light stretching and working tension points. I can't really do the PT exercises yet because it worsens my condition more than helps. The only significant think is I have a burning sensation in the upper spine area, which a lot of the PT exercises aggravate. For the last week and a half I've mostly been icing the area a lot, can't do much else.

It's been a difficult recovery. I've been trying to work on resolving the neck/spine issues, dealing with severe panic attacks and general anxiety levels, and then my actual head being screwed up. All three involve different methods of therapy, and a lot of it leaves me incapacitated for a day or needing long periods of time to calm down. I also have a lot of school work to do, which is effected by the medical conditions (and vice versa). All a lot of suck and I just want to be better already. It's been nearly a year since the initial injury.

 

I'm definitely interesting in reading if you want to write them down. I've been doing breathing/meditation for anxiety, but that's a bit different from working on physical issues. A lot of it has to do with accepting the way I feel (anxiety) and wrapping my mind around dealing with those feelings vs. relaxation techniques.

 

Sound like you may be suffering from post-concussive syndrome. This can go on for months after the initial injury though a full year is on the high end of that range, I think. Vertigo and tinnitus (the buzzing) are physical symptoms of it. Have you seen/been referred to a neurologist? If not, you should see one asap.

You can read more about PCS here:

http://en.wikipedia.org/wiki/Post-concussion_syndrome


Hopefully your doctor can diagnose you quickly and start managing the issue so you can return to a normal quality of life. I'm really sorry you've had to deal with all this.

 

Oh yeah, definitely have PCS, lol. I'm assigned to a TBI clinic at a Veteran's Affair hospital. I also was in an IED blast I didn't realize gave me a mTBI (I was knocked out momentarily, but never developed noticeable symptoms after). I was having issues that I wasn't aware of that were relate to the IED blast when I started boxing and up until the match, so injuring a potentially already injured head may be the reason it's taking so long to heal. I also kept trying to push through the symptoms on the onset of the mTBI from the boxing match. I wasn't bed ridden until a week after I had symptoms and kept trying to go to a summer school class (math) and it got to the point where I couldn't get out of bed and had to make a second trip to the ER. I've had a couple incidents where I tried to ignore symptoms too, which I'm sure hasn't helped my condition.

It would be nice if 1 year was the magical number for full recovery. At the rate I'm going though, and based on my experiences so far, I have a hard time seeing things clearing up entirely by June 1st. It has been quite the predicament for me.

 

Hey Ero, here you go mate.

Just a bit of background, this process is as a result of combing the ideas on structure/bio-mechanics of the art I study (I Liq Chuan) with my previous Chi-Gung/Tai Ji practices as well as the Buteyko breathing method I studied some time ago.

Also, this is part of something I’ve been meaning to write as continuation of an article I posted in the CMA Articles section. This method forms a big part of the process of my Zhang Zhuang (CMA/KF terms meaning “standing post”) practice which is used to create specific physical and mental coordination for various applications, including moving as more cohesive unit and dealing with various types of stress. I probably will expand on this in a more CMA/KF sense when I have more time, so you may see this again in a slightly different context with some additional info.

As it is the first time I’ve written this down, there may well be things which are not very clear. If there is something you don’t understand or doesn’t make sense to you, please ask and I will try to clarify. Also, please bear in mind that I am no medical professional and therefore some of my understanding of the below may be incomplete or outright wrong. I have however used this process successfully and I believe the below explanation should be sufficient to invoke correct practice of this method.

The method I use for dealing with issues related to the scalene and sternocleidomastoid muscles, though not exclusively these muscles, is to increase awareness of how the two different states of these muscles (relaxed VS tense) feel and reinforce this feeling so that one can better differentiate what the muscle’s state is and maintain the desired state.

As I understand it, problems with the scalene and sternocleidomastoid muscles arise due to them being repeatedly and maximally involved long term in the breathing process, specifically when the breathing is affected by stress. When one continuously breathes in this manner, usually due to long term stress, these muscles become overworked and develop problems which cause pain and tension issues in large areas of the upper body. The difficult part is that one is breathing continuously and if it has become habitual to maximally involve certain muscles (i.e. scalene and sternocleidomastoid) in the breathing process, it can be hard to stop the full engagement of these muscles and thereby differentiate their relaxed and tense state.

In addition to this, in my experience I have noticed that when there is tension in breathing or tension related to breathing, an additional factor to consider is that part of the breath is being subconsciously held, which requires some amount of subconscious tension to maintain. Therefore, part of the process is to bring to your awareness/consciousness the feeling of fuller respiration i.e. fuller exhale and inhale while reducing breath retention/holding.

The process itself is pretty simple. As both of the above (scalene and sternocleidomastoid engagement / subconscious breath holding) occur when one is breathing, the answer is to intermittently stop breathing and during this short time period, which with relative ease can be extended up to 30 seconds and with repeated practice to over a minute, feel the state of your muscles and relax them. Now personally, I think the thought of “relaxing muscles” is misleading, as I don’t believe there is an impulse for this. To me it feels like there is only one impulse which is to “tense”, relaxation is the absence of this impulse to “tense” which allows the muscles in question to relax.

One major factor which contributes to the success of this practice is understanding that this is not any sort of competition. It’s not about how long you can remain without breath as such a “competitive” mind-set creates tension which negates the goal of the practice which is to remove unnecessary tension from the breathing process. Now, at first this training may be quite frustrating and the process slow, this is as a result of habitual tension and you may, as I was, be tempted to take a more competitive mind-set and measure your progress (i.e. length of breath less time), however this is quite counterproductive and I would recommend not doing this. If you can only remain without breath for 10 seconds or less, don’t worry about it, don’t even count it, it’s not the goal of the practice. Just stay relaxed and continue practicing as long as you are relatively comfortable. If you start becoming agitated or feel too uncomfortable, just stop and pick it up again when you are more relaxed and at ease.

To begin, I would recommend starting off in a reclining position or lying on your back, more or less symmetrically. Since we are concentrating more on the scalene and sternocleidomastoid muscles, try to make sure your head and neck are well supported so there is no additional engagement of this musculature in order maintain whichever position you have adopted. Basically, you want as many of your muscles relaxed as possible, it will make the practice easier.

Step 1) Once you are comfortable, breathe out, not forcefully, just regularly and comfortably. In fact try to make your exhalation as soft as possible. When you feel your breath is more or less expelled from your lungs, don’t immediately breathe in. Remain without breath as long as you are comfortable. As soon as you feel the slightest discomfort or urge to breathe in, go ahead and do so, but try to make this inhalation as soft and slow as comfortable i.e. not forceful. Repeat this process until you feel somewhat comfortable remaining without breath for any amount of time, move on to Step 2.

Step 2) By this point you should have some level of comfort while remaining without breath. We will now use this short comfortable breathless time period to scan/feel your muscles for tension while these muscles are not being affected by the breathing process. Now depending on the length of the “comfortable breathless period” you can achieve, you will either scan/feel for tension in numerous areas or just one. If you only have enough time to scan/feel one area only, on the next “comfortable breathless period” if you think the area you just scanned/felt is still tense, either return to that same area or move on to the next one. Again, this is not any sort of competition and there should be no consideration in respect of time, just the quality of the process itself.

The areas to scan/feel are as follows:

1) Start with your jaw and feel if it is tense or not, your awareness should be around where your back teeth/molars are, i.e. the jaw muscles. When these muscles are tense, it feels like your jaw is being closed shut, this could be quite a subtle feeling. When it is relaxed, it feels like it is dropping down.​

2) Move you awareness on to your neck and specifically the scalene and sternocleidomastoid muscles. Scan how they feel. When they are tense, they should feel like they are shortened and are slightly pressing up on your jaw, potentially contributing to tension in the jaw muscles. When they are relaxed, they feel like they are dropping in to your chest/pectoral area. ​

3) Move you awareness on to your shoulders, specifically the trapezius muscles, make sure they are not lifting your shoulders and instead are dropping down towards your chest/ribs. ​

4) Move you awareness on to your chest/pectoral area and feel its state, make sure you are not puffing your chest out. When this area is relaxed it feels like it is dropping towards your abdomen. ​

5) Move you awareness on to your upper and mid abdomen, same principle as before. When this area is tense, it feels like its propping up the chest, when relaxed it feels like it is dropping in to your lower abdomen.​

6) Move you awareness on to your lower abdomen. When this area is tense, it feels like its propping up the mid and upper abdomen, when relaxed it feels like it is dropping in to your hips via the inguinal groove. ​

The above are the main areas you should work on, but you can continue the same process further down your legs to your toes, can also isolate infinitely smaller areas if you like. Likewise, you can repeat the same process with the musculature of your arms, back and so forth. These areas/muscles don’t contribute too significantly to breath related tension so do it only if you like. It is however a beneficial practice in terms of relaxation and increasing awareness of your body.

An important point I would like to reiterate here, the dropping feeling is as a result of lack of impulse to tense the muscles. Sometimes, we may, for whatever reason, attempt to create the feeling of dropping down by tensing the musculature in a downward direction. This is to be avoided at all costs as it is not relaxation and is merely replacing one bad habit with another, a completely counterproductive action.

Additionally, you may find it helpful to place the tip of your tongue on to your palate (the ceiling of your mouth), this can help increase awareness in the area and subsequently make it easier to relax the muscles of the jaw and neck.

Step 3) Once you are somewhat comfortable with Steps 1 and 2, you can try breathing while maintaining the relaxed state of the above (1-6) areas. All breathing should be through the nose. The process is simple, you will just breathe in, in as slow and relaxed manner as you can without engaging the musculature we worked on previously i.e. areas 1-6. One way of doing this, is by maintain the dropping down feeling as worked in Step 2. It may be also be helpful to look at this breathing process in terms of the breath not lifting any areas (1-6) we worked on dropping.

You may find it easier to start with very shallow breaths, and slowly, as long as you are comfortable, elongate and deepen the breathing. The softer you can make your breathing, the easier it will be to maintain relaxation in the musculature.

The goal is to eventually make your breathing (inhalation and exhalation) so soft that it is almost imperceptible, i.e. you can’t hear it, can’t feel the movement of air from the outside i.e. if you put your hand up to your nose, you will not be able to feel any air pressure or suction. Naturally, you should not try to achieve this straight away, but slowly work towards it, it will become easy with time and practice.

Step 4) Once you are comfortable with all of the above Steps, you can try and challenge your mastery of this process by attempting these while moving. Nothing too intense though, can try it when you’re taking a walk or doing something easy/simple in your day to day life.

Hope that’s of some use to you!

 

So at this point are you mainly wondering if the vertigo coming back is from the initial TBI or a more spinal injury? I thinking a more severe c-spine injury would show more significant physical symptoms. Neurological symptoms can fade and come back. Seems like the strain from the deadlift was the triggering factor here. Anyway, let us know what the doc and MRI say! Best of luck, man! Must have been a hell of a punch that you are still suffering from PCS a year later...

 

Not only should you visit a neurologist as a precaution, but you certainly should see the best ear, nose, and throat specialist in your city because I strongly suspect the source of your vertigo issue is inner-ear trauma, directly or indirectly.

 

It's unlikely to be trauma to the inner ear itself. The inner ear is embedded in the hardest part of the skull, and its very nature makes it fairly impact resistant (after all, it exists to deal with vibrations and movements!). Combined with the comparatively late onset, the fact that it seems to be linked to neck/spinal movement, and no mention of hearing problems (as a rule of thumb, the cochlea is less robust than the vestibular canals), the problem is much more likely to be neurological.

The priority is to see a neurologist. If the problem is in fact the inner ear, then the neurologist will be able to diagnose that fact, and make a referral -- and practically speaking, if the vestibular channels are damaged, there is almost nothing in the way of treatment.

 

The Vertigo likely IS a vestibular issue due to a bruising of the inner ear in this case. The presence of Tinnitus would seem to confirm that. You still want to a see a neurologist. He will refer you out to an otolaryngologist (ENT) if needed.

 

Admittedly, I am a researcher and not a clinician, but a review of all the literature I can easily find does not suggest that it is possible to bruise the inner ear. Possibly you meant the middle ear? That would account for most of the symptoms, but a year's delay between the trauma and the symptoms seems implausible. Additionally, any middle ear problem would impact hearing as well, in a much more profound way than tinnitus (and that's assuming that the "buzzing" is tinnitus, even though it's being described as a somatosensory effect). Tinnitus covers a broad spectrum of disorders, but the "classic" tinnitus is sensorineural -- that is, it is due to neural dysfunction rather than hearing loss per se. You can have tinnitus without hearing loss (possibly, there is a recent debate on this in terms of "hidden hearing loss"), and hearing loss (hidden or not) without tinnitus. In other words, it is a very poor diagnostic tool for inner ear trauma.

This is obviously a bit nit-picky, as we both agree on the course of action, but given that this is in my field, if I'm wrong I really should work out exactly why.

 

Guys, I have nowhere near the sort of knowledge that you seem to have plus I can barely understand half of what you’re saying, but I do remember reading (in the trigger point book I linked earlier) about such symptoms being as a result of trigger points in the neck/shoulder musculature. I don’t have the book with me, but a quick Google brought this up:

Perhaps its relevant.. :dunno:

 

Just finished up with the meeting. It was online and an appointment for a physical therapist and neurologist visit was made (in person this time, and not via webcam). They suspect that I may be having some inner ear issues with my left ear. At my worst the disorientation is just bad all around, but when I start getting better I feel like I'm "pulling left." The PT also noted that I put my left hand on the left side of my head, and that I am pushing against my hand which they said was a possible sign of my brain trying to make sense of where my head is in space.

I was having issues with my left ear a bit before the injury. After the IED blast in 2012 that ear has been very sensitive. I even started punching our machine gunner in the leg when he would set up next to me to fire. Nothing like a sensitive ear with a 240 medium machine gun going off.

All in all they think the deadlifts loosened some things up. The head issues (buzzing/foggy) is located only in the front left portion of my head now as opposed to most of all of my brain from the initial injury. The neurologist said the issues between the neck and ear could certainly be the reason migraines and head issues keep popping up.

We're going to do a lot of testing with the PT when I go to see if it's an issue, and then probably schedule an appointment with the ear/nose/throat clinic afterwards. I strategically made my wife sit in on this webcam visit to start scheduling appointments since I can't drive and visits are on her schedule.

I'm starting to get convinced that it might be an inner ear issue, but the correlation between the neck/spine issues and the disorientation is pretty strong too. My hearing does become extremely sensitive at times when I'm having head issues, and I get tinnitus quite a bit too. Will have to update after we do all the testing in a couple of weeks.

To quote my neurologist, "A lot of the testing has to do with observing your eyes. Your eyes are the gateway to your soul, but they're also the gateway to your inner ear as well." Part of me agrees a bit with what greg said that if it was a spinal issue I would have more debilitating physical symptoms beyond constant discomfort. Who knows, I just want to get better. :cry:

 

Just for clarification on what the neurologist and PT say when they talk about my ear, there are supposedly little grains of something in some part of your ear that when knocked loose can cause orientation problems. They believe this to be the cause of my disorientation. My disorientation was severe on the onset of the injury (I would almost fall over and steer off a straight line) and then resolved itself. Sometimes I would have a problem feeling like my body was swaying, like on a ship. After the deadlifts I started getting disoriented nearly as severe as the initial injury, but without the crazy stuff going on in my brain (although this disorientation brought migraines galore). While I'm still slightly "off" with my disorientation now, it's nowhere near as bad as it was a week ago.

The disorientation I experience is having things catch up to my field of vision. For example I can use the bathroom and look down while doing so, then when I look up it feels like I haven't looked up until a moment or two later. When I walk it feels like I'm "pulling left" as well.

Just thought I would clarify a bit more. The initial vertigo I experienced was extreme but it's not like that anymore. I used to be laying down and feel like I was skydiving all of a sudden.