Concussion, Arachnoid Cyst, and Strength I

Medical Q&A [Moderated]
1

Hey, I have a couple of medical issues at the moment and would really appreciate some advice about when I can lift again and my intention to do the strength I template!

A bit of background on my lifting experience. I have been lifting consistently since January. I did an LP, The Bridge, and have just ran Powerbuilding I twice in a row. I did all of this in a calorie deficit. But, now that I have achieved a waist and weight I am happy with, I am about to start eating maintenance calories. Prior to the health issues I am about to disclose, my plan was to commence Strength I on Monday November 11th.

Two weeks ago I fell and hit my head on some concrete after consuming a moderate amount of alcohol. Since then, I have suffered from a slight headache/feeling of pressure in my head - as well as a bit of lethargy - and have been diagnosed as having a concussion/possibly post-concussion syndrome. A week ago (one week after the fall) the pressure inside my head intensified a little bit. I was worried about the possibility of subdural hematoma and I went to the hospital. At the hospital I was given a CT scan, and was told that I have an arachnoid cyst and a concussion (or possibly post-concussion syndrome). They told me to avoid strenuous activity, including lifting heavy weights. I was told I should avoid this activity for up to six weeks after the fall, but that I could resume lifting sooner if the pain in my head subsided. I was also told that once I resume weights I need to start with very light weights and work my way back up. Now (six days after my hospital visit) my head is not very painful, but there is still a constant feeling of slight pressure. I am fairly convinced that this feeling is due to the cyst rather than the head injury - but it is hard to be certain because I never felt any pressure before hitting my head. I am getting an MRI next Friday, and should be seeing a neurosurgeon within two weeks of the MRI to discuss what treatment (if any) I need for the cyst. I was told that it is possible I may need surgery for the cyst, but the concern about lifting seemed to be focused on not performing strenuous exercise after the concussion, rather than any suggestion that lifting might aggravate the cyst. I find this a bit strange, because when a GP initially diagnosed me with a concussion they cleared me to go back to lifting straight away.

After the initial fall (but prior to my hospital visit), I continued to lift as normal and did not feel that it caused me any problems. Due to the advice I received at the hospital, I did not go the gym in the last week. I would really like to get back to the gym as soon as possible. The thought of not lifting for six weeks - and perhaps even longer if I have to undergo surgery towards the end of that period - is quite concerning to me; I really don’t want to revert back to an extended period of sedentariness. Ideally, I would like to be back in the gym on Monday, preferably starting Strength I. I’m hoping that the advice I received at the hospital is overly cautious or just plain wrong, and would be grateful to hear your take on the matter.

My questions are as follows:

  • Do you think it would be okay for me to start lifting again on Monday? If not, what time-frame would you recommend?
  • When I resume lifting, do I need to start with super light weights, or would it be fine to jump straight into Strength I?
  • If I should refrain from lifting for the time being, what kind of exercise (if any) would be appropriate for me to perform in the meantime?

Any advice you could give me on this matter would be greatly appreciated!

2

Why, exactly, do you think that your symptoms are due to the cyst that seems to just be an incidental finding? It could have been present and undetected for years until someone decided to perform a CT scan. This may not be accurate, but I am getting the sense that there is a lot of fear/anxiety and potentially some hypervigilance going on here.

With that said, I cannot give you specific / direct / individualized medical advice here. But in general after a concussion, as the symptoms improve, it is reasonable to resume exercise. I cannot tell you the level of specific intensity that you should target, as it is going to be depending on your tolerance and symptoms, but I would probably start low to assess tolerance and not jump right into the strength template yet. There will be time for that.

3

Thanks a lot for your helpful response!

There are a few things which make me think the symptoms are probably due to the cyst than concussion. I believe the sensation of internal pressure that I have been feeling is more consistent with the typical symptoms of an arachnoid cyst (when it is not asymptomatic) than a typical concussion. The feeling is mostly around the area that the cyst is located. The doctor told me that the cyst was quite large, and my discharge summary from hospital says the cyst has “local mass effect”, which I understand to mean that the cyst is displacing surrounding tissue - in this context that would presumably be creating some amount of pressure in my skull. I believe that arachnoid cysts can be caused by head trauma, and this being the case it doesn’t seem entirely unreasonable to think it is possible for head trauma to cause an existing cyst to worsen. Finally, although I hit my head on a hard surface, there was very little tissue damage, which makes me question whether the impact was severe enough to cause issues for several weeks.

I wouldn’t say there is much fear or anxiety on my part. While there was definitely some initial concern, I am fairly confident that the prognosis of arachnoid cysts is quite good. Honestly, I really just want to get back to the gym. My recent issue has coincided with the end of a long diet, and I was very much looking forward to seeing accelerated progress in the gym while eating at or slightly above maintenance calories.

Would you say that, typically, so long as symptoms do not worsen during or immediately following a workout, it is okay to increase the intensity a little bit on the following visit and continue in this manner for subsequent workouts until intensity is back to normal? And, when you advise starting low, are you talking mainly in terms of RPE, or would you advise using relatively high reps in order to keep the weight lower as well?

4

Again, this is not something that I can provide you with direct / individualized advice on for obvious reasons, but if I were in this situation I would agree with that approach to progression/monitoring symptoms. And I would start with lower RPEs, but I don’t think that the rep range necessarily matters if that RPE is kept low at first.

5

Thanks a lot for your considered reply!

6

The cyst is almost certainly something you were born with. The reason you got conflicting advice about returning to exercise is because the advice doctors give about activity after concussion varies widely and from doctor to doctor, and is usually based on folklore rather than evidence.

Getting the MRI and seeing the neurosurgeon will probably not lead to any specific intervention or recommendation, but I would do it too in your situation.