Valsalva with severe disc herniation

Pain & Rehab Forum [Moderated]
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I have a severely herniated disc (MRI confirmed) that is “causing severe left neural forminal stenosis compressing the exciting left C7 nerve root.” It is also “contacting and flattening the left ventral aspect of the cord.”

it it has been about 8 weeks since this happened and the pain is now tolerable, but I have pronounced weakness in chest/tricep on the left side (some atrophy now as well). I am in PT for cervical traction and will getting a epidural neck shot this week.

My PT has recommended no heavy lifting or any activity that is jostling (like mountain biking, etc.). My ortho did not say anything about these restrictions - only to make sure I keep a neutral spine when training. But one ortho also said I could not be cleared to return if I were in a contact sport (football, wrestling, etc.), which I am not. The PT also said not to use the valsalva as this can increase pressure in the neck and exacerbate my condition.

I have been training through this as best I can and am trying not to be “fragile.” Naturally, there are certain things I just can’t do in the gym due to this condition. But should I be concerned about lifting heavy weights (using rpe to gauge) and/or employing a valsalva?

Thanks!

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Hi Servo, glad to hear that your situation has been improving and that you’ve been continuing to train. Has anything changed over the last week since you posted this? What has your PT defined as heavy lifting?

In terms of the valsalva, I don’t see any inherent issue here in respect to a disc herniation, especially a cervical one. I don’t know of any evidence that would contraindicate it, especially since sneezing and coughing will produce a valsalva reflexively. It’ll probably be best to work up your RPEs week to week (6, 7, 8) on the main lifts and gauge how you feel from there, allowing yourself to progress within tolerance. You could progress the intensity of the valsalva in respect to the RPEs. In terms of the neutral spine position when training, it mostly comes down to, again, what feels comfortable to train in, since spinal position is dynamic during the lifts and impossible to maintain in a static position.

Also, the good news is that the strength in the chest/tricep should improve with time and training. Derek has a good story when it comes to his lower extremity after a lumbar radicular episode.

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