Degenerative Disk Disease

author : AMSSM

comments : 0

My doctor said that he doesn't see anything that would take me out of IMTX, but he also doesn't have anything that can make it better, so basically, I can train, but it is going to hurt.

Member Question

I have had some sharp shoulder pain when I ride on and off for over a year now. I have tried PT, chiro, ignoring it, etc., but with IMTX training and with ramping up the mileage, the pain has been worse. I finally bit the bullet and went and saw a Sports Med Orthopedic and he said that the pain is coming from my neck, not my shoulder. He did some Xrays, and determined that I have some degeneration between C6-C7. He says that it is basically like arthritis, but it can grow worse over time with symptoms going to numbness in the hands, muscle atrophy, etc. None of those symptoms are present...yet. He said that he doesn't see anything that would take me out of IMTX, but he also doesn't have anything that can make it better, so basically, I can train, but it is going to hurt. He has now ordered an MRI to just make sure there isn't further damage than what he can see and also look at other treatment options. He said that it may affect future racing or training. 

Anyone have experience with this? I have to admit, I am pretty nervous, though maybe I shouldn't be? I guess it is just the unknown as well as when you hear words like "permanent damage" and "I am afraid the MRI may tell us what you don't want to hear" that makes me nervous. Any insight would be great!

Answer by Sara L. Kennedy, DO
Member AMSSM

Shoulder and neck pain are very common complaints amongst cyclists and triathletes, especially those starting out. Depending on the location and nature of your symptoms, work up and treatment will vary. Your diagnosis can vary from overuse muscle strain to cervical degenerative disc disease. With that being said, the majority of the time, simple modifications with your equipment, training routine, and rehabilitation or cross training can make a big difference. For beginning cyclists, poor posture, weak upper body muscles, and chronic tensing of the trapezius all lead to overuse pain and injury. If your reach is too great, handlebars are too low or narrow, or stem is too short, your posture can be affected and over time cause significant shoulder and neck pain that can easily be improved with modifications and rehabilitation. Cervical degeneration becomes more progressive as we age where the disk space narrows and the exiting nerve roots can become “pinched.”

Almost everyone has a certain degree of degeneration noted on an x-ray that is usually asymptomatic. If the nerves are involved, pain is usually described as shooting but can also be burning, stinging, or tingling. At the C6-7 level, I would expect the pain to radiate down your arm. Over time, if the nerves really are involved, weakness can develop. A MRI will give you information if the nerves are pinched by a herniated disk or a narrowed space, but a electromyelogram (EMG)/nerve conduction test (NCV) will give you more information, and truly let you know if the nerve is being affected and is the cause of weakness. In your case, I would definitely start with a proper bicycle fit, which can be both static and dynamic. Contact your local cycle shop for help with these tests, and note special attention to posture length. They may suggest a more upright ride with a shortened reach, increase in stem height, shorter stem length, or to ride with hands on hoods or top of bars. While correcting mechanics, you can work on rehabbing your body. A good physical therapist can help guide you and focus on stretching and strengthening your upper back, shoulders, and neck. Specific strengthening exercises include wide rows (elbow presses), shoulder rolls, and neck sit-ups (extension and flexion). Yoga is another option to work on stretching and strengthening the targeted muscle groups. Specific poses include the Utthita Hasta Padangustansana (Extended Hand-To-Big-Toe), Janu Sirsasana (Head-To-Knee Forward Bend), Ardha Matsyendrasana (Half Lord of the Fishes), and Ustrasana (Camel).

Always remember that significant pain is a good indicator that something is not quite right. If you have adjusted for posture mechanics and completed a full course of good therapy without improvement, I would recommend an EMG/NCV at that time to investigate any nerve involvement. In the meantime, have fun, and don’t worry!

Sarah L. Kennedy, DO
Primary Care Sports Medicine
Assistant Professor Dept of Orthopedic Surgery
UNTHSC Teaching Faculty Primary Care Sports Medicine Fellowship 
Bone & Joint Institute at the Ben Hogan Center

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date: April 20, 2015