Don't Use Sustanon For HRT!

Training Over 35 Lifter
21

[quote]bushidobadboy wrote:
Doc, I think you need to get a full neurological screening exam done, including:

Myotomes

Dermotomes

Reflexes

Specific lower limb muscle testing of adductors, quads, hams, abductors, soleus, gastrocs, fibs.

Then we can see where exactly any deficits may lie and how to train around them and minimise the cahance of further imbabance-induced injuries.

Just what I would do though…

PS - any competent manual therapist (chiro, physio, etc) should be able to do this. I can and I’m only a 3rd yr student…

Bushy
[/quote]

 Competent would be the key word there, Bushy. Looking at my calves, can you believe ten doctors and four physical therapists missed this before they finally took me seriously? The couple docs and one PT who were good are in Florida, I cant get to them right now.

 I will attend to this...I just have my hands full with life at the moment. In the meantime I enjoy pounding my calves with as much tonnage as possible-that's my PT right now.   Doc
23

Bushy, I wish we were closer too. I dont fret about how my calves look. But it is disconcerting to feel the outer half, which is rock hard when flexed, and the inner half, which is mushy fat no matter if I “flex” or not.

I've had a bunch of neuro exams, but obviously most of them were crap. And the NCV/EMG was done more to cement the diagnosis of an atrophic calf secondary to my accident for legal purposes of getting my medical bills paid. I really wish I had somebody interested in phsycial fitness/lifting or bb ing who could evaluate my body and give me advice from that perspective.

Folks like that (like you) are rare. If there are any pictures that would help you “analyze” my case, since I know it is rare, I’ll be glad to take them and post them-start a new thread (lol). In med school we called rare cases like mine “Zebra’s”. We could have a Zebra thread. Doc

24

[quote]Dr.PowerClean wrote:
B
I’ve had a bunch of neuro exams, but obviously most of them were crap. And the NCV/EMG was done more to cement the diagnosis of an atrophic calf secondary to my accident … Doc[/quote]

Could you also have tibial nerve entrapment, unrelated to spinal trauma? Maybe one side, not both. … But a thorough NCV would have ruled that out.

DiRisio D, Lazaro R, Popp AJ.
Division of Neurosurgery, Albany Medical College, New York.
An unusual case of leg pain and atrophy in a patient with gastrocnemius due to tibial nerve branch compression by a Baker’s cyst is presented. The clinical findings and electrodiagnostic studies were supportive of isolated medial gastrocnemius denervation. Treatment by synovectomy along with decompression of the branch of the posterior tibial nerve to the medial head of the gastrocnemius muscle resulted in clinical improvement. No other cases of such selective branch compression have been previously reported.
PMID: 7969847 [PubMed - indexed for MEDLINE]

[other references available]

25

DrSKeptix,
The picture may not show this well, but there is bilateral atrophy, but by palpation there is some functional muscle on the right side, not the left. NCV was only done on the left, showing complete denervation. Did they do the NCV above the knee-you know, I dont remember. I believe they did, just above.
I came across one isolated case of bilateral medial gastoc atrophy, with tibial nerve entrapment on both sides. I actually spoke to the neurologist, one M.K. Hagy, who reported the case in a journal. I sent him my pictures and he did not believe it was a tibial nerve problem but most likely spinal trauma in my case.
But yes, despite a grand total of 17 docs and five PTs, it is still amazing that I am not 100% sure what the hell denervated my medial gastocs. And a big part of this is because they STILL did not do sufficient tests.
Many people who know me well have told me that at the time of the accident, I was in excellent physcial shape (I call it Men’s Health shape, you know, machine work and running). Many doctors took one look at me and automatically assumed there was nothing wrong with me. Yet I had no previous history of lawsuits, workers comp, or any of the red flags that worry doctors that a patient is presenting false or exagerrated symptoms.
I’ve lost a lot of faith in my own profession over how this was handled, even though I try to keep it in perspective, it is, after all, only half my calves. And my diskectomy relieved me of the radiculopathy that was horrendous, really brutal pain. The radiculopathy is really why I never doubted the atrophy was spinal related. Doc
BTW-you really got me rethinking…the accident was a lady smashing into my SUV from behind at 60mph. I smashed into the dash, including my knees. Everyone was so worried about my concussion (I had a brief coma), and my back, that I know nobody looked at my knees. Hmmmm… I never considered I could have had BOTH spinal trauma with radicular pains, with a separate case of bilateral tibial nerve damage from my knees slamming into the bottom of the dash. Man, what a remarkable idea…bravo, Dr. Skeptix.
Doc

26

[quote]Dr.PowerClean wrote:
DrSKeptix,
The picture may not show this well, but there is bilateral atrophy, but by palpation there is some functional muscle on the right side, not the left. NCV was only done on the left, showing complete denervation. Did they do the NCV above the knee-you know, I dont remember. I believe they did, just above.
I came across one isolated case of bilateral medial gastoc atrophy, with tibial nerve entrapment on both sides. I actually spoke to the neurologist, one M.K. Hagy, who reported the case in a journal. I sent him my pictures and he did not believe it was a tibial nerve problem but most likely spinal trauma in my case.
But yes, despite a grand total of 17 docs and five PTs, it is still amazing that I am not 100% sure what the hell denervated my medial gastocs. And a big part of this is because they STILL did not do sufficient tests.
Many people who know me well have told me that at the time of the accident, I was in excellent physcial shape (I call it Men’s Health shape, you know, machine work and running). Many doctors took one look at me and automatically assumed there was nothing wrong with me. Yet I had no previous history of lawsuits, workers comp, or any of the red flags that worry doctors that a patient is presenting false or exagerrated symptoms.
I’ve lost a lot of faith in my own profession over how this was handled, even though I try to keep it in perspective, it is, after all, only half my calves. And my diskectomy relieved me of the radiculopathy that was horrendous, really brutal pain. The radiculopathy is really why I never doubted the atrophy was spinal related. Doc
BTW-you really got me rethinking…the accident was a lady smashing into my SUV from behind at 60mph. I smashed into the dash, including my knees. Everyone was so worried about my concussion (I had a brief coma), and my back, that I know nobody looked at my knees. Hmmmm… I never considered I could have had BOTH spinal trauma with radicular pains, with a separate case of bilateral tibial nerve damage from my knees slamming into the bottom of the dash. Man, what a remarkable idea…bravo, Dr. Skeptix.
Doc[/quote]

“When one eliminates the impossible, what is left is the probable.”
–Sherlock Homes?

Of course, bilaterality implicates spinal level disease or stenosis. But really, you really are quite a specimen there, and persistent denervation and atrophy selectively in medial gastroc really points to peripheral nerve damage. (Recovery at the peroneal nerves and not at the tibial nerves may suggest, as you point out, spinal disease restricted to L5-S1–bilaterally! But, gee, you’d think that would be obvious on MRIs. Have I seen spinal disease with only isolated medial gastroc weakness? No, but then I am only an amateur neurologist.)

Anyhow, I would vote with Bushy for an exam and repeat directed NCVs–with the aim of distinguishing spinal from lower motor neuron disease. What could it hurt? (Ooops!) But what if it could be fixed?

[By the way…high foot arches or low?]

30

I have a home elecrtical stim machine, it cost $2000 and believe it or not, the my insurance paid for this, but not my four surgeries and four rounds of PT? I swear I could write a book on this saga.
I used the machine extensively on my back for over three years, and it helped me quite a bit with pain, and I believe in stimulation the muscles and possibly nerves in the damaged areas.
Although it got tedious, I tried it on my calves, mostly just the left, for about a year on and off. I can’t say it helped, but maybe it did, just slightly. I do not believe I have ZERO innervation on the worse one, the left. I think something is there that is still alive. And the right certainly is far from dead, there is palpable muscle and flexion produces a noticeable but miniscule contraction.
My electrodes wore out and are unusable, but when I can, I’ll get new ones and start again. You’re interest is causing me to not just “forget about it,” and when I’m not so broke I’ll go in for a new full exam.
I am actually currently more concerned to see if there is other muscle involvement other than my gastocs. In my OL comeback, front squatting/squat cleaning has been especially difficult, both from a reduced flexibility standpoint and a weakness standpoint. Weakness is a relative term, which always drove my insane when these lame PT’s checked for “weakness,” they tested me like a ninety year old lady, with minimal pressure against a muscle movement. If I have other leg muscles involved than medial gastrocs, it would really disappoint me and hinder my chances of lifting what I want to lift. Yes I need a professional, but for instance I tried various leg machines at the gym to see how my body reacts. I had a very bad experience with the leg adduction machine. I was much weaker there than expected, and I saw my legs twitch with spastic type movements-possibly fasciculations. This may be why I am power cleaning with a wider base than before, to rely on the stronger outer leg muscles that I have.
More food for thought. Doc

31

[quote]bushidobadboy wrote:
rainjack wrote:
You’re a doc, so you know to look for the signs of infection - what is it? Rubor et tumor cum dolor cum color?

I think the only one you missed is ‘functio leasae’ (sp?) which means loss of function. Far out, I didn’t know you knew these RJ.

Bushy[/quote]

I took a bunch of veterinary A/P classes as well as some pharmacology courses in college.

Our professor gave us the definition of “infection” in Latin, and we had to figure out what the hell he was saying. It was 20 years ago, and I can still remember it.

33

I have normally high arches, havent noticed a change in that. However, my feet tend to extend, I find myself weight bearing on my toes a lot. Weird, unnatural feeling, that. Even just sitting on the toilet, I catch myself with my damn toes on the ground only (and trust me, my legs are long enough to reach the floor). I have had five serious falls, broken several ribs in the process, and broken toes on both feet from loss of proprioception or foot dragging, banging my feet into walls. Pretty pathetic.

I work on stretching the calves at least 20 minutes each day. That neurologist Hagy warned me that in time, the atrophied muscles contract and shorten, causing permanent toe walking, and requiring a surgery to release the tension. Yuck.

But as long as you're interested, keep the questions coming. You know more about certain physiological/anatomical things than I do, I've forgotten alot of this stuff like which muscles oppose others, muscle chains, kinesiology. I got worn out just trying to deal with the severe pain in my back and down the legs to the point I quit asking all these good questions. And of course, all those stupid uncaring docs....Headhunter would like this part.                                  Doc
35

[quote]bushidobadboy wrote:
When you squat, do your heels lift? If so, at roughly what angle of knee flexion?

Just trying to figure out if the calf tightness is neurogenic or fascial/structural.

The carriage of weight on your toes might be a partial response to forward weight bearing posture. When standing relaxed, do your knees hyperextend?

Bushy[/quote]
Squatting is a bitch for me. I just did a few BW squats to answer your question. If I keep good back posture, no matter how wide the foot position, my heels start lifting at the 1/4 squat position (so if paralell is 90 degrees, I heel lift at 45). To be able to squat at all, I have to have my Olympic lifting shoes (with the built up heel of almost an inch), plus a homemade orthotic which gives me another 1/4 inch. Fortunately, I have found that from medium heavy weights on, it helps push me down into better position. But near 1rm, my posture falls apart, with back bending into good mornings. I understand part of that is normal for lifters whose back strength is relatively greater than their leg strength.
I may have what you call forward weight bearing posture. I never though of it, but I do think my knees hyperextend when standing relaxed (lets make sure-see I’m very rusty on terms-hyperextension of the knee is like having your patella going backwards into the leg, right?) If so, I’'ve got it. Doc

37

Bushy, you are well on your way to becoming a world class PT. Your knowledge and passion for anything and everything related to the muscular functioning of the body is very impressive, more than all the PT’s I have worked with put together.

I never gave a moments thought to my poor soleus, but I am sure you are right about this. Just as I was reading your post, sitting in my recliner, I was instinctively doing what I do every day, any chance I get. I was contracting my tib anterior stretching out my stiff and achy calves. It is the single best stretch I do, it feels like the best antidote to my problem. You explained why...and all this from one picture and a few posts.

I’ve actually never heard of PIR stretching (see, I told you I dont know as much as you think I do). I do know about PNF stretching, at least my understanding of it (yes, that Golgi organ thing) and I have found this to be very helpful in the following: Lying on my back, I do a single leg raise, and grab my toe with my hand. Five months ago, I could barely do this, even with my leg severely bent. Little by little, I have worked with off and on contraction of the quads, while dynamically stetching and pulling down on the toes.

Now, I can do this with a perfectly straight leg-so yes, progress can be made, even if permanent damage has occurred in some of my muscles and fascia. I neglected to say that imo, this one stretch has helped me to get in squat clean positions every bit as much as the shoes.
Doc

39

Bushy, you’ve convinced me that when I go back to the States next month, I need to find someone who knows what they’re doing study my odd body from top to bottom. I’ve thought about using Eric Cressey, who uses pictures online, but I really think I need a hands on assessment. Just…who? You know my history with PT’s. Know anybody good in Florida? I’ll travel.

 I pretty much hit the wall with frustration today having to spend half an hour stretching just to be able to front squat, and even then I was stiff and mobility challenged. It's just not gonna be any fun unless I can make the deep squat positions of OL comfortable, and �?'m sure I'll not regain the numbers I want unless I get that flexibility too.               Doc