Spontaneous injury caused by a muscle exerciser
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Injury, 15, 14 l-l 42 Printed in Great Britain 141 Spontaneous injury caused by a muscle exerciser James George and J. Aidan Twomey Department of Neurology, Leeds General infirmary Summary Two patients with spontaneous injuries occurring while using a ‘Bullworker’ exerciser are described. An explanation for their injuries is suggested. INTRODUCTION THE ‘Bullworker’ is a widely used exerciser which pur- ports to improve muscle strength and fitness by regular isometric exercise. We are not aware of any reports of serious injury occurring while using this apparatus, although other forms of sudden and severe muscle action may result in spontaneous fractures (Bingham, 1959; Peace, 1977; Rooker, 1977; Whitaker, 1977). CASE REPORTS Case 1 A 39-year-old West Indian man presented with stiffness and weakness of his legs. Six weeks previously he developed sud- den pain and paraesthesiae in his neck, shoulders and arms while exercising on a ‘Bullworker’. Since then his legs felt heavy and stiff especially when running or playing football. On examination, there was no muscle weakness or sensory loss although muscle tone and tendon reflexes were increased in his arms and legs. He had sustained clonus at both ankles and his plantar responses were extensor. Plain X-ray films of the spine were normal but a myelogram demonstrated a narrow cervical canal with a central protrusion of the disc between the third and fourth cervical vertebrae, with the diameter of the dural sac opposite this disc space reduced to 8.5 mm (Fig. I). Surgical decompression was not undertaken because his symptoms slowly improved. Twelve months later he was asymptomatic. Muscle tone and tendon jerks remain increased but plantar responses are now flexor. Case 2 A 23-year-old medical student attended casualty in 1973. Several hours before admission, while exercising on a ‘Bull- worker’ for the first time, he reported a loud crack with sud- den severe pain in the left arm, which fell limply to his side. X-ray examination showed a complete spiral fracture through the midshaft of the humerus. His arm was immobil- ized for six weeks after which an X-ray film showed satisfac- tory union. He subsequently made a complete recovery and has remained well since. DISCUSS10 N Congenital narrowing of the spinal canal in patient 1 was a likely predisposing factor to spinal cord injury. We speculate that the forceful contraction ofthe upper muscles of the back generated a sufficient compressive force to cause protrusion of the C3/4 intervertebral disc. Acute herniation of an intervertebral disc rarely results from athletic injuries, although Torg (1982) de- scribed a similar herniation in an American footballer. In patient 2 there was no radiological or clinical evi- dence of underlying bone disease. It is likely that his injury resulted from contraction of muscles exerting opposite forces on a bony fulcrum, a similar mechan- ism to fractures occurring while arm wrestling. (Whitaker, 1977). Although injuries caused by exercisers are rare, we feel their occurrence in two previously fit young men is noteworthy and calls for judicious use of these train- ing techniques, especially when used by those unac- customed to strenuous activity. Fig. 1. Cervical myelogram (Amipaque 200) showing com- plete block at C3/4 level.
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Transcript of Spontaneous injury caused by a muscle exerciser
Injury, 15, 14 l-l 42 Printed in Great Britain 141
Spontaneous injury caused by a muscle exerciser
James George and J. Aidan Twomey Department of Neurology, Leeds General infirmary
Summary Two patients with spontaneous injuries occurring while using a ‘Bullworker’ exerciser are described. An explanation for their injuries is suggested.
INTRODUCTION THE ‘Bullworker’ is a widely used exerciser which pur- ports to improve muscle strength and fitness by regular isometric exercise. We are not aware of any reports of serious injury occurring while using this apparatus, although other forms of sudden and severe muscle action may result in spontaneous fractures (Bingham, 1959; Peace, 1977; Rooker, 1977; Whitaker, 1977).
CASE REPORTS
Case 1 A 39-year-old West Indian man presented with stiffness and weakness of his legs. Six weeks previously he developed sud- den pain and paraesthesiae in his neck, shoulders and arms while exercising on a ‘Bullworker’. Since then his legs felt heavy and stiff especially when running or playing football. On examination, there was no muscle weakness or sensory loss although muscle tone and tendon reflexes were increased in his arms and legs. He had sustained clonus at both ankles and his plantar responses were extensor. Plain X-ray films of the spine were normal but a myelogram demonstrated a narrow cervical canal with a central protrusion of the disc between the third and fourth cervical vertebrae, with the diameter of the dural sac opposite this disc space reduced to 8.5 mm (Fig. I). Surgical decompression was not undertaken because his symptoms slowly improved. Twelve months later he was asymptomatic. Muscle tone and tendon jerks remain increased but plantar responses are now flexor.
Case 2 A 23-year-old medical student attended casualty in 1973. Several hours before admission, while exercising on a ‘Bull- worker’ for the first time, he reported a loud crack with sud- den severe pain in the left arm, which fell limply to his side. X-ray examination showed a complete spiral fracture through the midshaft of the humerus. His arm was immobil- ized for six weeks after which an X-ray film showed satisfac- tory union. He subsequently made a complete recovery and has remained well since.
DISCUSS10 N Congenital narrowing of the spinal canal in patient 1 was a likely predisposing factor to spinal cord injury. We speculate that the forceful contraction ofthe upper muscles of the back generated a sufficient compressive
force to cause protrusion of the C3/4 intervertebral disc. Acute herniation of an intervertebral disc rarely results from athletic injuries, although Torg (1982) de- scribed a similar herniation in an American footballer.
In patient 2 there was no radiological or clinical evi- dence of underlying bone disease. It is likely that his injury resulted from contraction of muscles exerting opposite forces on a bony fulcrum, a similar mechan- ism to fractures occurring while arm wrestling. (Whitaker, 1977).
Although injuries caused by exercisers are rare, we feel their occurrence in two previously fit young men is noteworthy and calls for judicious use of these train- ing techniques, especially when used by those unac- customed to strenuous activity.
Fig. 1. Cervical myelogram (Amipaque 200) showing com- plete block at C3/4 level.
142
Acknowledgements We thank Dr E. G. S. Spokes, Consultant neurologist and Dr M. A. O.D. for permission to report patients 1 and 2 respectively and also Mrs S. Garfitt for secre- tarial assistance.
REFERENCES Bingham E. L. (1959) Spontaneous fractures of the humerus
from muscular violence. U.S. Armed Forces Med. J. 10, 22.
Injury: the British Journal of Accident Surgery Vol. 1 ~/NO. 2
Peace P. K. (1977) Fractures of the humerus from arm wrestling. Injury 9, 162.
Rooker G. D. An unusual cause of a spiral fracture of the humerus. Injury 9, 62.
Torg J. S. (1982) Athletic injuries to the head, neck and face. Philadelphia: Lea and Febiger. p. 187.
Whitaker J. H. (1977) Arm wrestling fractures-a humerus twist. Am. J. Sports Med. 5, 67.
Paper accepted 17 December 1982.
Requests for reprints should be addressed to: James George, Department of Neurology, Leeds General Infirmary, Great George Street, Leeds LSI 3EX.
