I'm Randy Mouri and this blog is about my quest to be an official finisher in the Race Across AMerica (RAAM), the toughest endurance race in the world. It's over and I became an official solo finisher in 11 days, 1 hour and 13 minutes! We continue to raise money and awareness on behalf of Habitat for Humanity of Northern Virginia (Habitat NoVa). If you would like to make a donation to Habitat NoVa, please visit my page on Habitat’s site. Endless thanks to our sponsors and all the folks that have made such generous contributions. Team Mouri would not have been able to travel so comfortably, which certainly may have changed the outcome of the race.

Wednesday, June 22, 2011

Medical Report: Randy and Shermer's Neck

Long report focused on Randy's Shermer's Neck symptoms and treatment.

The occurrence of Shermer’s Neck is one of the ultra-endurance cyclist’s most feared problems. The onset can be very quick. The only commonly reported prodromal symptoms (warning symptoms) are tightness and discomfort in the upper trapezius, and erector muscles of the cervical spine. This leads, after a variable period of time, to rapidly progressive loss of the ability to extend the neck, and to neck and upper back pain.

There were a number of periods with higher winds, and also some very long descents where Randy spent many hours in the aero position prior to this. Our experience indicates that riding in the aero position may hasten the onset of Schermer’s Neck. Randy began to have prodromal symptoms by about 600-650 miles into RAAM. He complained only once or twice of upper back and neck pain before abruptly realizing that he could not extend his neck to see, nor could he properly position his head when he attempted to climb in the standing position shortly before coming into Durango, CO. We deployed an adjustable Laerdal Cervical Collar as immediate first aid. For the reader who experiences Schermer’s and attempts to use a cervical collar, you should know that this solution is very confining and uncomfortable. Also, the collar completely prevents neck rotation as they are designed to protect a broken cervical spine. Thus, with the collar on, Randy could no longer rotate his head at all to see to the side or behind him. He was, however, able to ride on while we addressed the issue.

When Rehab to Racing signed on to provide sports medical and physical therapy support for Team Mouri, Mary and I began to study the range of reported medical and physical problems. First, there is almost no scientific literature on this group of athletes. There are a few antidotal reports; mostly case reports and letters to the editor. The ultra-cycling blogosphere is replete with what from a scientific point of view are wildly variant statements of the origin, treatment, and prevention of Schermer’s Neck. These are often stated with certainty and conviction. We could find no single instance of a statistically valid survey or scientific study of the causation or treatment of Schermer’s Neck.

There are a number of theories of the causation of Schermer’s. These range from “Spinal mis-alignment”, to sternocleidomastoid muscle spasm, to weakness of neck muscles in general, to sequelae of prior neck injuries. Treatment recommendations are even vaguer. There are only two reports in the literature of physical examinations by medical experts of Shermer’s victims immediately after onset. One common thread seems to be the once Schermer’s occurs on an ultra ride, then the rider is stuck with the problem until they can rest (off the bike) for at least 24-48 hours. Randy has a past history of Schermer’s, which occurred after about 600 miles during the Paris Brest Paris Brevet ride.

We examined Randy with acute onset Schermer’s. First, there was no evident active sternocleidomastoid muscle spasm at all. Both were tender to deep palpation. Maximal discomfort on examination occurred in the upper trapezius, and the cervical erector spinae muscles. There were several trigger points in this area. Motor exam revealed that Randy had near complete inability to extend his neck against gravity. Attempting to do so caused posterior muscle pain in the previously mentioned muscle groups. Thus the current R2R theory of Schermers causation is that these muscle groups have simply been exercised to failure. Failure onset is accelerated by fatigue induced muscle spasm. This theory is strongly supported at present by Randy’s response to subsequent treatment.

At present we are 1800 miles into RAAM 2011. Randy is not using a collar at all. Randy can extend, and rotate his neck with only minimal discomfort. He has had no analgesics at all except 2 ibuprofen 200 mg tabs when the problem first started what seems like days ago. He rides about 20-30% of the time in the modified aero position with our McGivered chin support. We changed out his stem, raising the handle bars approx. 5 cm.

Additional therapy based on preventing/treating muscle spasm, while using the chin rest to give intermittent rest to the neck extensor muscles, has resulted in progressive resolution of Randy’s Schermer’s symptoms while at the same time he has had three back to back 300+ mile days through all of Colorado, and Kansas.

Chemically, we have markedly increased Randy’s [Mg] and [K] intake. Also, we immediately started the muscle relaxant methocarbamol 750 mg TID. Potassium intake has also been increased by feeding potassium rich foods. Immediately at onset, our expert Massage Therapist, Connie Griffith massaged his beck extensor muscles and upper trapezius. She has helped all follow vehicle staff learn to massage the neck extensors at every single stop. Randy’s neck continued to improve at this point.


Mike said...

Doc -

If I'm following your explanation correctly... your treatment of Randy's condition may well be the first documented case of relieving the symptoms of Shermer's Neck while the rider continued to pedal on.

This could be of tremendous value to ultra distance riders.


Mike said...

Is there any risk with the chin rest Randy is using; that when the front wheel strikes a pot-hole or other bump, that he could experience a severe bite to his cheek or tongue? Or worse cracked teeth if his jaw is forced closed suddenly?

Is the support rigid or does it have some means to absorb shock? Does Randy wear a mouth guard like a football or hockey player does to protect his teeth while resting on it?

I certainly don't want to throw any doubts on something that appears to be helping so well. But I am genuinely curious to understand how this gadget is constructed and used.

Right now; while the crew is still in the thick of the chase, might not be the best time to pause and analyze such details unless doing so could further Randy's immediate chances of success. But perhaps it's one more for the "lessons learned" in the weeks after RAAM.

Great work Randy and all of his dedicated crew. The more detail you're able to share about the challenges, and solutions, the team has addressed, the more amazing it is to those of us watching from afar.

God Speed!


Greg Conderacci said...

Thanks! This is very interesting stuff.

It just demonstrates once again what a great crew you all are and how important you are to Randy's efforts.

We're pulling for ALL of you back east. Go Randy! Go Team!

Cheers, Greg

Rando Rob said...

What a great team! Randy's neck, tush and arms (and probably the whole rest of his body) is suffering but he is getting great, proactive care. I have seen riders with Shermers neck ride before, but have not heard of the success you have had in getting ahead of, averting and minimizing the problem. Not to mention the attention to the tush and other vital parts. Great work!

If the team can keep the body parts working, I know Randy has the spirit to make it to Anapolis.

Keep it up, roomie! Go Randy!


Anonymous said...

Proud of you Randy... Super proud!
Keep your chin up (pun intended)

Whoop Whoop! Go Randy... Go!

Ride Strong, Be Safe and Enjoy!

P.S. Notice your heading to ts 38 Sullivan IN Whoop Whoop!
Sullivan is cheering for you.

Jane said...

Good Lord is he in good hands. Al, thanks for this post as I have been focusing positive energy against fighting off Schermer's, having remembered the Paris story. Al and Mary and Connie and, of course, Susie, and all of you that I don't even know but that I want to give the biggest hug in the world to are making this happen every bit as much as Randy. Clearly Randy's spirit has been injected into the entire team and there is a new term to add to all of our "McGiver" phrase and it is "Team Mouri spirit". As in, "I need a little of that Team Mouri Spirit to knock out this track workout...." Or, come on, dig down, where's your "Team Mouri Spirit." And after your book deal you (which will set you off on a new career as a motivational speaker), the whole world will be talkin' about "all ya need is some Team Mouri spirit." And to all of you out there reading and analyzing the pics on the altered bars, Randy's "attorney" says "patent pending!!" I love you guys and can't wait to celebrate (oh boy, how about with some schnapps!!). Tommy wants to know if you'll come to Charlotte and talk to his 2nd grade class on career day -- so much better than what Mommy does for a living! Rock on Team Mouri. Me, I'm headed for a litle 6 mile run....

Jane (again) said...

hey Al and Mary, one of my colleagues at work was talking about how he knew all about Schermer's neck bc apparently Rangers suffer from it also. So, when you get back and write up your your findings, I bet the military would find the early symption analysis and then what you did, are doing, to prevent it and keep it at bay very helpful. Randy's ride will then live on and be of value to many of our military men and women -- how cool would that be!!

Chris said...

"Patent Pending" for sure!! In the not to distant future we will be following RAAM, reading about Shermer's Neck and the "Mouri Support".

Randy, I am glad I knew you before you got to be so famous. You are doing an AWESOME job, keep it up. We are looking forward to seeing you in Annapolis.

Finish Strong!

Andrea said...

Wow, thank you for the detailed and helpful report! The RAAMifications will change the race forever mouri. : )

Go, Team Mouri, go!


Allen DeLaney said...

To all concerned. The McGiver'd Special Mouri Shermer's Chin Support is constructed out of high density polyethylene foam that provides quite a bit of shock absorbancy. and Yes we are worried about what could happen if he hit a pothole without seeing it while using the chin support. We would like to find a bite guard for him, but on this road that has not worked out yet. Meanwhile, as this is written at midnight Thursday, June 23...He soldiers on toward the finish

shane neck brace said...

I have the neck support brace for shermers neck ,i invented patented www.shanesneckbrace.com ,i have a weak neck i refused to wear a typical neck brace ,neck braces make your neck weaker when worn for long periods of time from restricted movement please see website www.shanesneckbrace.com for further information and read my story why i invented shanes brace ,you can call 480-233-1566
this is my cell phone my personal email peters85257@gmail.com

RAAM2011 said...

I have tested Shane's Neck brace. Though it did help with the neck strain and issues with heat build up, I found it to put an excessive amount of pressure on the collar bone when relaxing the head completely on the bike. Perhaps the inventor (Shane Peters) can come up with a modification before I race again.

akansha said...

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Shanes Neck Brace said...

i have made changes to the brace with more padding on the lower and top of the brace there are a few people that will be using the brace in the race this year as they have found that it works great for them please contact me www.shanesneckbrace.com 480-233-1566 for discounts ,


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