Doc Is In. Any Questions?

Training Bodybuilding
21

[quote]aellerbe wrote:
I am 40 years old and have been lifing for over 25 years. Stopped the bodybuilding splits and hit full body 2x a week. Now my knees are giving me fits. Stiffness and soreness right above the knee area. The weather in NY has been really damp, so I think that that may play a part. Any suggestions? I love to do front and back squats and would hate to give those up. If it is just age catching up, I will just work around it. Thanks for any advice.

Oldschool musclehead.[/quote]

If it is above the knee, it probably isn’t related to any intra-articular problem. I would suggest that you find a good sports med chiro or PT to assess the area. It may well be irritation to the quadriceps tendon, suprapatellar bursa or patellar retinaculum. Hard to say without actually examining you. They should assess the knee thoroughly to see if any symptoms are produced with stressing the primary knee structures. Also, if it is myofascial in nature, they can give you some treatment and a home program to perform.

No reason you would have to give up those exercises. However, you need to make sure that you maintain adequate flexibility in the quads and lower extremity kinetic chain. Also, make sure your program contains plenty of posterior chain work to balance out the quad work. An imbalance in strength and flexibility between these could lead to symptoms such as yours.

You may want to check out Cressey and Robertson’s Magnificent Mobility DVD for some drills to help make sure that flexibility issues don’t derail your training program.

Take care,

Ryan

22

[quote]firebug9 wrote:
David Barr wrote:
With all of your formal education and busy practice, how did you find time to become an expert in Photoshop?

Love the new avatar Doc!

Maybe he is on the pop tart diet!

Hey Doc - I seemed to have strained the left shoulder or lat insertion. Bench does not bother it, nor does squat, but heavy deadlifts - now that is another story. Range of motion is still good, but if I drop the shoulder down, I fell it at the top and back of the shoulder. Any ideas?[/quote]

Malinda,

It was nice to meet you in DC.

Now, about your shoulder, how did you injure it?

Obviously, deadlifts create quite a distraction force on the shoulder that must be made up for by contraction of the cuff and shoulder musculature. Also, the upper/mid-back muscles must contract significantly in order to maintain proper form during the lift. So it could be any of a number of structures producing the pain.

Knowing how you injured it would be helpful. Do you use an over/under grip with deads and does it make a difference in regards to your pain which position the hand is in?

Take care,

Ryan

23

[quote]Thad wrote:
How can you tell if you have an abdominal hernia? I have been recently feeling pain and burning in my lower abdominal. Thanks for any insight, Thad[/quote]

Where is your pain located and what seems to aggravate your pain?

24

[quote]bigrobbie wrote:
I started taking Carbolin 19 last week and at about day 3 I started getting some pretty nasty headaches during my training sessions, and they persist after I finish. I’m also taking Spike. I’ve read where it might not be a good idea to take them together, but I’ve also read on here people doing it and not having a problem. What’s your take? (I’ve since stopped the Carbolin 19 but still using Spike with no problems)

Also, what is the logic behind taking Carbolin 19 in the morning and 6 hours later. wouldn’t I want to take it every twelve hours so I can keep the blood level constant?

Thanks![/quote]

Actually, Cy would be the guy to answer these questions. He is the guy who is most familar with the mechanism of action, pharmacokinectics and side effects of these supplements. I’m sure he would be able to answer these questions for you.

Take care,

Ryan

25

[quote]fhhdsf123 wrote:
hey doc, my question is regarding a torn lambrum which is what i did in the middle of last summer. i am back to lifting heavy with out pain or discomfort, but am i rolling the dice as far as worsening the injured area or is what is done done? ive been told that the lambrum serves little function, but wanted to find out more info. thanks.[/quote]

Well it would depend on the type and location of the tear. I’ve heard several ortho’s basically say not to worry about it, if it is torn, it’s torn. However, if there is only a slight tear and it is not displaced, there is a risk that you could potentially make it worse.

If your training program is well designed and doesn’t place the shoulder in a position of risk for high amounts of volume or intensity, you will most likely do fine. I would suggest that you perform a good rotator cuff exercise program. The labrum will take more of a hit if the shoulder has less stability and shifts around considerably during exercise and general ROM. The labrum is basically a cartilage ring that serves to deepen the ‘socket’ that the upper arm bone sits in. The more the shoulder slips and slides in that socket, the more stress the labrum will absorb.

Take care,

Ryan

26

[quote]silverback3433 wrote:
I have constant tightness in my lower back an if I bend over without arching my back like a romanian dead it is really sore. I don’t want to take time off because I am on a great roll right now with my training. I do all olympic lifting. I stretch every night for about 30 min, any suggestions?[/quote]

I would really suggest that you find a good chiropractor that deals with sports and training injuries. They can perform a thorough evaluation and provide any necessary treatment as well as giving you advice on a home stretching program. Often what people think are good stretches, are often contributing to their symptoms.

I don’t know what kind of training background you have, but I would suggest that if you have a good Olympic lifting coach in your area that you have them assess your technique during the lifts. Due to the explosive nature of these lifts, if you don’t maintain proper form, especially in the hips and low back, you will really expose yourself to injury. I can assure you that a low back injury would take you out of training those lifts for quite a while.

Therefore, get it checked out sooner rather than later. It is much easier and less costly to have it evaluated now before it gets worse.

Take care,

Ryan

27

Thanks Doc for taking the time.

My question relates to pain that seems to radiate from either my Infraspinatus or Rhomboid on my left side. Do to the location of what seems to be a knot I?m guessing it?s the rhomboid. Short of going to the doc and having him prescribe muscle relaxants. What can you recommend? I do use the active release roller and attempt to stretch it.

The pain seems more when I awaken vs later in the day after my muscles are warm. Also when the pain is at its peak, deep breaths seem to bring more pain to the area.

thanks again

28

[quote]Mastermind wrote:
Hey Doc,

A few months ago I strained my delt doing dips too fast and too low. It was only moderately bad and I worked around it with other exercises, everything seemed fine.

About three weeks back I was doing some heavy eccentrics on incline bench.
I strained it again. It isn’t any of my rotators. The strain is really on the anterior delt, really close to the medial. I feel it when I abduct at about fifty degrees away from body, through to about 130 degrees. I feel it way more when I get to the stretch when moving my arm straight back.

I felt it would be wise to start by getting range of motion, then add light resistance in that stretch position and make it stronger there first before moving on to other movements. Also, I’m using massage and self ART. It seems to have the range of motion back, and ten pound dumbbell raises laying on a decline bench seems okay (it is getting better, I was going to wait until it feels fine then add some weight).

What are your thoughts? Should I do anything different?

Thanks,
Rolo.[/quote]

I would want to evaluate it to see what structures are involved. The long head of the biceps tendon would be one that I would want to rule out.

Yes you want to get a full pain-free ROM. However, when you start back to training you do not want to start off putting the arm in the end-range position that produced the pain and then loading it with weight. You would be better off performing the exercise with a light weight and assessing for pain or restriction throughout the ROM. Start the resisted exerise only through the ROM that is pain-free and gradually reassess and try to add a little movement until you are able to perform the full movement.

I would suggest that you have it evaluated by a good sports med chiro or PT. They could provide some treatment and advice after doing a full exam. Self ART is ok, but usually you can’t reach all the structures you need to. The painful area may have been injured due to a biomechanical problem in a different structure.

Take care,

Ryan

29

[quote]Nate Dogg wrote:
Dr. Ryan! What’s up big dog?

Hey, something weird happened on Saturday. I was playing some tackle football and after the first few plays, I noticed that my left ankle was tight, stiff and felt “locked up.”

I did a few small hops (similar to jumping rope) and then my ankle (on the inside ankle of my left foot) popped/cracked. It started to hurt at that point.

I continued to play football and mostly ran on the outside of my foot because it hurt to walk/run/stand with my foot completely flat. The pain never went away and I could barely walk the rest of the day and ever since.

It swelled up slightly on Sunday, but I never had any bruising or anymore swelling. Just constant pain and the inability to walk on it competely. Same with today.

So, did my ankle popping/cracking cause serious damage? Do you think I fractured something? Like I said, it just felt tight and stiff until it cracked. Then it hurt. It never happened as a result of being it or running or anything.

Any ideas?[/quote]

Nate Dogg,

It was nice to see you in DC. I know I enjoy making fun of you and all, but I’ve got to say you and Stacy are really good together. Sorry if that ruins your reputation.

Now about your ankle. They are actually pretty complex structures considering the number of joint, ligaments, muscles in the area.

It would be hard to imagine that you fractured anything based on what you have described, but I’m sure stranger things have occurred.

The popping sound could have been caused by shifting of one of the bones causing a 'cavitation’of the associated joint. Similar to the sound of popping your knuckles. That could have caused irritation to the cartilage which could result in pain and inflammation. Obviously whe ndealing with an ankle, a ligament sprain should be ruled out.

Hard to say without examining you buddy.

You should ice the area 15-20 minutes every few hours for the next couple of days. Try to prop it up when you sit down. Also, try to avoid too much weight-bearing activity for a few days and see how it responds. I would suggest that you get an ankle brace to help provide support temporarily. Those canvas ones that you lace up do a good job. If it is really painful, you could use some crutches for a few days whe you have to be on your feet.

If it doesn’t improve considerably within the next couple days, definitely go get it checked out.

Keep me posted.

Take care,

Ryan

30

Hey Doc, I’m having some sort of problem with my neck/shoulder cuff. The reason I say it’s my neck is because I feel, primarily in the upper trap, a tightness and a bit of a pain, but when I pop it first thing in the morning everything seems to be ok.

It could actually be an imbalance in my upper back and rotator cuff, as when I do external rotations and any sdduction work for the scapula the next day I have relatively little to no issue with the area. It’s one of those things that the morning after a workout I woke up and my neck hurt.

I have has issues in the past with a neck sprain and muscular imbalances in my upper and mid back, and I don’t think this is any different. What do you think my course of action should be? Take time off or just try to work the elements into my current program? Thanks Doc.

31

Dr. Ryan

What would be a good alternative to ART? My ART provider is excellent but I have to wait over an hour (even after making an appointment) to see him. A chiropractor who also performs ultrasound comes highly recommended but I do not know if this will address those ailments that ART can fix

32

Doc,

Over the past year, I’ve always been in a constant state of tiredness… I get 8 hours of sleep every night as well as take ZMA.

Now, I’m starting to lose my drive to lift very heavy weights and run very fast (sprint). Obviously, these are signs of overtraining but I’m also wondering if I might have a low testosterone level even though I’m 24.

I have hard time growing a beard (the best I can grow is a gritstache) and have zero chest hair (save for one or two strands). Would it be worth my time to visit an endocrinologist?

Thanks,
Kurt

33

[quote]PumpnIron25 wrote:
What the best stretches/exercises to work on a severely tight hip flexor on my left side. The right is 3-4 times more flexible.[/quote]

Get in the bottom position of a lunge, (the leg you are trying to stretch will be the back leg), with the back knee on the floor, glide your body forward. You should feel the stretch in the hip flexor. Now put the arm, of the leg you are stretching, over your head and lean to the opposite side. Since the psoas attaches to the lumbar spine vertebrae, the lean will create more of a stretch.

Hope that helps.

Take care,

Ryan

34

[quote]Joebob wrote:
Doc, I have been doing the Supersquats program. Friday and today I got a very intense headache about half way through my work set of 20. The pain is in the back of my head at about eye level. Friday wasn’t so bad, but today the pain lasted for about twenty minutes.

Is this caused by over exertion? I am very concerned because I have never experienced such intense pain from lifting. I have been supplementing with a caffeine and L tyrosine product for about a month now, and it is the only supp other than the regulars that I am on. The new avatar makes you a lot more credible ;)Thanks for your time.
[/quote]

Well, I’m glad my credibility has increased. It’s amazing how taking your shirt off can make you more intelligent and credible. Maybe we should let the T-vixens in on this little bit of information. What do you think? LOL

Actually, I know what you mean.

About your headaches, it is hard to say for sure, but an exertional headache is a definite possibility, as well as a muscle tension type headache. The vascular pressure during a squat can be significant and could precipitate a headache. Plus, with the weight sitting on the upper back and trap musculature a tension headache could be considered.

How long have you been doing the SuperSquats program? Do you take the caffeine/tyrosine supplement prior to working out? Any other changes in either medications, daily activites?

Take care,

Ryan

35

[quote]gags wrote:
hey doc, i PM’d you last week, about chiro school, just wondering if you got it? [/quote]

Gags,

Yes I did, sorry I didn’t get back to you sooner. I’ve been getting a large volume of PM’s recently. Sometimes I read them and don’t have time to respond right away, and then by the time I come back, there are more waiting. So unfortunately it got lost in the shuffle. I’ll go back and respond.

Take care,

Ryan

36

[quote]Dr. Ryan wrote:
gags wrote:
hey doc, i PM’d you last week, about chiro school, just wondering if you got it?

Gags,

Yes I did, sorry I didn’t get back to you sooner. I’ve been getting a large volume of PM’s recently. Sometimes I read them and don’t have time to respond right away, and then by the time I come back, there are more waiting. So unfortunately it got lost in the shuffle. I’ll go back and respond.

Take care,

Ryan[/quote]
thanks alot doc, your insight is greatly appreciated–Adam

37

[quote]novagreg wrote:
Hey Doc,
Just wondering what your current workout routine and nutrition plan are like, and what are you physique/performance goals for 2006?
-Greg[/quote]

Well, I am fortunate enough to be able to work out on the weekends with Dave Tate and crew at his EliteFTS facility. So I am getting some powerlifting influence on my training program right now. I’m not a powerlifter, but I am interested in getting stronger in the Big 3 lifts and there is no better group to learn from. With my job, I can not afford to injure myself, so I am focusing on getting stronger, but not in a manner that would jeopardize my health. Dave is a great guy. Also, if your gym doesn’t have one of his GHR machines and a Reverse Hyperextension then you need to start hounding them about getting them. Great equipment.

Also, I am looking to gain maybe 10-15 pounds of muscle while keeping the body-fat low. Since I’m single for the first time in 6 years, I’ve got to ‘look good nekkid’. LOL

Nutrition program is pretty basic. High protein/High carb breakfast, mid-morning Metabolic Drive bar, High protein moderate carb lunch, pre/during/post workout Surge, high protein/lower carb dinner and then a Metabolic Drive shake with some fish oil and ZMA prior to bed.

I think Metabolic Drive Protein Powder and Bars along with Surge and ZMA are staples. I really like Spike, and I’ll do different cycles of Alpha Male, Carbolin 19 and Methoxy-7.

Let me know if you want any more info.

Take care,

Ryan

38

Hey there Dr. Ryan…quick question.

Last spring/early summer I had some shoulder issues. Basically could not do any lateral motion on the right side. I avoided those motions for a few months and things cleared up.

Yesterday I did standing military presses and upright rows and my shoulder has been bothering me ever since. Basically any rotation hurts in the shoulder area and makes my hand tingle slightly. Any ideas?

Thanks and great avatar!

AG

39

[quote]Wreckless wrote:
Hi Doc,
I had some pain in my right shoulder, tried to train around it and that seemed to work at first. But finally, things got worse instead of better so I went to see a doctor.

It hurt most when I moved my arm inside over my back. The doctor told me to get an echo and this revealed irritation on the tendon on my right supraspinatus and also swelling on the bursa.

Now I have to rest my shoulder for 4-6 weeks, so no chest or shoulder exercises and no overhead movements (pull ups and such).

Can I do something to speed up recovey?
My doc says icing won’t do much, since the muscle is internal. He warned against massaging it, especially while the tendon is still irritated.

Is there anything I can do to recover a bit faster.

How do I start again after these six weeks? Just benchpresses with low weight and grudually increase the weight?

Any help would be appreciated. [/quote]

Well, I wouldn’t want to contradict your doctor’s advice, but he could have sent you for some physical therapy. Rest is usually never the best advice, although relative rest should be a component of the program. I would suggest that you call his office and see what he thinks of sending you for some physical therapy. Atleast they could provide some treatment to help with the inflammation and help to promote proper healing. In addition, they could teach you a good rotator cuff program.

Without treatment and a good rehab program, if you start back into the same training program, the symptoms will most likely return.

Also, you may want to take a good look at your training program and make sure that it is balanced and will not predispose you to injury. If you have an interest in designing training programs, you may want to consider getting Alwyn Cosgrove’s new Program Design manual. It will give you plenty of information on how to design a good program with injury prevention a primary strategy. It is a great resource to add to your library.

Take care,

Ryan

40

[quote]Mod Laurie wrote:
Love the new avatar…Looking good, Doc![/quote]

Coming from you that is high praise indeed. Makes me feel kind of funny, like when we used to climb the rope in gym class (bonus points if you name the movie that line is from).

It was nice to meet you in DC. I really had a great time hanging out with you guys. Tell your significant other I said ‘Thank you’ and that it was nice to finally meet him. I hope you are doing well.

Hopefully we will be able to meet up at another event sometime soon.

Any plans for you to come to the Arnold Fitness Weekend?

Take care,

Ryan