Doc is in the House

Training Bodybuilding
61

apayne,

Her symptoms are fairly typical of a lot of patients that I see. Unfortunately, several different things can cause it. Anything from myofascial trigger points/local muscle irritation, facet joint irritation or disc problems. Problems with any of these can result in mechanical neck pain. Once any one of the tissues is irritated it will result in some inflammation, muscle pain/tightness and restricted or painful motion.

If her pain recently flared up use ice, some NSAID’s for a couple days, mild ROM exercise and stretches. If her symptoms persist, have her checked by a chiro/PT to figure out what all is involved. The treatment and stretching recommendations would be different depending on what exactly is the problem.

What kind of postures is she in all day? Often prolonged desk/computer/telephone work can contribute to the problem.

Take care,

Ryan

62

Dr. Ryan,
Every time I work my chest, especially doing flat bench and incline bench, I feel a sharp pain that seems to be next to the bone between the bottom part of my deltoid, like on the side of my arm. Sorry I can’t explain in more detail, but it only hurt right after I do the exercise and that day. Any thoughts on what it may be?

         Thx for any help,
                    -CJ
63

Nate,

If you turn your head to the left, the spot where the muscle on the front of your neck tightens up on the right, is right next to your sternoclavicular joint.

To me, it sounds like you are talking about a lower spot. If that is correct, then it most likely is the ant. rib region that I referred to in my first response to your question.

If it pops that frequently, I would think there is some laxity in that joint. I would definitely avoid laying in the position you described, as that puts a tensile strain on this area that has a distraction type force. I’ve had a similar problem with a rib joint in the the back, as opposed to the chest and that same position caused it to flare up as well.

It also drives the humerus (upper arm bone) up into the shoulder and can produce some shear through the GH joint (you mentioned a labral problem) as well as compression of the tendons and bursa in the subacromial space since the arm is abducted and externally rotated in that position.

If you have had good results from the chiro in the past, I would have him assess you. There are some techniques for adjusting both anterior and posterior rib problems.

Try assessing how it feels at the bottom vs top of a bench and at the start vs finish of the pec dec or fly.

What position do you sleep in? Sometimes side sleeping can put some stress on the area when it is irritated.

Take care,

Ryan

64

Well the pec major inserts on the lateral (outside) lip of the intertubercular groove of the humerus (upper arm bone)

Most likely, you are feeling pain at either the musculotendinous portion of the pec major or at it’s insertion point.

While there are other muscles that could be creating the problem, that would be a likely culprit.

Is this pain different than DOMS that normally accompanies a workout?

Many injuries go through stages:

  1. No pain with exercise, pain after
  2. Pain w/ exercise, does not limit performance
  3. Pain w/ exercise, does limit perf.
  4. Pain severe enough that it prevents performing the activity.

Typically, the earlier the injury is assessed and treated, the quicker it can be fixed, with the least disruption of a training program.

Obviously, not all injuries go through all of these stages, but it is something to be aware of.

Have you recently either changed your exercises or signifcantly changed the volume or intensity of your workouts?

Take care,

Ryan

65

Hey Doc,

I have a question about my foot. I have an ingrown toenail. I’ve had this for about 3 years now. It doesn’t hurt at all at this point. However when I’m doing heavy lifts or running hard on it the veins in my foot seem to pop out. Also, at times, when no activity is taking place the vein on the side of my ankle is tender and if I push on it I can feel the veins lower in my foot. What you think is the problem? Should I get it checked out? I went to the doctor already about the ingrown toenail and he said if it isnt causing any pain there is not reason to take action on it. However I didnt notice the vein problem at that time.

66

greetings doc!
hope this post is no too late…
anyways, i strained my neck a couple of months ago trying to complete my last rep of a back squat… i was prescribed some anti inflamatories and it went away. now i am doing a program (ABBH) that calls for 80% of my 1RM for front squats. 5sets 10reps.

now i get a throbbing pain in my head after my third set… does this have anything to do with the strain in my neck? am i going too heavy? it is also very humid in my enviroment. does this have anything to do with it?

i would greatly appreciate a reply! thanks for this thread!

BlAzE

67

[quote]Dr. Ryan wrote:
Well the pec major inserts on the lateral (outside) lip of the intertubercular groove of the humerus (upper arm bone)

Most likely, you are feeling pain at either the musculotendinous portion of the pec major or at it’s insertion point.

While there are other muscles that could be creating the problem, that would be a likely culprit.

Is this pain different than DOMS that normally accompanies a workout?

Many injuries go through stages:

  1. No pain with exercise, pain after
  2. Pain w/ exercise, does not limit performance
  3. Pain w/ exercise, does limit perf.
  4. Pain severe enough that it prevents performing the activity.

Typically, the earlier the injury is assessed and treated, the quicker it can be fixed, with the least disruption of a training program.

Obviously, not all injuries go through all of these stages, but it is something to be aware of.

Have you recently either changed your exercises or signifcantly changed the volume or intensity of your workouts?

Take care,

Ryan[/quote]

First off (excuse my ignorance) what is DOMS, and if whatever’s wrong with my mid-upper left arm is what you say it is, how can I start to get it feeling better on my own. I already changed some of my workout routines to suit the intensity levels that don’t seem to bother it so much, or should I seek medical help for sure?

thx,
-CJ

68

First off (excuse my ignorance) what is DOMS, and if whatever’s wrong with my mid-upper left arm is what you say it is, how can I start to get it feeling better on my own. I already changed some of my workout routines to suit the intensity levels that don’t seem to bother it so much, or should I seek medical help for sure?

thx,
-CJ[/quote]

i know what DOMS is… its Delayed Onset of Muscle Soreness… that tight feeling you get the day(s) after a workout…

69

[quote]rainjack wrote:
So what about my knee, doc?[/quote]

Yeah, same here, although I don’t know if you saw my knee thread.

I have been able to pinpoint it to the ligaments behind the right knee (lateral and medial collateral ligaments, I believe). When I bend the knee under weight, as in a squat, I can feel increasing discomfort in that area as I go down. The discomfort continues from there down into the calf, primarily on the lateral side. Again, this is most notable under flexion.

I haven’t squatted in two weeks hoping that it will heal, but I’m going to try again soon. Any thoughts or recommendations on possible causes and remedies would be most welcome!

70

[quote]Dr. Ryan wrote:
Nate,

To me, it sounds like you are talking about a lower spot. If that is correct, then it most likely is the ant. rib region that I referred to in my first response to your question.[/quote]

Correct. Lower spot.

I’m avoiding that position for now on not only because of the chest pain but also because of what it’s done to my left shoulder. The pain has been off and on. Haven’t had it happen in a week now. But it comes and goes just like that and can happen multiple times in a week.

I will definitely bring this up next time I go. I don’t have medical insurance at the moment, but I should within a few months (just started a new job).

I don’t normally feel anything when benching. I work out at home (power rack, flat bench, weights), so I don’t use a pec dec (not that I would, due to previous shoulder injuries).

I start out on my back when I first go to sleep. After a little while, I move to my side and end up sleeping on both sides throughout the night (more so on my right side).

Thanks!

Nate

71

provy,

I would doubt if it had anything to do with your ingrown toenail, although I’m sure stranger things have happened.

Sometimes the valves in veins become incompetent and can result in dilation of the vessel. Is there any swelling in the foot compared to the other side?

You should mention this to your doctor so he/she can check it out and make sure there is no impaired circulation. It’s always best to err on the side of caution.

Take care,

Ryan

72

Blaze,

Where is the throbbing located? Throbbing type pain usually has a vascular component. It could be due to many different things. Any other symptoms?

I would suggest that you follow up with the doc that saw you for the initial injury. Without knowing anything about the intial injury or any other medical history, it is really hard to give you better advice.

If the strain has resulted in muscle contacture/tightness in the neck, due to the number of blood vessels that pass either between or through myofascial structures, vascular irritation can occur. Muscle tension headaches are very common for this reason.

If they rule out any other causes, then some myofascial therapy and a good home stretching program should help to alleviate the muscle tension.

Take care,

Ryan

73

CJ,

I really don’t have that much info about your problem. I don’t know when/how it started. I don’t know what kind of workout program you have been using (freq/ exercises/ sets /reps /length of time you have been training). Do yo do any kind of warm-up or stretching program.

I need more info to be able to give you any good advice.

Take care,

Ryan

74

Dr. Ryan,

What can you do for a broken finger that has healed but does not have the flexibility of the others. During the injury I squished a ball for like 24/7 and that helped when it was almost stuck straight. I extended the joint up and down several times during the day too.

When I close my fist the top joint of the finger does go all the way under in the palm and doesn’t curl as much as the others.

Anything I can do to increase the flexibility? I have another finger that has a bulge on the nuckle and the tissue appears swolen around it more than my other finger on the other hand. Whats the deal and what can i do to fix this?

-Get Lifted

75

Dr Ryan, as a Chiro I know you’re into aura readings. Can you read my aura online tonight, or does it have to be over the phone?

Thanks!

76

Nate,

Side sleeping can sometimes contribute to pressure on the region where you have your symptoms. Adjusting the side sleeping posture a little will usually help:

For side sleeping I suggest putting a pillow between your legs to prevent your pelvis from twisting and then tucking another pillow firmly behind your back so that you can lean back onto it slightly to remove pressure from the ‘down’ shoulder and then the upper arm can either rest at your side or you can hug around another pillow. You just don’t want it to flop forward and hang in front of your body. The neck pillow should keep your head and neck in a neutral position and not either bend your head upward or let it drop downward.

If you have any questions about the above position, let me know.

Also, if you sit a lot during the day, check out the Cool Tips archive for my Get on a Roll suggestion. It will help prevent you from sitting with a slumped or ronded shoulder posture, which also sometimes contributes to the problem.

Take care,

Ryan

77

Dr. Ryan,
Which isomer, if any are in fact, of CLA is/are most effective for lipolysis?

78

Dave,

Not to worry, I can smell your aura from here.

By the way, who is the scrawny looking Survivor cast-off in your avatar? :slight_smile:

T-Nation members, Dave should have some pretty interesting articles coming out before long. Stay tuned.

79

Fonebone,

I would seriously doubt if the problem is your MCL and LCL. Could be a hamstrings problem or even gastrocs.

How/When did your symptoms start?

80

Robert,

Enjoy. (To read the free full text articles, go to Pubmed and search CLA isomers and lipolysis)

Am J Clin Nutr. 2004 Jun;79(6 Suppl):1153S-1158S. Related Articles, Links

Dietary conjugated linoleic acid and body composition.

Wang Y, Jones PJ.

School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.

Conjugated linoleic acid (CLA) is a group of positional and geometric isomers of conjugated dienoic derivatives of linoleic acid. The major dietary source of CLA for humans is ruminant meats, such as beef and lamb, and dairy products, such as milk and cheese. The major isomer of CLA in natural food is cis-9,trans-11 (c9,t11). The commercial preparations contain approximately equal amounts of c9,t11 and trans-10,cis-12 (t10,c12) isomers. Studies have shown that CLA, specifically the t10,c12-isomer, can reduce fat tissue deposition and body lipid content but appears to induce insulin resistance and fatty liver and spleen in various animals. A few human studies suggest that CLA supplementation has no effect on body weight and could reduce body fat to a much lesser extent than in animals. To draw conclusions on this form of dietary supplementation and to ultimately make appropriate recommendations, further human studies are required. The postulated antiobesity mechanisms of CLA include decreased energy and food intakes, decreased lipogenesis, and increased energy expenditure, lipolysis, and fat oxidation. This review addresses recent studies of the effects of CLA on lipid metabolism, fat deposition, and body composition in both animals and humans as well as the mechanisms surrounding these effects.

Int J Obes Relat Metab Disord. 2004 Aug;28(8):941-55. Related Articles, Links

Conjugated linoleic acid and obesity control: efficacy and mechanisms.

Wang YW, Jones PJ.

School of Dietetics and Human Nutrition, Macdonald Campus, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.

Obesity is associated with high blood cholesterol and high risk for developing diabetes and cardiovascular disease. Therefore, management of body weight and obesity are increasingly considered as an important approach to maintaining healthy cholesterol profiles and reducing cardiovascular risk. The present review addresses the effects of conjugated linoleic acid (CLA) on fat deposition, body weight and composition, safety, as well as mechanisms involved in animals and humans. Animal studies have shown promising effects of CLA on body weight and fat deposition. The majority of the animal studies have been conducted using CLA mixtures that contained approximately equal amounts of trans-10, cis-12 (t10c12) and cis-9, trans-11 (c9t11) isomers. Results of a few studies in mice fed CLA mixtures with different ratios of c9t11 and t10c12 isomers have indicated that the t10c12 isomer CLA may be the active form of CLA affecting weight gain and fat deposition. Inductions of leptin reduction and insulin resistance are the adverse effects of CLA observed in only mice. In pigs, the effects of CLA on weight gain and fat deposition are inconsistent, and no adverse effects of CLA have been reported. A number of human studies suggest that CLA supplementation has no effect on body weight and insulin sensitivity. Although it is suggested that the t10c12 CLA is the antiadipogenic isomer of CLA in humans, the effects of CLA on fat deposition are marginal and more equivocal as compared to results observed in animal studies. Mechanisms through which CLA reduces body weight and fat deposition remain to be fully understood. Proposed antiobesity mechanisms of CLA include decreased energy/food intake and increased energy expenditure, decreased preadipocyte differentiation and proliferation, decreased lipogenesis, and increased lipolysis and fat oxidation. In summary, CLA reduces weight gain and fat deposition in rodents, while produces less significant and inconsistent effects on body weight and composition in pigs and humans. New studies are required to examine isomer-specific effects and mechanisms of CLA in animals and humans using purified individual CLA isomers

: J Nutr Biochem. 2002 Sep;13(9):508. Related Articles, Links

Isomer-specific effects of conjugated linoleic acid (CLA) on adiposity and lipid metabolism.

Evans M, Brown J, McIntosh M.

Department of Medicine/Endocrinology, Emory University, 30322, Atlanta, GA, USA

Isomers of conjugated linoleic acid (CLA), unsaturated fatty acids found in ruminant meats and dairy products, have been shown to reduce adiposity and alter lipid metabolism in animal, human, and cell culture studies. In particular, dietary CLA decreases body fat and increases lean body mass in certain rodents, chickens, and pigs, depending on the isomer, dose, and duration of treatment. However, the effects of CLA on human adiposity are conflicting because these studies have used different mixtures and levels of CLA isomers and diverse subject populations. Potential antiobesity mechanisms of CLA include decreased preadipocyte proliferation and differentiation into mature adipocytes, decreased fatty acid and triglyceride synthesis, and increased energy expenditure, lipolysis, and fatty acid oxidation. This review will address the current research on CLA’s effects on human and animal adiposity and lipid metabolism as well as potential mechanism(s) responsible for CLA’s antiobesity properties.

PMID: 12231420 [PubMed - as supplied by publisher]

J Nutr. 2002 Mar;132(3):450-5. Related Articles, Links

Trans-10, cis-12 conjugated linoleic acid increases fatty acid oxidation in 3T3-L1 preadipocytes.

Evans M, Lin X, Odle J, McIntosh M.

Graduate Program in Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27402, USA.

The purpose of this study was to examine the effect of 0-50 micromol/L trans-10, cis-12 conjugated linoleic acid (CLA) and cis-9, trans-11 CLA isomers on lipid and glucose metabolism in cultures of differentiating 3T3-L1 preadipocytes. Specifically, we investigated the effects of 6 d of CLA treatment on the following: 1) (14)C-glucose and (14)C-oleic acid incorporation and esterification into lipid; 2) (14)C-glucose and (14)C-fatty acid oxidation; and 3) basal and isoproterenol-stimulated lipolysis. Trans-10, cis-12 CLA supplementation (25 and 50 micromol/L) increased both (14)C-glucose and (14)C-oleic acid incorporation into the cellular lipid fraction, which was primarily triglyceride (TG), compared with bovine serum albumin (BSA) controls. Although glucose oxidation ((14)C-glucose to (14)C-CO(2)) was unaffected by CLA supplementation, oleic acid oxidation ((14)C-oleic acid to (14)C-CO(2)) was increased by approximately 55% in the presence of 50 micromol/L trans-10, cis-12 CLA compared with BSA controls. In contrast, 50 micromol/L linoleic acid (LA) and cis-9, trans-11 CLA-treated cultures had approximately 50% lower CO(2) production from (14)C-oleic acid compared with control cultures after 6 d of fatty acid exposure. Finally, 50 micromol/L trans-10, cis-12 CLA modestly increased basal, but not isoproterenol-stimulated lipolysis compared with control cultures. Thus, the TG-lowering actions of trans-10, cis-12 CLA in cultures of 3T3-L1 preadipocytes may be via increased fatty acid oxidation, which exceeded its stimulatory effects on glucose and oleic acid incorporation into lipid.
J Nutr. 2001 Sep;131(9):2316-21. Related Articles, Links

Trans-10, cis-12, but not cis-9, trans-11, conjugated linoleic acid attenuates lipogenesis in primary cultures of stromal vascular cells from human adipose tissue.

Brown JM, Halvorsen YD, Lea-Currie YR, Geigerman C, McIntosh M.

Graduate Program in Nutrition, University of North Carolina at Greensboro, 27402, USA.

We have previously shown that both a commercially available mixture of conjugated linoleic acid (CLA) isomers and the trans-10, cis-12 isomer of CLA reduced the triglyceride (TG) content and induced apoptosis in differentiating cultures of murine 3T3-L1 preadipocytes. However, the influence of CLA isomers on differentiating human (pre)adipocytes is unknown. Therefore, we conducted a series of studies using primary cultures of stromal vascular cells isolated from human adipose tissue to determine: 1) the influence of seeding density and thiazolidinedione (TZD) concentration on TG content; 2) the chronic dose response of cis-9, trans-11 CLA vs. trans-10, cis-12 CLA on TG content; 3) whether chronic linoleic acid supplementation could rescue the TG content of CLA-treated cultures; and 4) whether trans-10, cis-12-mediated reduction in cellular TG was due to decreased lipogenesis and/or increased lipolysis. In expt. 1, the TG content [micromol/(L x 10(6) cells)] increased as both seeding density and TZD concentration increased. For example, cultures seeded at 4 x 10(4) cells/cm(2) and supplemented with 10 micromol/L BRL 49653 had 10-fold more TG than similarly seeded cultures without BRL 49653. In expt. 2, TG content decreased as the level of trans-10, cis-12 CLA increased from 1 to 10 micromol/L, whereas the TG content increased with increasing concentrations of either linoleic acid or cis-9, trans-11 CLA. In expt. 3, linoleic acid supplementation restored the TG content of cultures treated with trans-10, cis-12 CLA compared with cultures treated with CLA alone, suggesting that attenuation of TG content by CLA is reversible. In expt. 4, glucose incorporation into total lipid decreased with increasing levels of trans-10, cis-12 CLA, whereas neither CLA isomer acutely affected lipolysis. These data suggest that the reported antiobesity actions of a supplement containing a crude mixture of CLA isomers given to humans may be due to inhibition of lipogenesis by the trans-10, cis-12 isomer.