Any questions?
What no questions?
Sweet, I guess we’ve managed to fix everyone’s problems.
My work here is done 
Doc,
I’ll bite here; how would you treat someone with unilateral knee crepitus? In other words, what exercises, stretches, adjustments and/or soft tissue work would you use?
Stay strong
MR
Can I play? I hope that I have given the guys enough to make some kind of suggestion concerning my back, but TT said you would be a good guy to ask about my psoriasis/eczema.
It runs in the family, all the siblings have it and so do both parents. The old man has been diagnosed with fibromyalgia so I would bet my body chemistry is goofy. TT thought it may be related to an EFA imbalance. Any thoughts? Thanks.
Mike,
Well, just like most things, it would depend on what was causing it, how long it has been present…
Now obviously if the crepitus is due to arthritis, the severity would be an important determining factor.
If it was due to altered patellar tracking, then that is another question.
It would also depend on the person’s fitness level, normal exercise program etc.
Typically, I would assess the whole pelvic/lower extremity kinetic chain looking for any causative/perpetuating factors.
Definitely check out hip add/abd relative strength/tightness. Often tight TFL/ITB and lateral patellar retinaculum contribute to altered patellar tracking. Often this is associated with weak or inhibited VMO activity.
Obviously any genetic biomechanic contribution shoudl be assessed ie. degree of hip ante/retro version, coxa and genu valgus/varus, etc.
In addition flat feet/fallen arches or excessive subtalar pronation all play into the equation.
As far as treatment goes, ultrasound or cold laser has some application. I’ll usually do some kind of myofascial release for any tight areas or adhesions identified.
I’ve also found patellar mobilization to be beneficial.
Stretching would be performed on all tight muscles, usually TFL/ITB, hams, gastroc/soleus…
Strengthening exercises for VMO, posterior chain and lower legs, both gastroc/soleus and TA.
I’ll usually start the patient doing quad sets for the VMO while palpating the area in order to facilitate motor learning. Most of the studies I’ve seen suggest that training the VMO requires motor learning to teach the patient how to fire the muscles sufficiently.
I would check the patient’s ability to get to the bottom position of a squat without crepitus or pain. I feel that this is a functional activity they would have to perform in the normal course of daily activities.
As far as for an experienced lifter, TKE’s seem popular. I would also try some squats or deadlifts and assess the patient’s tolerance. GHR and rvs hypers to help the posterior chain as well.
Obviously if the person had significant subtalar pronation a corrective orthotic could be used in conjunction with a training program to help address the gastroc, peroneii etc.
That is what is coming to mind off the top of my head, I’m sure there is more.
What has your experience been?
I’m always looking for more good ideas.
Take care,
Ryan
I’m sure there is more
I have a question!
I know this is still a burning subject, but i wonder about my knee health…
I started training for sprint 2 months ago and really pounded squat from that time. My concern is about the vastus medialis. I always felt huge tension in that muscle every time i go for the weight or simply try to full squat ass to the grass.
So…
1-Is there another way to work the vastus medialis than +90 degree squat since they seem to create huge tension in my knee/vastus.
2-I know that athlete like ben johnson worked with 1/2 squat or just beyond parallel, but it seem that so much people say that full squat are good for knee balance, doesn’t seem to be the case for me even when i use texbook form.
Informations about me.
I am 6"0, 190pounds
weight training for about 8 years
knee stressfull positions (HB/NS)+(MB/N-MS)
Thank you in advance for your answer
Keep fighting
adonail
DA MAN,
Well to give you more meaningful advice, it would help to know a few things.
How old are you?
How long have you had the psoriasis?
What kind of diagnostic work-up have you had?
You mention back problems, what kind of problems are you having?
Do you have any GI problems?
Other than the back pain, do you have any other joint pain?
I would definitely suggest you start on fish oil probably 3-6 grams combined EPA/DHA.
I have a list of supps and dosages for psoriasis at the office. I will check it out tomorrow.
What supps do you currently take?
What meds do you take?
Have you noticed if anything in particular causes it to flare up?
Take care,
Ryan
[quote]Dr. Ryan wrote:
DA MAN,
Well to give you more meaningful advice, it would help to know a few things.
How old are you?
How long have you had the psoriasis?
What kind of diagnostic work-up have you had?
You mention back problems, what kind of problems are you having?
Do you have any GI problems?
Other than the back pain, do you have any other joint pain?
I would definitely suggest you start on fish oil probably 3-6 grams combined EPA/DHA.
I have a list of supps and dosages for psoriasis at the office. I will check it out tomorrow.
What supps do you currently take?
What meds do you take?
Have you noticed if anything in particular causes it to flare up?
Take care,
Ryan
[/quote]
Dr. Ryan
Thanks for the reply. to answer your questions:
How old are you?–26
How long have you had the psoriasis?–6 years
What kind of diagnostic work-up have you had?–Dermatologist physical examination, I honestly cant remember if he took blood or not.
You mention back problems, what kind of problems are you having?–Evidently a disc problem and inflammation issues with the musculature of my lower back/glute/hip.
Do you have any GI problems?–Not really. I do have some food allergies, though. MSG gives me freaky migraines. Peanuts and onions actually give me cold sores.
Other than the back pain, do you have any other joint pain?-- Every once in a while I get some knee pain, but it is very rare.
What supps do you currently take?–Multi vitamin, MSM, extra E.
What meds do you take?-- 200mg Zoloft. I have been prescribed clobetesol (sp?) and fluocinonide (sp?) for the condition. The clobetesol works well, but every time I cycle back onto the fluocinonide it flares back up.
Have you noticed if anything in particular causes it to flare up?–Not really. It comes and goes, but I have never coupled it with anything in particular.
Thanks again, I appreciate it.
This is question for next prime time:
I use tennis ball or foam roller I sometimes find painful part of the muscle.
Is this always a trigger point?
What if the painful part of muscles arises after a workout. For example I performed dips and noticed a tightness in chest - not a enough to disrupt workout (in muscle closer to insertion point). About two hours later I used a tennis ball to apply pressure to that point, is that acceptable?
What feeling am I looking for (the release) because whenever I apply pressure either direct for up 30 secs or oscillating, I never reach a point where the pain simply subsides.
Dr. Ryan, I have a question for you about my brothers back.The following is a brief synopsis of the events surrounding the onset of the pain and the results of his MRI exam. I felt a sharp pain when I stood up from sitting at a table in the break room at work on April 12th. I worked on the 13th and 14th being sore. I was off on the 15th. By 8 PM that night I could barely move. I went to work at 4 am on the 16th and was turned away at the door because I could barely move. I have been under a Dr’s care ever since 9 am on the 16th and have not worked since.The disc between L 4 and L 5 has shifted and is causing mild to moderate blockage of the spinal canal and impingement of the nerve bundles going into the right leg.
The disc between L 5 and S 1 has a very severe shift and is causing severe to extreme blockage of the spinal canal and impingement of the nerves going to the right leg.
Up until he had the MRI earlier this week he had been going to a Chiropractor for twice daily massages, with no relief. I do not know the kind of massage therapy. He has since been refered to a spinal surgeon for a consultation.
Thanks for your help. If you need more information let me know and I will get the answers from him. I know he is planning on getting several opinions before agreeing to surgery. If you think that you will be able to help him avoid surgery he may be able to make the trip to your office as he lives in Beaumont,although the 100 mile trip maybe too far for him.
Sammy,
All tender spots are not necessarily trigger points. Most trigger points have common locations within individual muscles and often will either refer or radiated pain in a certain pattern.
Most of the time when palpating or treating the trigger point, the pain does not completely go away, but it usually lessens. Often when the trigger point is associated with a taut band of tissue, you will feel a gradual release of tension.
Without seeing the area you are describing it is hard to tell if it is a trigger point or not. Usually some mild TrPt work followed by stretching won’t be a problem. If is is more of an acute injury even minor, you can ice it down following the treatment.
Obviously, regular DOMS should not be confused for a trigger point.
If you have any other questions please let me know.
Take care,
Ryan
Usually when considering surgery, a few criteria are usually considered.
- The severity of pain must be sufficient to severely restrict your daily activities and reduce your quality of life.
and/or
-
There needs to neurologic symptoms such as loss of reflexes,significant motor weakness, or lack of sensation.
-
Usually these symptoms have not responded to other conservative treatments.
Of these significant neurological findings are most significant, as the longer or more severe the nerves are injured, the less of a chance of complete recovery.
If you PM me I will give you the name of a neurosurgeon, he actually has a satellite office in Baytown I believe. He is very conservative and will not suggest surgery unless other treatments have failed.
If you have any other questions please ask.
Take care,
Ryan
Hey Doc, what do you think of those Barr’s with which you “massage” your muscle? You know, you roll it up and down the muscle as you roll up and down the floor in excruciating pain.
Also, do the Rockets have a chance against Dallas?
Thanks!
Adonail,
I’m not quite sure what you mean by tension in your VMO. Obviously you feel that the tension is some how negative and not a productive type of muscle tension.
There are plenty of exercises that will hit the VMO, terminal knee extensions are one.
You may want to PM Mike Robertson or Eric Cressey, as I think they may have done an article discussing some of these options. Also, I think Dave Tate did a recent article that included some of these exercises.
If you have any other questions, please let me know.
Take care,
Ryan
When can we expect stem cell research to be used and what purposes might it serve for injuries, muscles, etc?
-Get Lifted
I have a problem with my left knee I was hoping to get your feedback on.
There is lateral, deep knee pain. It is exacerbated during heavy flexion and extension exercises, during ascension / descension of stairs, but normal walking doesn’t seem to be an issue.
My left IT band is very tight compared to the right one. I have attempted some myofascial release with a foam roller while strengthening the VMO with leg extensions in a two up/one down pattern, and TKE’s.
There is also an issue regarding the knee at near full flexion, whether or not I have weight on my back. This is an issue because of Olympic weight lifting and Brazilian Jiu-jitsu, in which I find myself in this position often.
In the fully flexed position, I find that my gastroc seems to be folding over laterally on to something causing a tingling sensation in the popliteal area. I didn’t think the peroneal (common) nerve would be an issue, but that’s why I’m asking you.
Any thoughts to help me out? I’d love to hear your feedback.
Dave,
Do you mean the foam rolls like Mike and Eric talked about in their article?
If so, then they definitely can be used effectively to treat some myofascial problems. You just have to be careful not to put to much pressure over certain area. Just because it hurts doesn’t mean it is helping. I would suggest being careful over the mid-lower glutes as you don’t want to put a lot of pressure over the sciatic nerve.
Now if you mean a Barr that you roll around on the floor with, I wouldn’t recommend it as I don’t think it would be therapeutic for anyone but the Barr:)
Now the Rockets have a good chance if they realize that the games last 48 minutes and not 45 minutes. I haven’t seen so much choking since the Deepthroat marathon on the Spice channel.
Ryan
Hey Dr.
I’ve got a question. I think someone explained this to me before, but a long time ago and I have forgotten. Every once in a while I’ll be minding my business, sitting down, reading, watching TV, whatever. All of the sudden my heart will start racing and beating irregularly. Afterwards I’m scared and confused. It usually lasts about 10 seconds max. I haven’t had them in a while, but recently they started happening again. I’ve been having them since I was 15 and I’m 19 now. What’s the deal with this? What should I do?
Please help,
-poper
Get Lifted,
I am not the person to ask regarding a time line of stem cell research.
However, much research is being done with stem cells and spinal cord injuries. There is great potential, but honestly, I haven’t seen any specific timeline. I think they have been doing research related to muscular dystrophy as well.
Unfortunately, since the issue has become a political hotbed, I’m sure the process will progress at a slower rate.
Take care,
Ryan
With deep knee pain, I usually suggest that you get it evaluated by a sport’s med. specialist to rule out any intra-articular problems.
The popliteal area is a hotbed for nerves, arteries and veins. Full flexion could be crimping these structures and putting pressure on them, resulting in the symptoms you are experiencing. Sometimes a Baker’s cyst (fluid filled bursa like structure)is present in that area that can result in more pressure on the structures in that area.
A good sport med chiro with myofascial training could def. help. A good PT could also do it. If they don’t help then some imaging should be done and a referral to an ortho pending the imaging results.
If you have any other questions, please let me know.
Ryan