Doc, what are your thoughts on Stu McGill’s work?
His lab was right below mine at Waterloo, which made for some interesting conversation when our water tank overflowed…
Hey Dr. Ryan. I’m 6 foot 2 inches, 295 pounds and 23 years old. I have about 27% bodyfat and a very large body frame. About a year ago I weighed 450 pounds. After I lost the weight my resting heart rate went from 89 to 55. I had my blood tested recently as well and I am 100% metabolically normal.
I just started adding weight training about 2 months ago and I’ve already been making some nice gains. However, I haven’t started doing squats or deadlifts yet because of a concern for my knees. For some reason my knees still make strange sounds when I bend my legs. It’s kind of a grinding sound but there’s no pain at all. I can easily do body weight squats with no pain but sometimes the sounds my knees make kind of scare me. I kind of get a mental image of my bones grinding together because the cartiledge is all scraped away from my years of being morbidly obese.
Is this something I should even be concerned with? Or should I start slowly incorporating squats and deadlifts and stop only when I feel pain?
marcus,
Well, personally, I can’t carry the bar high on my back because with any significant weight it either grinds into my vertebral prominence (the spinous process of either C7 or T1 depending on the person) or compresses my traps to the point that it hurts like hell (go ahead, call me a pussy). Therefore, I carry the bar a little lower, in the groove across the posterior delts.
When I want to perform high bar type squats, I use a Manta Ray and it completely eliminates the problems I listed above.
Now, for people who don’t have the problems I listed, and who can carry the bar comfortably without it sitting on a cerical vertebra, I don’t think it will cause a serious problem. The problems would arise if the bar rests on the cervical spine vertebra to any significant degree or if the person flexes the neck and lets the shoulders round forward to the point that the weight starts to ride up and place a lot of pressure across the C-spine. The cervical spine, by design, isn’t constructed to be a major weight bearing structure.
I try to assess exercises from a risk/benefit perspective, based on the needs of the individual.
Let me know if you have any follow up questions.
Take care,
Ryan
Dave (aka Barrbarella),
From what I’ve read, I think highly of his work. His books, Low Back Disorders and Ultimate Back Fitness and Performance, should be required reading for anyone in the low back pain field.
Other than flooding his lab, do you have any personal experience with him?
So, how long are you in Boston for? Seems like you always manage to stay one step ahead of INS.
Take care,
Ryan
Hey Doc,
Yesterday I had my first PT session. The therapist found I had a lack of motor control of my transversus. He also put me in this posture where I was down on my arms and knees. He had me lift the right knee straight up and that worked fine. I tried that with my left knee and could barely budge. He stated that made perfect sense since I had a L5-S1 injury. He stated that I had some muscles that were going to have to be reeducated.
Based on this can you add or suggest anything?
Spad,
Well, congrats on the progress to this point.
Now, regarding the grinding sound, the fact that it is not associated with pain is a good sign. It may be related to patellar tracking and retropatellar cartilage issues. There are stretches and exercises that can be done to help improve tracking.
If you are concerned, you could get weight-bearing knee x-rays done to give you an idea of how much joint space remains and whether the patella is tracking off center. However, if there was significant joint issues, you would have pain.
I think you should be able to add in squats and deadlifts without causing a problem.
Keep me posted.
Take care,
Ryan
You’re a pussy.
[quote]Dr. Ryan wrote:
I can’t carry the bar high on my back because with any significant weight it either grinds into my vertebral prominence or compresses my traps to the point that it hurts like hell (go ahead, call me a pussy). Ryan[/quote]
My involvement with Stu McGill has been limited, but there’s an interesting anecdote about how we met. I’ll share that one at the Staley seminar this October.
I’m in Boston for a couple of weeks but need to head back and defend my masters thesis (finally).
Thanks for your input about the books!
[quote]Dr. Ryan wrote:
Dave (aka Barrbarella),
From what I’ve read, I think highly of his work. His books, Low Back Disorders and Ultimate Back Fitness and Performance, should be required reading for anyone in the low back pain field.
Other than flooding his lab, do you have any personal experience with him?
So, how long are you in Boston for? Seems like you always manage to stay one step ahead of INS.
Take care,
Ryan[/quote]
Phoenix Rising,
If you are interested in learning about low back injuries and RH, I would suggest you get the book, Ultimate Back Fitness and Performance by Stuart McGill. Not only will you come away with a good RH program, you will know more about the low back than most docs.
Let me know if you have any other questions.
Take care,
Ryan
WhiteLable,
Well let’s see if I can answer your questions.
What hurts so bad? Your jaw?
Why? Because you got hit there playing steal the bacon.
Sorry, I couldn’t resist. By saying that it’s OK, your trainer basically means he doesn’t think you broke anything. That doesn’t mean that you didn’t hurt anything.
Other than bruising of the tissues where you got hit, depending on the mechanics of the injury, you could have strained some of the muscles or sprain/irritation of the TMJ. Regardless, you want to control the inflammatory reaction. Ice the area for 10-15 minutes every couple hours for the next 2-3 days. Usually the first 24-72 hours after an injury are the worst.
Let me know how it responds, and if it doesn’t start to improve or it gets significantly worse, get it checked out.
Take care,
Ryan
Well, I guess it is true what they say, it takes one to know one.
[quote]David Barr wrote:
You’re a pussy.
Dr. Ryan wrote:
I can’t carry the bar high on my back because with any significant weight it either grinds into my vertebral prominence or compresses my traps to the point that it hurts like hell (go ahead, call me a pussy). Ryan
[/quote]
[quote]Dr. Ryan wrote:
DA MAN,
Well the ‘decompression system’ you are talking about is a proprietary unit. However, there are many different types of axial traction tables that can perform the same basic procedure. Any doc with an axial traction table can place you in the same position and put a lumbar roll under your low back prior to starting the traction. Usually these machines have variable control settings that can either provide constant or intermittent traction. This therapy can be useful for disc injuries and nerve compression.
The seated back extension that they use to strengthen the muscles could, in certain circumstances, aggravate an injury as there is greater disc pressure with sitting.
I would check around your area for a doc that has an axial traction table (these are different than the inversion type traction tables) and can get you on a good lumbar spine rehab program.
I would also suggest that you get the book Ultimate Back Fitness and Performance by Stuart McGill. It will give you an excellent RH program as well as a great education on back injuries.
Regarding inversion tables, they can safely be used to decompress the spine in some people, but I wouldn’t recommend them for everyone. If you are healthy and don’t have any significant cardiovascular issues you can get some relief. However, if used improperly you could potentially aggravated your condition. If you get one, get one where you can stop the table at different degrees of inversion. Going from straight up to upside down would most likely create too much of a traction force.
Let me know if you have any follow up questions.
Take care,
Ryan
[/quote]
Yo Doc
Thanks a million for your time. I have been poking around the web- which can be dangerous- and found quite a few home versions that can supply 150-200lb of pull. Do you have any opinion on these devices?
Since I have no idea what doctors my insurance will cover- It kicks in the very first day I start at GE, tell me that doesnt rule!- I cant really tell if there are any covered docs in my area. Like I said before, the only ones that do the axial decompression with the VAX-D is 100+ miles away and only open 8-5.
So I was lookin at home versions… I have McGills Ultimate back book and am reading it w/ his low back disorders on the way, so I am learning as much as i can concerning my spine and back musculature.
I am doing really well w/ basic motor drills for the glutes, but my left side- the side of the disc herniation- started to spasm this tuesday and has been freaking out on me ever since. It isnt my back, per se, but more my glute and hamstring. I do not know if it is the compression on my nerve root or a muscular issue, though.
So I am backing off and upping the meds- which makes me angry. I am doing trigger point multiple times a day, doing SMR daily and stretching. The rehab doesnt bother me, I would just like to hit every possible base I can to try to get this thing resolved.
I read about the decompression therapy and how it can create a true negative pressure in the disc, and that seemed like a dream come true. well, I will stop babbling like a love struck school girl now… Thanks again for all your help and patience through this entire thing. Have a good one.
x-rays have just exposed fairly extensive osteo-arthritis below both knee caps and lateral side if the knee.
My pain.especially at night can be severe.
His main suggestion… glucosamine… which I just recieved in liquid form (syn-flex).
Any other immediate suggestions?
To what extent does exercising (moderate squatting etc) exacerbate the arthritis?
Thank you