T Nation

Dr. Ryan Prime-Time 10/11-12

Alright, I’m ready for some questions.

Also, I’m getting pumped up about the Staley Bootcamp this weekend. If you are going, feel free to send me a PM with your contact info.


Hi Doc,

Good to see you are pumped up for the bootcamp!

I have gone and wrecked my back. I was doing some squats last week and I felt a tearing sensation in my lower back down near my hips, just to the left of my spine. It didn’t hurt immediately, but an hour later I was in bed with sharp stabbing pains. I couldn’t get out of bed the next day. Even rolling over in bed hurt!!

The stabbing pains have subsided into a dull ache now (6 days after the incident). My hamstring and glute flexibility is up the shit. I used to be able to place my palms flat on the floor while keeping my legs straight. Now I can touch mid-shin with my finger tips.

Foam rolling on my glutes and hammies gives me immediate, but short lived relief. For about 2 minutes, it’s like nothing happenned. Then the dull ache starts again.

I have an appointment with a GP later this week to get an MRI referral. Is there anything I should be doing until I can get some concrete info through the MRI?

Thanks for your time.

Damn, I’m getting off easy tonight. That gives me some time to troll around and harass Dave Barr. Excellent!


Welcome to the club. I hurt my back about three weeks ago doing squats as well. Then I irritated it more last week moving an adjusting table. It is starting to get better. Just my luck I would hurt it right before going to a training bootcamp.

Regarding your injury, definitely use ice 15-20 min every few hours. Using some NSAIDs for 5-7 days should help with inflammation as well.

Do you have a history of disc injury? An MRI isn’t a bad idea, however, unless you have a history of prior injury or you have neurologic findings or incapacitating pain, they may have you try some conservative treatment for a couple weeks prior to doing the test.

I would find a good chiro or PT in your area that can assess you and provide some treatment. Depending on how your back responds to movement and loading, bending forward at the waist as you describe (trying to touch your toes) could be an aggravating factor.

Try to stay active, but avoid any activities that reproduce your symptoms.

What movements, positions, postures or activities seem to give you the most problem right now?

Take care,


You too? This is one of my favorite activities!

[quote]Dr. Ryan wrote:
Damn, I’m getting off easy tonight. That gives me some time to troll around and harass Dave Barr. Excellent![/quote]


I almost feel bad about it. He is such an easy target.

Actually, I need to be nice for at least a few days, he is letting me crash with him on Thursday night in Phoenix.

I hope all is well with you.

Take care,


[quote]Dr. Ryan wrote:
What movements, positions, postures or activities seem to give you the most problem right now?

Take care,



I ruptured my L5-S1 about 10 years ago. I couldn’t even walk properly for about 18 months after I did that, and had severe sciatic pain.

Basically, sitting annoys it at the moment. When I stand up, it feels stiff and sore for about a minute, then it loosens up. Anything where I round my back is generally bad at the moment, even without weight on it. I can bend at the waist with no problem, rounding the back = ouch. Rotation to the left is also tight, but feels more like a stretch than “bad” pain.

I am keeping active. Last night I did some stretching after gym, and did some reverse hypers with no weight just to get some movement going. That didn’t aggrevate it, so I’m telling myself that is a good thing.

It’s funny. When I first did this, I thought is felt more like a muscular injury. Now I’m not so sure, hence the getting the MRI.

Dr. Ryan wrote:
Get Lifted,

I’m glad your heel is doing well.

With a grade 1 sprain, the ligaments are still grossly intact. There are some torn fibers but the joint still has stability.

In an acute situation ice the joint for 15 minutes every couple of hours for atleast 3 days. You can also use NSAID’s for 5-7 days. Avoid exercises that distract the shoulder or place strain on the AC joint(shrugs, deadlifts, bench press, flyes, etc). Some people will use a sling to take pressure off the joint to allow the tissues as chance to heal.

In a grade 1 sprain, there really shouldn’t be much disruption of the joint planes. There is an adjustment you can do to the AC joint to help with the problem.

Let me know how you are doing.

Take care,


This is for next week.

This injury is from last year but I was curious if they can do anything after football is done. Done in the sense that if I don’t get picked up after college in the combine, done.

I got one of those bumps on the top of the shoulder so it might be a grade 2. I have full strength and it doesn’t really bother me unless I sleep on it wrong than it feels stiff. I was just curious if it is worth doing anything for it.

I don’t know what the protocol is but was curious. I think it is a grade 1 because I have not lost much mobility except for a slight feeling of my shoulder being more pulled forward than my right shoulder and some “pressure” when I bench heavy or press heavy. I’m going to see a sports doctor after this season from the team and just want to be informed so I can discuss it with him intelligently.

If you can look at these pictures you may be able to somewhat see it. This is before the program http://www.t-nation.com/readTopic.do?id=617026 which may give a better view . It is my left shoulder.

-Get Lifted


Do you have the films from the old injury?

If so, you would want to compare them to any new films that you might get.

Your symptoms could be disc related, but also squats place a pretty good load on the thoracolumbar fascia, erectors, lumbosacral ligaments and facet joints. The fact that you don’t seem to have any leg symptoms is a good sign, especially considering your past history.

I would get see a chiro or Pt that could do a good eval and provide some treatment and give you some advice on what/what not to do based on their findings.

I would recommend that you use a towel roll behind your lumbar lordosis when you sit. This helps to decrease some of the strain that sitting places on the low back.

Also, check out the Ultimate Back Fitness and Performance book by Stuart McGill, if you haven’t already read it.

Keep me posted.

Take care,


Dr. Ryan-

I practice BJJ. Several weeks ago my left knee was put into a knee bar and hyperextended in a fairly violent manner. It hurt at the time, but then faded.

I experienced a mild pain when walking that grew over the weeks. It passed the two week test so I had it checked out.

It has been diagnosed as a Quadricep tear near the insertion to the knee. It feels fine now except at full extension and mildly painful to the touch. I start rehab this week, but was wondering if some light training would be ok. I can get into the squat position and can do a SLDL type movement without pain. I even lifted some things at work.




Where is your pain located?

By hyperextended do you mean your leg was straight and it was forced to extend past the normal point, or that your heel was forced toward your glutes violently?

I would never try to diagnose you without an exam, but if your leg was straight, I don’t understand how you would have strained a quad.

Where is your pain located and what movements or positions seem to aggravate it?

What kind of symptoms are you currently having?

Any history of previous knee injury?

Take care,


Get Lifted,

Regarding your shoulder, I would suggest that you get it checked out by a chiropractor that specializes in sports injuries. He/she should be able to evaluate your AC joint and provide the appropriate therapy. I wouldn’t imagine that it would be too extensive.

If you want to get more information about AC joint sprains, just do a Google search. There are some good web-sites that will have more information than you could ever want.

If you have any questions about any of the sites/articles etc., please let me know.

Also, if you get pain in that shoulder from sleeping on your side, try using a modified side sleeping position. You will need a couple of extra pillows. Place one pillow between your knees (this prevents your pelvis from twisting). Put the other pillow snuggly behind your back and then roll back slightly onto the pillow. This should help to take pressure off the ‘down’ shoulder and the upper arm will rest against your side. If the 'top shoulder should want to flop across the front of the body, then hug around another pillow. I have used this successfully in many patients whose shoulders were aggravated by sleeping on their sides.

Take care,

Where do you play football?

Take care,


Yeah, I already checked out some sites actually. This being the best one I found:

Pretty cool website actually. Why would i go to a chiropractor instead of getting x-rays or an mri?

-Get Lifted

Get Lifted,

A chiro can take X-rays and order an MRI. In addition they will perform a full evaluation of the joint and can provide some treatment.

If the X-rays or MRI should reveal a problem that needs an orthopedic consult, the chiro can make the appropriate referral.

Take care,


Dr. Ryan,

I have been a gymnast for 20 years, competing for about 16. During this time, I have had numerous surgeries and injuries; two of them being ulna shortening surgeries, one on each arm. I have a four-inch plate and about 6 or 7 screws in each arm. One was done about 6 years ago (after my senior year in high school) and the other done about 4 years ago (after sophomore year in college).

While these surgeries fixed what they intended to do, they have given me some other problems. I have been able to manage and deal with the compressive forces due to support-type skills through building up a good work capacity and pain tolerance, however I feel my wrist strength has continually limited some things. By wrist strength, I mean the ability to effectively transfer power from my arms to my hands or maintain tension across the wrist joint, which is critical in gymnastics. While this isn?t a significant weakness, I feel it?s definitely not as strong as it could be, or how it was before the surgeries, and that it could be limiting my overall strength and skill development.

The option to have the plates taken out has always been there if the plates cause problems, but I guess I wasn?t sure what was meant by ?problems?. Do you think the hardware in my arms could be affecting my wrist strength? Could my wrist strength improve if the plates were removed? Or, should I put a strong emphasis on trying to bring up my grip and wrist strength? Thanks for your time.



Unfortunately there is know way for me to give you the answers you aare looking for.

Since I don’t know where the plates are placed and the orientation of the screws, etc. it would be impossible to say what roll they are playing in your problem.

The best thing you can do is contact the doctor who treated you and performed the surgery. He/she would be the most qualified to address those questions. They should perform an exam and request diagnostic tests if need be.

If they are able to determine that the hardware is not causing your problem then we can address the strength and stability issues.

Keep me posted.

Take care,


Dr. Ryan,

Thank you for previous advice regarding my problem with numbness in my arms. I haven’t followed up yet with my HMO since the problem seems to have disappeared for now.

I now have a second problem for you. Last week I was doing heavy eccentric work for my arms and I seem to have strained my right wrist. I supersetted CT’s clean-reverse curl & close grip press-skullcrusher with a barbell.

I now have a sharp pain on the little finger side of my wrist whenever I supinate or pronate my wrist. No pain when my palm is pronated and doing a wrist extension/flexion motion. Minor pain when my palm is neutral and flexing/extending. Major pain if my palm is supinated and flexing/extending in a wrist curl motion.

Any suggestions on speeding up the healing process?

I received the Accelerated Sports Healing Hypnosis CD as part of the last Gear article & I’ve been trying that as well.

Thank you for your time!

Dr. Ryan,

After my first day back to football, there is now a large patch of skin missing from my foot. it is very painful and getting bigger.

It is about 2 inches directly below my big toe. It is all red and very soft.

Any ideas on how to stop it from growing and to help the skin grow back?

So far I have just put a band aid over it and taped on the band aid so it would not move. IT didnt help that much but made a little difference

I gotta ? about natural hormone levels. In the mags, they say that high test levels decrease cortisol and cortisol is catabolic. Then, they say that test and cortisol are both highest when you make up in the morning. How is that possible when high test supposedly decreases cortisol and vise versa?