T Nation

Dr. Ryan-Prime Time 6/27-6/28


I'm ready for some questions.


what kind of doctor are you


just a few weeks ago my ankle started to hurt. it still does whenever i run, deadlift, squat, or stand on one foot. it is also very painful to stretch my ankle inwards. (like sideways so the bottom of my foot is facing up) any idea of what is wrong? i also cannot rotate my ankle with out it hurting alot. it is my right one.


The following is from a post several months ago when Prime-Time started, but it should answer your question.

Well I'm not really a doctor, but I did stay at a Holiday Inn Express last night...

Seriously, I have a BS degree in Exercise Science from The Ohio State University and did an internship in the Exercise Physiology/Fitness program at NASA's LBJ Space Center in Houston.

I graduated Summa Cum Laude and received my Doctor of Chiropractic degree from Texas Chiropractic College in 2000. I did an orthopedic surgery rotation through the Baylor Sports Medicine Institute with Dr. Bill Bryan, one of the Houston Astros physicians.

I've taken 1 year of diplomate level Clinical Nutrition coursework.

I've served as an on-site doctor as well as sports nutrition/medicine advisor for the USA Fit marathon training programs (I know marathons, ugh)

I am currently practicing in Kingwood, TX a suburb of Houston.

That is my background, please feel free to ask me any questions, particularly regarding injuries, rehab, clinical nutrition.

I have been training for about 14 years now. I am 5' 10" weigh 195 at about 8-9% bodyfat.



Where is the pain located?

Was the onset of symptoms associated with any kind of trauma or any change in your workout or daily routine?

By bending your ankle inward, do you mean the bottom of the foot faces inward (inversion) or that the bottom of the foot faces outward (eversion)and the actual ankle goes inward?

Also, do you have any history of prior injury to the ankle/foot? What about your foot structure (high/normal/flat arches)?

Any additional information would be helpful.

Take care,



What are your favourite recovery strategies?

Anything you do out of the norm?


Pat Battaglia



Well, I take Surge prior to and during my workout and then use Powerdrive post-workout to help with CNS recovery. Based on Dave Barr's article on post-workout nutrition, I used the Power Drive shortly after my workout and then wait another 30-45 minutes to take a serving of Surge.

I take ZMA at night as I have found it helps with sleep quality. I usually take it about 1 hour before going to sleep and then take some Low-Carb Grow! with 3 grams of fish oil right before bed.

I have found that if I have significant DOMS from workouts, that some active recovery like light cardio/exer followed by some light stretching helps significantly.

If you have a problem area, some ice massage immediately post-workout can help to reduce pain/inflammation. I know Charles Staley suggests ice massage following some of his EDT workouts.

Also, do a search of CT's articles, he did one earlier this year on some different recovery strategies.

I also recommend getting regular massage, and chiropractic care as part of a total program.

Let me know if you have any follow-up questions.

Take care,



The pain is located right above the lateral malleolus i think its called, on the outside of my ankle.

About a month ago i took a 2 week break. when i got back into lifting, right after i deadlifted it started to hurt. i went on and did squats, then ran on it. i have been lifting on it for the last couple weeks but its starting to hurt too much.

When i said inward, i meant inversion

About 7 years ago i had broken this ankle

I am 5'6, and on vacation i gained 10lbs so am now 160


Doc, you mentioned that you worked for NASA at JSC. What did you learn while you were there?



I learned that unlike you, I didn't have to have an escort when I took a piss. That is just a little joke we like to play on the Canadians. I hope you enjoyed it.

One funny story. When I first started there, I remember a guy came to the office and asked us if it would be safe for him to run in the cold weather. It was 50 degrees. Having just moved down form Ohio to do the internship, I just stood there with a deer caught-in-the-headlights look on my face wondering if he was serious or joking. Unfortunately, he was serious.

Also, I learned that if you lead a class of middle-aged people in a warm-up that consists of crunches, and the room is quiet, inevitably one lady will let out an audible fart, which serves to intensify your ab contraction as you try not to laugh out loud.

Take care,




Is the pain over the bone or is it in the soft tissue above and behind it? The peroneal tendons pass across that area. Whether or not you have some kind of tendinitis or local muscle irritation would have to be ruled out.

What kind of treatment providers do you have available to you?

Take care,



nice, an OSU graduate....GO BUCKS!!

BIG game Sept. 10 ya know....I hope living in Texas doesn't present any sort of conflict of interest for you:-).


Thanks for the response. So I guess the tried and tested stuff is used by most everyone eh?

With the Power Drive post workout, I started mixing my creatine in with it. Will any of the ingriedients in the PD affect the creatine absorbtion? Also, I recently started taking Hydrogen Peroxide baths, only maybe once a week or so. Have you experimented with any bio-oxidative therapy at all?

On the same lines as Chiro adjustments, what are you thoughts on something I believe is called "The activator" The D.C. I go too barley uses one, but some friends parents of mine see another Chiro who only uses it and not hands on adjusting. They know I am thinking of applying to Chriopratic college and as such ask my opinion. I have talked to my D.C. about it but I am interested in your thoughts.

Have a nice night,

Pat Battaglia


Hey Doc,

I have lower lumbar issues going on. Heres a brief description of the problem. I know you dont have a MRI to go by but if you could make so helpful sugestions I would greatly appreciate it.

L1,L2 are degerative
L4,L5 small herniation not protruding
L5-S1 small herniation protruding touching the nerve causing sciatica

I went to Emory Spinal Clinic last week had an epiderial.

I first tried going to a chiropractor 3x a week that did ART sometimes. This time didnt help the problem.

Am I screwed ??? Is my hopes for competive bodybuilding over?


Hey Doc! How ya doin? I was wondering if you knew of any website or article here that had a good picture of neutral spine while standing. Icing on the cake would be proper posture while sitting.

I have done some searching on the interweb and even gotten some biomechanics books to try to figure it out, but they all seem to disagree w/ each other. Thanks a million.

ps- those damn texans dont know what cold is.



No conflict of interest. 100% Buckeye!

I'm looking forward to the big game. I haven't had a chance to break out the Buckeye jersey and necklace since I watched us own Ok. St. in the Alamo bowl. (My wife went to Ok St., it was a glorious game indeed)

Take care,




I don't think the creatine would be a problem. I know that you want to avoid other amino acids that might compete with the absorption/transport of the tyrosine.

I don't think creatine would compete with the tyrosine. You may want to ask Dave or Lonnie if they have seen any reports of this in the studies they've seen.

Regarding hydrogen peroxide baths, I can't say that I have seen any info about them. However, the Epson salt baths can have a muscle relaxation effect.

The "Activator" ,in my opinion, can be utilized effectively in certain patients. However, if it is used as a stand alone procedure in all patients, I just don't see how it can be effective. There is no way you can convince me that it will adjust a low back in a very large person. I think they have more use for necks and the thoracic spine or in osteoporotic patients who may not tolerate a manual adjustment as well. Some patients who can not relax or tend to tighten up during a manual adjustment may also be candidates for the Activator.

Let me know if you have any other questions.

Take care,



Hey Dr. Ryan, few questions I have posed to others and was wondering about your take.

1) What is your opinion on Glucosamine/MSM for PREHAB purposes and not to just treat existing injuries?

2) Why does one feel physically sick after a deep tissue massage? I have been told that it is because the massage drives toxins out of the muscles but I never totally bought into this.

3) How important do you think rest weeks/deload weeks are when it comes to weight training? How often do you believe they should be taken?


Phoenix Rising,

First, no you are not screwed.

Second, you can continue your quest for body-building. Ronnie Coleman had a herniated disc a couple years ago.

Third, you will have to learn about how your back works and how to limit strain on it while you rehab it and return to normal training.

The best thing I could do is to suggest that you get the book Ultimate Back Fitness and Performance by Stuart McGill. It will be your new best friend. Once you have read it, you should have a pretty good road map for rehab.

Then I would suggest searching T-Nation for some of the articles by Mike Robertson, Eric Cressey and Ian King. The Get Your Butt in Gear article series will provide you some info and exercises that will help you progress from some of the rehab exericses to more strenuous training. Not all the exercises may be right for you, but after reading the book, you should have a pretty good idea which ones to avoid.

If you have any questions as you read the book, please feel free to ask. I'll be glad to help you any way I can.

Take care,




The link below gives some basic info, but the pictures are just low quality drawings. I'll have to search a little more for some good quality pictures or photos. You may want to ask Eric or Mike if any of the articles they have on T-Nation have posture pictures. I know the Neanderthal No More series focuses on postural issues, but I don't remember if it had photos of correct and incorrect posture types.


Take care,