T Nation

Dr. Ryan- Prime Time 9/27-28


I'm ready for some questions.


In your chiropractic practice do you see alot of strength athletes / bodybuilders?

Also a general question about performance: Do you feel that someone who has problems (subluxations)but not pain can benefit from chiropractic?


I have two questions, the first is I have severe pain at my hips, and waist for 1 or two days after squating or dlifting. ANy ideas why?\
The next is a sharp pain directly behind my left shoulder near my shoulder blade. It hurts when I sit for a long time, or dlift / shrug?


Hey Dr. Ryan

Last month I asked you about my shoulder condition. I have gotten a MRI and seen an orthopedist last week. My doc said I have several problems. I have a tear of the superior labrum extending anteriorly. There is no evidence of a rotator cuff tear. He showed me where the superior labrum was: where the long head of the bicep tendon attaches. However, the pain is slightly behind that spot, under my acromian which leads me to believe the tear is under the supraspinatus.

2) There is a little inflamation in the shoulder joint. If it's constantly inflamed and if I live an active lifestyle, it will never get a chance to decrease inflammation.

3) I also have an os acromiole which may account for the constant clicking, grinding sounds whenver I raise my arm overhead.

He gave me a cortisone shot last Thurs, pain was temporarily relieved. Now the pain has returned. He has given me the option of surgery to resculpt the shoulder. The shoulder pain has first started with minor pain in Nov 2004, and has worsened to chronic dull pain since June 2005. Surgery sounds like the best option to me. What are your thoughts?



Doc, maybe you can help me out with this. My sister is a dance instructor, she has been dancing her whole life. She recently had a baby and has some extra body fat to lose. But before the baby she was having some back issues(I don't remember exactly what)she saw a chiropractor a few times and that seemed to solve the problem for the most part, it still bothers her from time to time but nothing she can't work through. Recently her ankles have begun to give her grief, no doubt from the extra weight she is carrying. I guess I'm asking if there are any preventative measures you can think of, nutritionally, physically, anything, to keep her from falling apart? I realise I'm being very vague, and it's hard for the most part to diagnose anything specific this way, just wondering if you had any ideas. I'm trying to get her to take some fish oil capsules(her diet is not exactly ideal, she eats like a normal person, like crap). Just curious I guess. Thanks for whatever you can offer.



I see quite a few pateints that workout regularly, although i see more patients that do not.

Yes you can definitely be helped by getting evaluated and treated even if you don't have pain. Many injuries that eventual become painful are caused by muscle imbalance, postural strain, etc. By getting evaluated, these problems can be detected and corrected with much less treatment than it would take to to fix once the problem became more severe.

I think most people who train should get regular massage and chiropractic care.

Take care,



Dr. Ryan.

I have an update for my heel bruise.

I can run on it now but am still careful and I can cut on it a lot more now. I'm ready to start squating and everything. However, I feel like there is a bit of it left still. The pad or whatever feels hard still and I want it to keep getting better so what can I do?


-Get Lifted


hi doctor. about 14 weeks ago i had surgery on a sports hernia on my left side and am currently just starting to jog and do light weight leg workouts,i am a discus thrower and really need the muscles involved with the hernia. what are some rehab exersises and warnings i should have. anything will help. thanks doctor ryan.



Well if it is not just bad delayed onset muscle soreness, then I would want to evaluate the low back and hip area to see what shows up. Obviously squats and deadlifts place a severe load on the low back and glute region and problems can be related to a myofascial strain, joint irritation, or disc problem.

If it has been on-going, I would suggest finding a good sports med based chiro or PT that can perform a good evaluation to see if they can identify the problem.

Also, have someone watch you perform the exercises to make sure that there is not any kind of breakdown in your form. Losing the low back lordotic curve during the lift increases your risk of low back injury. If it is found to be a problem during your lifts, you may have to back the weight down and try to groove the proper motor pattern. If you can not get into the proper position, then you would need to determine what is restricting the motion and stretch any tight muscles and strengthen any weak ones.

Take care,



G'day Doc

One question for u today.

Ive noticed a mole on my front deltoid that looks like a melanoma.Now it is red in colour only a spec of black in the middle.Now its less than 1cm in length or width.It has stayed the same size for 1-2 years maybe longer.

Would u advise that i get it checked out.
Now i dont have fair skin or red or blonde hair,live in a cold climate,sunburn is limited because ive always got a shirt on even though i live in the sunburnt country.Now the feral thing is i have black hairs growing on this mole,usually i just pull them out ,no hassles there.I always assumed that moles that grew hair were usually birth marks?

Anyway your advise would be much appreciated.

Thanks Doc




Sorry, I forgot to comment on the shoulder issue. I'm not sure if you are talking about the area of the shoulder blade that is closer to the spine or the part that is more lateral, below the actual shoulder joint.

If you are talking about the medial portion, it could be related to the traps or levator scapulae muscles that attach in that area. Also some of the splenius muscles, serratus posterior superior and even rhomboids should be evaluated.

The lateral tissues would involve the teres group, infra/spraspinatus, lats etc.

You could have it checked by the same person as your other problem.

Take care,



Dr. Ryan or anyone else with any knowledge in this area. Last week I came down with a fever and excruciation pains in my side. To make a long story short, after blood work and an ultra sound and cat-scan I was diagnosed with pancreatitis. The doctor felt it was from alcohol abuse (which I'm sometimes guilty of) but it had been a while since I had a drink before the attack. Also the cat scan showed no present or prior damage to the pancreas from alcohol.

The only other thing I can think of is that I started a cycle of Superdrol 5 days before the attck. Could this have cause it? Also do you know what things or supplements that can aggravate it that I should stay away from?


Dr. Ryan;

Two weeks ago, I hypextended my elbow hitting a heavy bag - I caught a sink hole and the bag pulled my arm to full extension before I could start a proper snapping motion.

Last week, after I had done a week's worth of ice/heat, massage, stretching, and rest, I was lifting. I did every lift involving my elbow with ease. Then, I'm doing triceps pressdowns with a V-Bar. All of a sudden, I get a "balling" sensation in the triceps of the hypextended arm (interior side, about a solid inch back from the elbow joint) as well as some immediate soreness in the brachioradialis and the muscle/tendon following from the knot in my triceps.

So, since last Monday, I've been doing light stretching of the arm (letting it lay out fully extended), as well as ice and heat, massage, and hypnosis. One thing I notice is extreme stiffness on the biceps side of the elbow if I let my arm lay out for 10 or so minutes (this occurs in the dead center of the elbow).

I've elected to take a few weeks off from lifting and karate, and will focus on therapy stuffs.

My questions:

what does it sound like I did, aside from something stupid?

what's going to be the best way to get this recovered?



I got your PM and was planning on responding tonight.

Sounds like you have a SLAP lesion, Superior Labrum torn Anterior to Posterior. It is a relatively common injury. A lot of throwing athletes get this type of injury.

Usually the decision for surgery involves several factors. One, you indicated that the problem has gotten progressively worse and has been relatively long-standing. Second, while it responded to the injection, the relief was very short-lived. Third, usually involves your response to therapy and RH. If it does not help then surgery is the next step.

Lastly, the problem should be causing either enough pain or limitation to your daily activities to warrant the procedure.

From what you have said, it sound like the problem has gotten to the point where surgery may be the best option for you. Fortunately from what you have said, it doesn't sound like there is a significant rotator cuff problem, which is a good thing. However, when the doc is doing surgery with the arthroscope, he/she will evaluate all the structures and clean up any other problem they might find.

Keep me posted.

Take care,



Dr. Ryan,
I have allergies to grass and tree, for which I'm taking 10mg zyrtec-D once a day. But for the first time, 2 days ago, I have fluid inside of my ear, which has really muffled that ear. I haven't been to the doctor but I did try to sleep on my side and put a heating pad up to my ear, to see if it was just in my outer ear, but it didn't help. I was recommended by a friend to try some nose spray and clear my sineses, he said some tube was swelled up. What is the best way to fix this problem?


Dear Dr. Ryan,

Thanks for your response. I agree, the pain has gotten worse, to the point I can't carry a bookbag (double-strap.) Normally, people hang the straps off the ends of their clavicles (the crease between pec & anterior delt.) I have to use the sternum strap (common in North Face bags) to pull the two straps together so the straps cross my upper traps and down my pecs. Get the picture?

Also, I used to feel pain when only AFTER I pressed. Now I feel pain DURING rows (when the weight is fully lowered.) That makes sense since SLAP tears are also caused by traction as well as overhead. I'm not a thrower athlete, but I have done TONS of overhead presses and widegrip chins (PR of 35 dead-hang chins.)

Anyway, thanks alot for the advice. I will keep you posted. I will have more questions when the surgery date approaches.



high doc regarding shoulders I seem to experianse a similiar problem with a popping in my shoulder especially when doing an overhead press so obviously i have to avoid them. Effects both shoulders but the left more than the right.Noow the bad part does this sound like possible cuff damage or hopefully something else. for reference. age 40 weight 218 6 ft 1 work out three days a week religously and am employed as a carpenter so needless to say pretty active.


next time I should proof read lol.



Well, obviously losing the weight should help.

How long ago did she have the baby? In the later phase of pregnancy, her body releases a hormone called relaxin, which actually allows ligaments to become more flexible. This allows the pelvis to spread apart to facilitate delivery. However, it can make the joints temporarily less stable. After delivery, the ligaments gradually tighten back up. Since I don't know how long postpartum she is, I don't know if this could be a contributing factor or not.

If she is back to dancing, she may want to tape her ankles temporarily until her ligaments regain full stability and she has a chance to get the rest of the weight off. Also, she should ice them down after dance or prolonged weight-bearing.

She could do some non-weight bearing exercise like swimming or bike riding to help with weight loss. It would help to reduce the strain on her ankles.

Your suggestion for fish-oil may help to mediate inflammation.

Also, some ankle stability exercises like one-leg standing or balance board training could help.

Let me know if you have any other questions.

Take care,



Get lifted,

I'm glad you are doing better.

Massage would be fine.

Ice after practice.

Take care,