T Nation

Dr. Ryan- Prime Time


Better late than never. Sorry, I got stuck in a meeting that lasted much much longer than I expected.

Please post your questions and I will answer them during the day tomorrow and I will extend my Thurs PT an extra hour.



Already aked MR in his Knee Pain Thread about this, he referred me to you:

I recently had issues with my right knee , thought I tore my menisci medialis but MR diagnosed an ulcerative chondral defect (retropatellar).
(Felt like a little marble comming out right next to the patella - kept comming and going, now that I paused my leg routine, I got no probs at all)

I'm supposed to see my orthopaedist in a few days.

You got any infos on that kind of diagnostic findings. Any implications on my future training?



On Monday i was doing a barbell shoulder press and on the second set, fourth rep or so, my left hand immediately went numb and the numbness shot down through my arm. I had to rack the weight, and after 10 seconds i grinded out the last rep (though the reason of discomfort was not muscle tiredness, but the pain coming from the webbing between my thumb and index finger)

at first i thought it was the "pressure point" that most people know about for relieving stress. and it well could be, but i am not so sure because it is not in the same place...


Good Dr,
How are you? I have been having a pain in my mid back for about five months now and it will not go away. I thought it was my rhomboid and I hard ART done, but it was only a short fix and not a very good one. I do not actually know if it is my rhomboid, but it is in my mid back between my left shoulder blade and my spine. The sensation is not a sharp or aching pain, but more like a burning sensation.

It really bothers me after I squat and after any back work. I know it is hard to diagnose over the net, but what do you think it could be? I know one thing for sure, I can't relieve the pain by stretching. The only thing that works is ice and that only helps for a little while. Any help would be appreciated.



Dr. Ryan,

I have been suffering from shoulder pain for about two months now. The pain is in the front of my right shoulder. I can't do chin ups, pull ups, and the bench press.. forget about it. It is also usually aggravated when I sleep on it as well.

I have been following the Neandrathal No More routine for three weeks, and my shoulder pain has improved a bit. Still, I feel that I should be completely healed by now.

Do you have any suggestions? Thanks in advance.



I've not heard of an ulcerative chondral defect. Do you mean osteochondral decect?

Retropatellar chondral problems i.e chondromalacia patella are quite common. May be there is a difference in terminology where you are located.

If you could clarify a little, that would help, as chondromalcia and an osteochondral defect are two different things.

I'll be glad to help once you fill me in a little more.

Take care,




Sounds like you might of had some kind of nerve impingement or tension. I would want to evaluate the cervical spine versus the thoracic outlet to see exactly where the problem is coming from.

What kind of symptoms are you having now? What movement/positions etc, either worsen or relieve your symptoms?

The position you were in could have just caused some transient compression or stretch of the nerve and may not result in much residual problem.

Let me know how you are doing and I'll try to help you as best I can.

Take care,




Other than the ART, what kind of treatment have you had?

The area of your problem contains many different structures that could be pain generators.

In addition to the rhomboids, you have the mid-traps, thoracic paraspinals and several different intersegmental muscle groups. Also, you have the thoracic spine facet joints, costovertebral and costotranverse joints. While thoracic spine disc problems are not as common as lumbar spine disc problems, this would be something else to try to rule out.

Any of these structures could potentially produce pain in that area.

You should look for a good chiropractor in your area. One that deals with athletes and can address the joint problems as well as the myofascial problems.

Often pain between the shoulder blades can be related to having rounded shoulder posture especially if your daily activities require a lot of flexion dominant positions.

After you get checked out, I would suggest to look at Mike Robertson's and Eric Cressey's Neanderthal No More article series.

Take care,



Did your shoulder pain come on gradually or as the result of some acute injury/trauma, etc?

Do you have problems with any exercises, other than the ones you mentioned?

Do you get pain with just general ROM or any particular positions?

What did your workout program look like prior to the onset of the problem?

Since it has been going on for a few months now, I would suggest you have it looked at by a sports med ortho, chiro or PT.

The fact that it is getting better is a good sign. Shoulder problems can be notorious for hanging around, especially if you continue to do activities that bother it.

Take care,



I dealt with shoulder impingement, have been doing art has helped a lot, and its hard once you get it stronger, then another part hurts, i would go light, with slower reps, not too heavy, have you tried cresseys rehab shoulder exercises, could even try cable exrensions coming across your body my pain was in the front for a while, does it hurt with reaching movements like reaching up to grab something up high, mine was hurt for almost 2 yrs but progressed from yrs of not lifting the right way in college some you pay for, but am now back to full strength, Im not the expert but the art combine with rehab.

exercises helped the most, cold and hot therapy helps as well Io have a heating pad use at night, and cold pack, i did get from a sports medicine place, helps, mine did hurt the most at first with bench and pullups


Hey Dr. Ryan I was wondering btw what your insight on the hot and cold therapy, cressey said in a post to not do more than 20 minutes of cold therapy, and doing pulling movements would help, my pain now in my shoulder is real minimal thanks to your advice and everyones here, in combination with ART, and rehabing both my shoulders, I realize now essential it is to work all part of shoulder to keep from getting an imbalance, thanks


I agree with Eric's comments. He knows his stuff.

I'm glad your shoulder is doing better.

Take care,



Thanks for compliment man, good to hear from you, how you been doing, I might be taking a job back in houston going back home to houston, you ART certified or know anyone there ART certified, I still go on occasion,Hopefully i get that job im ready for a change, im from the area what part do you work out of yeah its funny I was benching 235, did it 8 times was amazed because cam remember when light weight would hurt it, but yeah


yeah look up Cressey's article type in Rotator Cuff Conodrum, I think Eric has an update version and older article


Knowing how to do ART and being certifed are two different things.

Do I have the manuals and have I been taught by a certified instructor? Yes

Have I spent $1500+ per body region (3) to take a weekend seminar to become certified? No

Best of luck in your Houston job search.

Take care,



Thanks for your response. Whenever i grip around a bar (handlebars, barbells etc.) a very odd sensation shoots up through my arm, a numbness of some sort. As soon as i take my hand away, the feeling goes away. This restricts me from working with barbells however, so it must be dealt with immediately. I am going to see a chiropractor tonight if possible because some people thought that they might be able to help.




A chiro should definitely be able to assess you and provide you some treatment.

Let me know how it goes.

Take care,