T Nation

Dr. Ryan- Prime Time

I’m here for a couple hours. Any questions?

Also, if you have sent a PM recently I will try to get to it tonight as well. I have had some problems with Internet access for the past couple days.

They say RoadRunner is ‘always on’ but don’t believe them :slight_smile:

Dr. Ryan,

Last Thurs, I sent you a PM about my shoulder injury. Should I repost everything? Thanks.


Hi Dr. Ryan,

I did overhead squats as part of my training for the first time yesterday. I was intelligent enough to go very light for I had only done a few reps with the bar just to get a feel for the exercise up to this point. Upon completing my third set and racking the weight I noticed numbness from my left shoulder down to my hand, especially the thumb. No pain, just some numbness, which wore off within a few minutes. Could this be sign of a nerve impingement, or anything else I should be concerned about?

Iron bro,

I have the PM and you are next on my reply list.

Take care,


I’d like to apologize beforehand for this question possibly being too vague for you to answer.
A friend of mine has a 15yo son whoose kneecaps are not held firmly in place by the surrounding muscles. Are there any specific exercises that could help to alleviate this?

Thank You


The same thing happened to me, except both my arms went numb.

I think it is due to a combination of traction of the nerve and compression in the thoracic outlet.

I would suggest doing some pec stretching and neural mobilization techniques. I would try doing the exercise with the bar for a couple warm-up sets. Hold the max stretched position for 10 sec then back off. Try 2-3 sets of 10. If the bar is too light to provoke a good stretch then increase the weight to an appropriate amount.

You may want to ask Dan John if he has any tips. I’m sure he has encountered this problem with many athletes.

Keep me posted.

Take care,


Thanks much, Doc. I will.


Typically this problem is due to excessive tightness on the lateral side of the knee coupled with inadequate strength of the muscles on the medial side. The VMO is the most potent stabilizer on the medial side.

Therefore, I usually suggest stretching of the ITB/TFL on the lateral side. Doing some home foam roll therapy (Check out the Feel Better for 10 Bucks article for more info) on these structures can help as well. In addition, strengthening of the VMO can be accomplished by perfomring terminal knee extensions (Search the site for pictures of this exercise- I know Dave Tate showed it in an article), straight leg raising with the leg laterally rotated (toe out). Some VMO activity is seen with hip adduction exercise, especially with the leg straight and the resistance applied below the knee.

What kind of athletic background does he have? Squats and step ups can help once the intial prolbem is addressed.

Take care,


Dr. Ryan,

Should I post my loback injury history here or send you another PM?



Go ahead and post it here.


Please forgive my mistakes. I was only 19yo, and had nobody to show me correct form. Nor did I have access to this great site: T-Nation. Here goes my loback history.

April 2004: strained Left rhomboid?? (docs never knew) while deadlifting 405lb PR. Stopped dead after that, forgot dead technique.

July 2004: Deadlift for the first time after rhomboid injury 315lb bad form, shoulders in front of bar - left loback (QL??) pain

July-Nov 2005: stopped doing deads. Squatted occasionally. I constantly experimented with ways of working around my injury. Leg press, hack squat - they all hindered my loback recovery process b/c they all caused the left loback to pop. Whenever my Left loback pops, I know I will be in pain the next morning.

Dec 2005: First time deadlift - worked up to 345lb 1RM - small pop left loback. So I stopped deads for a few weeks.

Feb 2005: Read numerous deadlift articles on this site. I realized my mistake, I used to deadlift and squat with a very arched back & major anterior pelvic tilt. This placed alot of pressure on the L5,Sacral vertabrae area. I began deading with a slight pelvic tilt (flat back) and my loback held up. I have powerful glutes. Hams are normal, but weak compared to quads (I have genetically strong legs, when compared to my upper body). With a posterior pelvic tilt, I could not recruit my hamstrings as much, but I’d rather not kill my back again. So I began deading light at 225lb.

April 6, 2005: dead 295lb 5x4reps

April 7, 2005: loback sore. I was hyped to try out the snatch, which I’ve never done before. So I warmed up with the bar, then 95lb. When I exploded my hips, I felt a sharp pain blast across my sacroiliac area. I was in pain for a few minutes. Stopped deads for the next few months.

June 7, 2005: back feels better, so I do rack pulls. 225lb 6x4reps

June 10, 2005: a girl stepped on my back to massage me and the next morning, loback pain. It’s been downhill from there.

August 2005: the pain seems to be in sacrospinalis tendon where it inserts into the anterior side of the hipbone on the iliac crest. The left side seems more injured. My friend lent me a pair of gravity boots. If I hang for 5 mins, the back will loosen up, no pain, no tightness. Sometimes it loosens, sometimes it doesn’t. There is no pain in my legs so no nerve pinching. I don’t think its a spine issue. Maybe a torn ligament or tendon in the sacroiliac region.

I apologize if this is long. I’m in mental agony and depression from not being able to train. I recently read about Westside, and was so eager to try it. But shoulder & loback injuries prevent me from doing Max Effort lifts. Do you have any advice or rehab exercises? Thank you so much for your time.


PS: some more tips that might help
-I used to lug a duffel bag (10-15lb) hanging on my right shoulder. Maybe that’s what pre-exhausted the left QL and made it more prone to injury during heavy squats and deads.

-My leg workouts used to be squats, leg press, and finally deadlifts. Got that from Arnold’s encyclopedia.

-When I used to dead in 2004, I never retracted my scapula at the top, maybe that’s what led to my rhomboid injury in April 2004.

-The left leg is about 3/16" lower than my right. Thus, I always catch myself favoring the right leg.


Have you ever had any type of diagnostic imaging performed on your low back? What kind of treatment have you had?

With your young age and ongoing history of training related injuries, I would suggest that you get a copy of Stuart MCGill’s Ultimate Back Fitness and Performance book.

Take care,


In Jan 2005, a spine orthopedist took an X-ray of my spine and said, there is nothing wrong with my spine, so therefore it is probably a muscle strain. He gave me some anti-inflams (vioxx - I think) and muscle relaxants and told me no heavy lifting for 2-3 months.

I’m still waiting to see a shoulder ortho (appt on Sept 6). The reason why I am so injury-prone is because I began lifting heavy at 15yo under no guidance. This built up some imbalances. The bad form also screwed me over.



An x-ray is very limited. An MRI would have been a much better test. At least the X-rays should have ruled out any underlying spondylolithesis (vertebral slippage)


I always prod for an MRI, but nooo, the orthopedist refused. Do you happen to know any chiropractor/orthopedist/ sport doctor in New York City? Thanks for the book recommendation. I am going to get it pronto. Thanks for your responses. I look forward to hearing your advice for my shoulder.


My left shoulder ,rotator culf, is always bothering me. It doesn’t hurt but it cracks,like when someone cracks their knuckles, It seems as though my left collar bone is a bit smaller than my right collar bone. I’ve had this since I was 14 years old, I’m 28 now. I’m currently taking MSM,Chondoitin and Glucosamine. Could it be that my joints or the fluids in the joints are gone and is bone rubbing against the bone?

Hey guys, unfortunately my schedule has changed and I won’t be able to be on Prime-Time this evening.

Please feel free to post questions as usual and I will answer them tomorrow.

Take care,