T Nation

Dr. Ryan- Prime Time

Ok, time for another round of questions.

Hi Dr. Ryan,

What would be the best way/treatment to recover from a Tennis-Elbow injury?

By the way, it concerns my father who is 50 years old.

Any advices would be appreciated.

Thanks.

Doc, how’s the weather there? Any effects of the hurricane?

Hey Doc
As of late been getting stiff neck alot, with it popping alot, anything to worry about?
thanks in advance

Grimskunk,

If it is Tennis elbow (lateral epicondylitis)I would suggest that he find a good sports med chiro or PT. They can do some ultrasound and myofascial (active) release on the wrist extensor muscles and lateral epicondyle.

In addition, he should avoid doing any significant “palms down” lifting. If he does any weight-training he should use wrist straps for any exercises that require significant pulling or gripping.

Also, some people benefit from using a lateral epicondyle strap that helps to decrease the strain placed on the common extensor tendon.

Eccentric based exercise can be added for the wrist extensors to help facilitate healing.

If he does a lot of computer work involving typing or using a mouse, he may need to cut back or take frequent breaks, as the constant repetitive motion can keep the area irritated.

What caused the problem?

Take care,

Ryan

Dave,

I’m actually in Ohio visiting my family right now, but from what I hear there hasn’t been any significant rain in Houston.

We are getting rain in Ohio for the next couple days that is related to the hurricane.

I hope you are doing well re-adjusting to Canada.

Try answering the PM’s I sent you earlier.

Take care,

Ryan

nabz,

Really not a lot of info to go on. If you could provide a little more history or pertinent info. that would be helpful.

If you have a good chiro in your area they could perform an exam and provide some treatment if necessary. Based on what you have said, I would imagine they could fix you up in a couple treatments and give you some stretches and exercises to do at home. Also, they could try to determine if any of your daily activities are contributing to the problem, and how you may be able to modify them to decrease the strain on your neck.

Take care,

Ryan

I’ve been getting lots of pain around my lumbar erectors when squatting deep. Is it possible to emphasize the lordodis too much and/or sticking my butt out too far? Do I need stronger abdominals? It hurts my lower back to squat deep and pulling on anything even slightly in front of me hurts (ie. unracking dumbbell off lower rack). My squat won’t go anywhere until I fix this.

This all started when I injured it by pulling a boat out of water. I leaned over and jerked a load that was out in front of me. Every month or two I’ll start going for a max attempt and bang the pain hits me at the bottom of the squat.

I’ll post this here as well (re: my rehab):

Going really well, I think. It’s always tough because I’m not really sure how things are supposed to feel now versus before. As well, I know it typically takes a while for things to normalize in the joint and your body to figure out how to re-distribute the loads.

Have you dealt with many people who have had partial meniscectomies? If so, what were their outcomes? Any thoughts on keeping the OA bug at bay?

Stay strong
MR

Hi Dr. Ryan
I’m GrimSkunk’s father, the one asked about.
Your diagnostic is very good.
Here’s some extra info. I’ve been playing badminton twice a week from Sept to June for about 10 years. For the first time over all those years, I caught a tennis elbow/epicondylitis three weeks before the summer break. Never had any arm, elbow, wrist problem before. Some shoulder incomfort few times, but nothing severe. But now…
You’re right, lifting something palm down is tough. And, very bad, I tell you that fly fishing is really painful. Using an arm bracelet near the elbow helps a bit though.
I tried not to challenge my arm over the last 2 months, no racket game, no fishing.
Over the last 25 years, I’ve been consulting chiropractors, naturopathes, and acupuncturist several times, always related to my back, which didn’t had a crisis for a very long time.
Now, my question is: before using ultrasound, what would be your suggested eccentric based exercise for the wrist extensors.
Thanks.

IHateGymMorons,

Based on the mechanism of injury you would want to rule out disc involvement versus muscle or ligamentous sprain/strain. The facet joint capsule could be a factor as well.

Now regarding your specific question regarding arching too far, yes it can happen. Usually this is more common with overhead lifting, where the person leans back excessively. This can cause excessive loading of the facet joints leading to injury.

Based on what you are experiencing with squats, I would say it has to do with excessive loading at the end range of motion. The tissues most likely haven’t healed enough for them to tolerate max effort loading.

I don’t know what your training goals are, but unless you are training for a powerlifting meet, I would avoid max. squats right now. If you can perform squats using submax weight without causing pain, then stick with that and gradually increase weight. Trust me, the gains you will get from max squats in the short term will not outweigh the negative impact that further injury will create on your training program.

Also, it would be a good idea to see a good sports med chiro or PT since this has been a recurring problem. I would also suggest that you get the book Ultimate Back Fitness and Performance by Stuart McGill. It will help you understand low back injuries and how to customiize a training/RH program to fit your needs and minimize injury risk.

Take care,

Ryan

Any ways to set up a training program for a guy(me) that can only use 1 arm? I was seriously wounded in OEF and won’t be able to use my left arm for about a year

Thanks!

No, I’m not training for a powerlifting meet or anything like that. I’ve just wanted to get my lousy squat numbers up for like a year and a half now and I can’t even break 300! Mostly because I keep getting hurt. I want to rush recovery too much. I get to feeling good then I try to creep up to that max attempt again. First rep I’m fine, second rep, pretty good, then the third rep…“ouch” and I drop it to the pins.

I’m so afraid that I may lose whatever progress I made the last few months. There was a time when 245 was really hard. Meanwhile, due to my body’s natural leverages, my deadlift is 375 without even trying that hard. I’ve never really tried to get the deads up that much, they just seem to come easy. I’m hesitant to attempt an increase in deadlifts simply because I’m afraid that it may throw me out of whack even more. I’m afraid to deadlift 1/3 more than my squat cause maybe it causes some imbalance I’m unaware of - even though it is a good compound lift?.. Is this a plausible fear? It seems like the deads would improve my squat if anything.

Where’s the best place to find this book?

http://www.t-nation.com/readTopic.do?id=719457&pageNo=2

In case you didn’t see the p.m. could you help me out with my questions in this threat? Much appreciated. Sry for any typos, my battery is giving out on me and i typically look at the keyboard instead of the screen :slight_smile:

Grimskunks Dad,

I usually have the patient perform 3 sets of 8-12 reps of eccentric reverse wrist curls. Do this every other day. Normally I will have them do some ulnar and radial deviation exercises with a weighted hammer as well.

Make sure to do 15-20 reps of just normal full range wrist extension and flexion to sort of warm-up the area prior to performing the exercises. Then perform slow resisted eccentric motions and use the opposite hand to assist on the concentric portion of the lift.

The myofascial therapy along with ultrasound works pretty well.

Let me know how it goes.

Take care,

Ryan

Jason,

Sorry to hear about your injury. Does the injury involve the whole arm?

I don’t know your lifting history, but most exercises can be adapted to single arm movements. Also, you will actually get some neurologically mediated carryover to the injured side.

Give me a little lifting history along with any specific goals or limitations and I’ll see what I can do.

Take care,

Ryan

23 and beginner

I read your post from the other thread and I’m not quite sure what you mean by it “feels like you step in a hole.”

Do you mean that it feels like it gives out, buckles or locks up?

Also, where is the pain located?

Based on the pain when the foot is planted and you rotate or change position, I would want to rule out rotatory instability due to ligament problem or a meniscus problem.

Since it has become a chronic problem, I would suggest that you get an MRI done. That test would show whether you have any meniscus tear or some ligament tear. It would also show how much chondromalcia patellae is present.

If you have a local professional team, you could always contact their offices and ask who they use for their sports injuries.

Take care,

Ryan

[quote]Dr. Ryan wrote:
23 and beginner

I read your post from the other thread and I’m not quite sure what you mean by it “feels like you step in a hole.”

Do you mean that it feels like it gives out, buckles or locks up?

Also, where is the pain located?

Based on the pain when the foot is planted and you rotate or change position, I would want to rule out rotatory instability due to ligament problem or a meniscus problem.

Since it has become a chronic problem, I would suggest that you get an MRI done. That test would show whether you have any meniscus tear or some ligament tear. It would also show how much chondromalcia patellae is present.

If you have a local professional team, you could always contact their offices and ask who they use for their sports injuries.

Take care,

Ryan[/quote]

When i said it feels like you step in a hole i meant it gives out. When you run at a high speed and hit a hole your leg gets stuck and you overextend your knee if you don’t see it coming. Feels like the knee ist giving out.

When i bend my knee to a 90? angle the pain is located about an inch from the top of the knee cap vertically down. That’s on line. It’s about half an inch inwards into the leg from the marked position. Where the lines hit centre of the pain is located. (Hope pic helps a bit)

It might be some sort of rotatory instability. Is there anything besides surgery that could be done in case of a ligament or meniscus problem that you would consider a good idea?

What exactly does MRI stand for? I think it’s the one that looks like a tube but the full name would be helpful in case they gave that a different name in Germany. I just want be on the safe side.

We have some good teams here. I never thought of just calling and asking the office who they use. That clearly shows i need a job. Just studying makes you retarded in some areas of life. What a moron i am. hahaha

Thanks for helping me out Dr. Ryan.

hey i posted the results to my ct scan on the blown disc thread in building a better body, heres my symptoms, light pain and reduced mobility that starts in glut mid/glut max and spreads to my upper calf, it is aggravated specifically by leg leavers, extended periods of sitting. no pinsa and needles or numbness. As for weuight training as stated recreationallly for 5 years I do (rather did) perform deads and squats,

23 and beginner,

Well if it feels like it is giving out, it could be due to instability or a neurological mediated response due to pain.

MRI stands for magnetic resonance imaging. It does look like a tube.

If there is a problem with a ligament or meniscus, the severity of the problem as well as the location would determine whether surgery is necessary or not.

What kind of leg training are you doing and what exercises can you perform without reproducing your symptoms?

Take care,

Ryan