T Nation

Dr. Ryan- Primetime


Fire away.


Dr. Ryan,

No question today, just some gratitude and thanks.

My knees are basically 100% better. The Osgood Schlatter's seems like its on its way out, and I'm no longer taking anti-inflammatories.

I think the main problem (that you mentioned) was and imbalance between my quads and my hamstrings. Since our first discussion I started incorporating more deadlift variations along with some sprints.

Thanks for the articles and the great advice!



Dr. Ryan,

Whenever i squat, my left knee makes a clicking noise. it is internal and is actually quite painful. keep in mind i played 4 yeard of D1 sports and definitely put some miles on it. i have had an MRI and they ruled out torn miniscuses so i wondering if you had any insight. i know it is a pretty vague question but i figured i would try anyway.


Hi Doc.

I posted a note to you recently - a clicking but pain-free right knee, and pains in right leg (at point where glute meets ham) after sprinting. You advised to see a Chiro, who specializes in atheletes.

I found a Chiro who has "30% atheletes as clients". He found my back to be a little out of alignment (confirmed by X-ray), and it has "responded well" to manipulation. My right knee was also found to be compacted a little - not much movement, and apparently some inflammation. He's been tugging at it, and doing some ultra-sound. I've done a couple of gravity-boot inversions, which seems to help all-round, but he's now asked me to stop that for a while. My legs are now same length (right was shorter than left - I did not know before Chiro Doc found this). I still get the same, quite strong pain in right ham/glute and the clicking in right knee is presently much worse, which is disconcerting. I am still undergoing treatment, but I wanted to touch base with you to share findings thus far see if you had any thoughts on this. The Chiro Doc is not concerned that my clicking is "worse" - he keeps manipulating the back ("very pleased with how I respond"), and pulling on right leg ("ditto").

I'm pleased to say I am still pain-free in the right knee, but the ham/glute is as sore as ever for several days after even a reduced sprinting session (not 100% effort - more like 90%+) My range of motion is also reduced considerably for a while after sprinting (e.g. when stretching).

You said to check back with you after I saw a Chiro - I gladly check thus - but maybe I'm being a little premature in that I don't know how long I should wait to see an improvement, and the Chiro doesn't seem to know either (and I don't criticise him for that).

Do you have any thoughts you could share on my glute/ham pain and what I might do to try to prevent it from re-occuring and/or minimize it (other than stop sprinting)? Any thoughts on why my knee clicking seems to be much worse (still painfree though!) - and should I be worried or pleased?





Do you have a copy of the MRI report?

Were there any other findings on the MRI?

Regarding your symptoms, do you only get that pain with squatting? If it only occurs with squatting, does it happen with every rep or does it only occur some of the time? Where in the ROM does the problem occur? Where do you feel the pain? Also, do you have a history of any knee injuries?

If you could provide some more info, I'll try to help you as best I can.

Take care,




Thanks for the gratitude, I'm glad I was able to help you out.

From the looks of your progress pics, it seems like the lifting has served you well.

Keep up the good work.

Take care,



I'm a 50 year old fat guy who blew out a bursa lifting weights overhead. What is the best way to go about recovery?




Did the Doc do an ortho. eval of the knee to try to figure out what was causing the clicking? Saying the knee is a little compacted isn't really telling you why it is clicking.

Has the Doc addressed the hamstring directly. I would think doing some ultrasound and myofascial release would help.

It wouldn't be uncommon for you to get a change in the knee clicking due to possible biomechanical changes as a result of therapy.

What kind of warm-up do you do prior to sprinting? If it continues to bother you that much, I would change your program around and give the tissue a chance to heal. If you continue to push it hard, it won't heal well. Hamstrings are notorious for becoming chronic or re-injured. You definitely don't want it to get worse.

I would ask the doc what he thinks is causing the clicking. Make sure to emphasize that your hamstring is bothering you.

Let me know what he says.

Take care,



thanks for the help.



Have you had it evaluated?

What kind of symptoms are you having? When did you hurt it?

Take care,



Yes, I've been evaluated, and the doc said it was definitely a bursa.

I can't lift my arm above my head. I can't take Cortisone shots. I did a 12 day Prednison cycle, felt good during but after the cycle the pain returned.

The injury occurred three months ago, and I was treated a month after.

I'm not so interested in how to decrease the pain as I'm seeking how to aide the healing.




Sorry about not getting back to you sooner.

If the problem has been present for five years, when did you have the MRI? If possible, I would ask the doc or imaging center for a copy of your report.

Based on your symptoms, a meniscus problem would be in a diff. diagnosis. However, you indicate that the MRI was negative. I would also want to rule out patellofemoral dysfunction resulting in cartilage irritation. I would be interested in seeing if the report mentioned any kind of problem with either retropatellar or articular cartilage.

Regarding the bilateral pain on the outer part of the knee, it could be the IT band. Check out Mike R's article called Feel Better for Ten Bucks about how to use a foam roll for self treatment.

What kind of treatment have you had so far. Since this has been a chronic problem, I would definitely recommend that you get it evaluated and treated.

Take care,




Have you had any kind of diagnostic imaging done on the shoulder to rule out any rotator cuff damage?

Are you familiar with any rotator cuff exercises?

I would avoid laying on that shoulder while sleeping.

What movements or activities do you have the most problems with?

Take care,



Dr. Ryan,

A question about orthotics...should one cycle their use or wear them non stop ?

(I ask because I thought if one used them, then one might create a dependancy )



Dr. Ryan,

My mother dropped something on her foot a couple of months ago while standing (something like as a heavy book, with the corner hitting the top of her foot). Now she experiences pain when she walks for long periods of time (I think it's a sharp pain, but I'm not sure). She has gone for an x-ray, but there were no obvious bone breaks. The doctor suggested an MRI, but she hasn't gone yet. Any ideas as to what could be causing the pain? Also, what would the benefit be for her to get an MRI?

Please let me know if you need more information!





It would depend on why you wear them. If you have a significant structural problem, then you should wear them with any significant amount of weight-bearing activity.

If you have some mild problems that can be partially helped by doing strengthening activities for the foot/lower leg, then do not wear them while performing the specific exercises. Some athletes will do some warm-ups and limited exercise without the orthotics and then use the orthotics for extended or strenuous exercise.

Let me know if you have any more questions.

Take care,




Good to see you online! I actually just found a great chiro here in Indy, so I'm very happy to have someone I can count on.

Now, to my question. As you know I'm about 9 weeks post-op, and the knee is feeling very good. However, as the knee/meniscus learns to absorb forces in its new state, things still don't feel just quite "right." Any thoughts on how long this takes? I wasn't sure how familiar you were with this kind of surgery (partial meniscectomy) but I thought I would ask.


Stay strong


Dr. Ryan,

I don't actually wear them -- yet. I went to my Chiro (actually volunteered when he was learning the ropes so to speak) and he said that I had a "very slight" pronation.

I've been contemplating getting them, but then some people tell me things like, walking around barefoot is actually good for the feet as it strengthens the arch (mostly my hippie math friends walk around barefoot around the city -- don't ask :))

I have no noticeable problems (personal and as assessed by my D.C) but I'm afraid if I get them, I could actually weak my arch in the long run -- thoughts ?




Sorry to hear about your Mom's foot.

The foot is a pretty intricate body part. Without being able to evaluate the area, it would be difficult to give you any specific advice.

The MRI would give you much more information about the anatomy. An X-ray only shows the bones and would only show a fracture in this case. Whereas, an MRI would show the bones and is much more sensitive to any kind of bone trauma. Also, the MRI will show the muscles, joints, tendons, ligaments, etc.

If she is still having problems this long after the injury, it would be a good idea to have the test done. Hopefully she has insurance because they aren't cheap.

Keep me posted.

Take care,



Thanks Dr. Ryan. I know that my description is a bit vague, but I'm going with what she has told me.

At least now that I know the purpose of an MRI, I can try to push her to go get the test done ASAP =).

Thanks for the clarification!