Q&A with Orthopedic Surgeon Dr. Victor Prisk!

[huge285]

Post all your quesitons regarding muscle and joint injuries for our good friend, Dr. Victor Prisk! As a bodybuilder, you can never have enough orthopedic surgeons around!

[MIKE]

This is a great part of the forum! Exactly what I was needing right now. I have been diagnosed with early stage Plantar Fasciitis in my left foot. Its one spot exactly where the flat part of my heel begins coming from the arch in my foot directly in the middle, its hurts all day long. Other than rolling my foot over a tennis ball (which hurts like hell btw) what else will make this go away? Thanks a lot!

[loomster2000]

Mike, I'll be looking forward to hear what the Doc says about this.

At one point, Dave had me doing 2.5 hours of cardio per day. I broke this up into 2 different sessions (1 hour & 15 mins. per session). I was walking on the treadmill the entire time. I too developed PF. I tried all the 'net remedies and I got some temporary relief, but then it would quickly come back. I then switched to the bike for about a month. The PF went away, but as soon as I starting walking on the treadmill again, it came back. I have since moved permanently to the bike and have had no more probs with PF (although I would like to get back to the treadmill from time to time).

[knine110]

I just had a full Rotator Cuff Repair and I am already showing signs of atrophy in my arm, Lat and shoulder (of course). I was wondering if I did moderate training on my "good half" would it positively or negatively affect my progress in recovery. Is there anything that I need to be wary of. I start my physical therapy today but any other advice you can provide would be greatly appreciated.

[Johnny Phenomenon]

Just thanking the Doc in advance!!

[Hardcore]

HI, my knees are clicking when I do squats. Its getting louder as time goes by. ANd they do get sore sometimes, not during exercise though but when Im walking one might give way slightly?

Both my parents have had various knee ops int he past. Can this be genetic?

Cheers mate!

[Sliced N Diced]

My left knee for a while has been bothering me for a while. While back I was doing A LOT of cardio and thats where it started. Now here and there my tendon and rarely quad tendon bother me. Sometimes the inside part of the ligament as well. Last week, it bothered my knee on the negative motion of leg extentsion. What can this be?

[orhochris]

hey doc... great in the trenches vid.

ive had three shoulder surgeries. one to repair a posterior capsule shift (tighten the tendon/ligaments in the back to prevent minor dislaction/instability during lifting/sports. and two others to remove the screws that came loose from the first procedure.

What shoulder strengthening exercises do u recommend for general health, stability, and injury prevention... times per week??? and before or after lifting? thanks

[not2big]

ok...ortho doc said i had petelar tendinitis, (or however you spell it), due to cardio training..2 aleve a day and rest and i was supposed to be g2g in a week..well..no dice...its FAR better, but after laying off for about 3 months, i squated super light weight, and could feel something going on..so, squats, stairs, stuff where i'm pushing down, up or whatever, isn't comfortable, leg extensions and hamstring curls are fine..any thoughts?

[PittOrthoDoc]

This is a great part of the forum! Exactly what I was needing right now. I have been diagnosed with early stage Plantar Fasciitis in my left foot. Its one spot exactly where the flat part of my heel begins coming from the arch in my foot directly in the middle, its hurts all day long. Other than rolling my foot over a tennis ball (which hurts like hell btw) what else will make this go away? Thanks a lot!


Gastrocnemius stretching!!!

Cushioned heel cups

Night splints... help to hold the foot dorsiflexed to prevent the gastroc from getting tight at night

Arch supports

Custom orthotics... most insurances cover for PF

ice massage

BTW , gulp, I just wrote a full article on this in MD for this month.. on stands.

[PittOrthoDoc]

ok...ortho doc said i had petelar tendinitis, (or however you spell it), due to cardio training..2 aleve a day and rest and i was supposed to be g2g in a week..well..no dice...its FAR better, but after laying off for about 3 months, i squated super light weight, and could feel something going on..so, squats, stairs, stuff where i'm pushing down, up or whatever, isn't comfortable, leg extensions and hamstring curls are fine..any thoughts?


Get it checked out. If any doubt about the severity, get an MRI.

Physical therapy with an emphasis on progressive eccentric training may help.

Chopat strap often helps too.

[PittOrthoDoc]

hey doc... great in the trenches vid.

ive had three shoulder surgeries. one to repair a posterior capsule shift (tighten the tendon/ligaments in the back to prevent minor dislaction/instability during lifting/sports. and two others to remove the screws that came loose from the first procedure.

What shoulder strengthening exercises do u recommend for general health, stability, and injury prevention... times per week??? and before or after lifting? thanks

RC strengthening exercises as i'm sure you know all about.

Rear delt machine (fly machine) would help. Reverse cable cross overs and delts on cables too.

[PittOrthoDoc]

My left knee for a while has been bothering me for a while. While back I was doing A LOT of cardio and thats where it started. Now here and there my tendon and rarely quad tendon bother me. Sometimes the inside part of the ligament as well. Last week, it bothered my knee on the negative motion of leg extentsion. What can this be?


Do not ignore tendonitis around the knee... you don't want to end up like Victor Martinez in surgery.

Have it examined by a physician.

Sounds like patellar tendinitis.

[PittOrthoDoc]

HI, my knees are clicking when I do squats. Its getting louder as time goes by. ANd they do get sore sometimes, not during exercise though but when Im walking one might give way slightly?

Both my parents have had various knee ops int he past. Can this be genetic?

Cheers mate!

Patellofemoral clicking is not uncommon in lifters.. can be early degenerative changes in the cartilage on the kneecap.

Other sources of clicking include the meniscus... get checked with an MRI

May be as simple as a knee scope to debride the meniscus or cartilage. back to lifting in 3-4weeks.

[PittOrthoDoc]

I just had a full Rotator Cuff Repair and I am already showing signs of atrophy in my arm, Lat and shoulder (of course). I was wondering if I did moderate training on my "good half" would it positively or negatively affect my progress in recovery. Is there anything that I need to be wary of. I start my physical therapy today but any other advice you can provide would be greatly appreciated.


Biofeedback from training the opposite side is essential to limiting atrophy in the operative limb! Do it if you can.

[Corkwally]

Hi Doc I have been assed as having a facet joing injury in my lumbar spine from the mri it looks as if the disc hyas been totally wiped out and has ruptured frontways instead of the usual backways.

the doc that im seeing has basically said straight out no more lifting or contact sports my question for you is I have been doing a bit of research and came across spine cages which are inserted instead of the disc do yu have any knowledge of these?? do you think my lifting days are over??

[thor159]

Hey Doctor. First of all, thanks for being here answering the doubts of the guys.

I'll suffer a surgery in the right shouder due a labrum glenoid + slap lesion and I'm planing to take some chondroitin/glucosamine after the surgery to see if I'll get better faster and also for some knee pain I'm feeling. I'd like to know if you can tell me the right dosage to take it per day, how many times per day and which times.

One other thing is that I saw some places writing glucosamine sulfate and others just glucosamine. Is there a difference?

Thanks in advance and all the best!

[PittOrthoDoc]

Hi Doc I have been assed as having a facet joing injury in my lumbar spine from the mri it looks as if the disc hyas been totally wiped out and has ruptured frontways instead of the usual backways.

the doc that im seeing has basically said straight out no more lifting or contact sports my question for you is I have been doing a bit of research and came across spine cages which are inserted instead of the disc do yu have any knowledge of these?? do you think my lifting days are over??

That is a bad problem bro... sorry to hear it.

Cages or Posterior Lumbar interbody fusion PLIF or posterior spinal fusion may be necessary... lifting days are not necessarily over, you just have to modify your training and train creatively and smart. Heavy squatting and deads would not be in the creative training plan.

[PittOrthoDoc]

Hey Doctor. First of all, thanks for being here answering the doubts of the guys.

I'll suffer a surgery in the right shouder due a labrum glenoid + slap lesion and I'm planing to take some chondroitin/glucosamine after the surgery to see if I'll get better faster and also for some knee pain I'm feeling. I'd like to know if you can tell me the right dosage to take it per day, how many times per day and which times.

One other thing is that I saw some places writing glucosamine sulfate and others just glucosamine. Is there a difference?

Thanks in advance and all the best!

Stick with the glucosamine sulfate products... the only randomized trials that didn't show an effect with supplementation were done with glucosamine HCL.

Generally, the bottle will give an appropriate dosing regimen.. 1500 to 2000mg per day.

[orhochris]

RC strengthening exercises as i'm sure you know all about.

Rear delt machine (fly machine) would help. Reverse cable cross overs and delts on cables too.


thanks doc,

I'm in week 3 of rehab. last procedure was 1-31-09. I'll add more reardelt work when I get back in the gym. appreciate the help.

[wolverine565]

I having 2 discs repaired in my neck. The doc said he was going to hook me up with a bone stimulator to speed up recovery. How does a bone stimulator work? Is there any thing else I can do to speed recovery?

[tornquad2]

hi,i work in a nj prison and hurt my right elbow during a confrontation!!!i use my elbow to strike his head several times.since my ortho"workman comp"injected my elbow with cortison but it did nothing now he said my ulner nerve is out of place and rubbing against the bone when i move my arm,my option is leave it alone or surgey to relocate the nerve.i havnt been able to workout very well since and my strenght went down bad.what would you reccomend i do,iam 41 andwish to compete again

[orhochris]

Hey Doc,

Just wanted to thank you for the advice again. I saw you at the arnold, (you were talking to some folks and I didn't want to interupt.) Looking good doc. good luck with the training.

[firefightermac]

I broke my collarbone in december 02. it wasnt reset and just healed overlapped with the big lump in it. As a result my right shoulder is slightly shorter and lower than the other. also it really fucked up the biomechanics of this shoulder. grinds, pinches and has caused me chronic bursitis.

Despite this in the proceesing years I have managed to build my physique from 60kg to an offseason weight of 115 and competitive around 92-93. However ive never been pain free and always nursed it and worked around it.

My question is, is it hypothetically possible to get the collarbone straightened surgically to put it back how it was pre-break and give me full/pain free movement?

[BigJD69]

Hey Doc I had my neck fused C5-6,6-7 in 2003. Still in a lot of pain, have been using pain meds and going for cortisone injections. The injections only work temporarily, should be going for my second round soon. My pain management Doc wants to do the injections 3 times and if it doesn't work wants me to do Radio Frequency. Can you explain what Radio Frequency is and how affected it is with my situation. THANKS!!!

[Cyanide]

hey Dr.

I have had 7 injection site lumps for 8 months now. I went to my Dr at 4 months after the injection because the lumps were growing and I hadnt injected them for the 4 months. He sent me to get an mri and they found that it was just scar tissue. The lumps are huge! The lumps on my biceps are spreading down my arms. I saw a surgeon and she said she wanted to wait six months to see if the scaring gets any better. Its not getting better, its getting worse. This week the scaring developed in the pit of my elbow, it hurts, I went to see her today and she cancelled. I might go to the ER. The injections were sustanon with a 1" needle. I have done many injections in the past and never had this problem. I dont think my surgeon or dr know what they are talking about, they didnt even know what sustanon was. I asked her about using a tens unit, she said no, I asked about antibiotics, and I still havent got a answer. Have you seen anything like this before. I dont think they will ever go away without surgery, and she said that might make the scarring worse.

[MaxC]

Hi Dr. Prisk,

Thank you for making yourself avaliable on this board. I am a competitive bodybuilder and medical student. I have had a knee problem for over 8 months now. I have not been able to workout at all for 8 months because in addition to this knee problem I also have an elbow problem, and I am pretty frustrated with the sportsmed/ortho field right now, even though that is what I want to go into.

I saw an orthopedic surgeon, and had an MRI done on the knee. The MRI showed only minor chondromalacia beneath the medial aspect of the patella, and some thickening of the medial plica. The doctor said this is to be expected for someone of my age. But I don't think they know much about weightlifters and bodybuilders, and I think it is causing my intractable knee pain, and I want it scoped. I also know that sometimes MRIs do not show minor meniscal tears, so I am not convinced that minor findings on an MRI rule out the need for a scope. I just think that a simple scope and simple debrdiment might help my situation, but it is hard to get a word in edgewise with a physician. I can't squat or lunge at all. It hurts if ride a bike for more than 20 minutes. I have done physical therapy for it on my own, and then tried to slowly work it back into activity. I need help. I want to know if you would consider scoping the knee.

Thank you, Max

PS. Congrats on your residency at Pitt, and Fellowship at HSS. you must have really rocked the boards, and kick butt at what you do.

[thor159]

Hi Doc., how are you? I'd like to know the difference between glucosamine sulfate and just glucosamine. In some places I see "glucosamine sulfate + chondroitin sulfate" and in others "glucosamine + chondroitin sulfate". Other question... is it a problem to take more glucosamine than chondroitin? For example 2000mg glucosamine and 500mg chondroitin.

Thanks and all the best!

[slackadjuster]

Excellent answers above. I have a problem that I'm too hard headed to go to the doc and looked at. I had my meniscus in my right leg repaired about 4 years ago. It was a tear that was on the edge (doc used stitches) to put the edges back together. The problem is that I feel like there is fluid on the knee all the time. I also have arthritis is the knee. I am able to function, but it is very painful. I also think that I may have had some nerve damage to the vastus medialis during surgery. Is there any way to restimulate the muscle? Do you think that going back under the knife could help clean up the knee some and get rid of some of the pain?

[loomster2000]

Doc,

Thanks for your time in answering these questions.

I am experiencing pain just above my left elbow. I suspect I injured it doing heavy one-arm tricep pushdowns. Now, when I try to do pushdowns, I get shooting pain when I begin the movement (when my tricep is fully stretched in the non-contracted position). Also, there is a bit of uncomfortable pain to the touch, such as when I turn over in bed at night and press my elbow into the bed to turn over. Though not as painful, this is also affecting my other pressing movements I do when training chest and shoulders.

Any help would be greatly appreciated!

[j-t-fuentes]

hi Dr. Prisk i would just like to know wether you could help me with a problem? about 2 weeks ago i was squatting and i squat real deep, but on my last set i felt a weird pain in my knee. the pain was just below the knee cap to the right a bit, i would just like to know is it serious? it only pains me when squatting really deep (a** to ground), its annoying me because i can only now squat to parallel!! any advice please!

Thanks for your time Doc:D

[captaincardio58]

This may seem like a common question but i never got a def answer even in school when i was there for exercise phys, why do joints click and pop??

[Cyanide]

I dont think the dr is going to answer our questions, he just did an interview with md.

[BigJD69]

What's going on asked him a ques???? No Response!!!

[Biggie973]

Dr. Prisk, I know I hurt my knee, I have a limp when I walk & when I walking up the stairs, I'm walking gingerly. What do you think happen to me?

[B7emm]

Doc,

I have a herenated disk in l4 and l5, I would like to get back to my HIT training asap. I have been out of it for 6 months I have lost a lot of my mass ofer the corse of this past year from 250 to 220. any ideas that may help? I have had my first epadurel today and it was ok. I start pt on friday.

[RealLilSwole]

Hey Doc! I am getting ready for Jr Nats and as soon after, I am thinking I am going to have to have this bunion wacked off my foot. It hurts bad!! It sometimes wakes me up at night with burning pain up my foot. I am also a nurse, so I am on my feet for 13 hours a day. How long is the normal person off their feet when having this operation? THanks for the advice in advance!

[Cyanide]

can we eliminate this thread?

[cbower420]

I have two questions. The lateral head of my calf does not contract. I did have herniated discs in l4, l5, s1, which I had an epidural for. My calf also gets really tight, especially after sleeping. I constantly stretch it. When I doing a standing calf raise it also locks up every single time. It is now half the size of my other calf. Could this be from a possible pinched nerve in my back, and is there a way to fix it?

Second question:
I feel like a pussy asking this question, and I don't want to be a pussy and go to the doc for it, but my pinky snapped back a few months ago during jiu jitsu class, and it hurts like hell sometimes. The craziest thing is that my hand falls asleep now throughout the entire day from the top lateral part of my hand down to the tip of my pinky. The pain is coming right at the PIP joint. WTF is wrong with it? Should I get this checked out or just grow some balls?

Thanks so much doc!

[Vicki Nixon]

hey DOC!!! If u ever get back to these people about their issues..I have questions too!!!!! I see how it is...u move to NY get involved with the BIG dogs and forget us Little People! LOL! Kidding of course...hope u are well!!! Hit me back IF u ever come back to this thread!!!!!!!!!!!!!!!!!!!!!!!!!
xoxo

[Cyanide]

hey DOC!!! If u ever get back to these people about their issues..I have questions too!!!!! I see how it is...u move to NY get involved with the BIG dogs and forget us Little People! LOL! Kidding of course...hope u are well!!! Hit me back IF u ever come back to this thread!!!!!!!!!!!!!!!!!!!!!!!!!
xoxo
are you a firefighter? hope your not the one I just heard about from oklahoma!

[mdn636]

Dr. Prisk,
I just had fusion of the C6-C7 as a result of a pinched nerve which caused my left tricep, pectoral and lat to stop contracting. How long before the muscle should begin to contract again? I have had a severe loss of strength. If the muscles will never contract again, how can I work around that? Thanks.

[darb1]

I visited my general practitioner about 3 weeks ago because I have some neck pain and weakness in my right tricep, chest and lat. My GP diagnosed me with a nerve impingement and told me to take 10 to 14 days off. I took the time off but the problem has not improved, so I am going to see an orthopedic surgeon on the 19th of August.

I think I have a nerve impingement to the right brachial plexus, it is causing significant loss of strength to my right tricep and pec, as well as some neck pain. I am unable to get a pump while working out and cannot flex the affected muscles.

I am going to ask for an MRI and EMG, should I be seeing a neurologist or chiropractor to address this injury?

PS: my injury appears to be similar to that of mdn636

[zubbeyboy]

Dr Prisk,

Your opinion on this would be greatly appreciated.i am training for a NPC Show in April and things have been going GREAT.Too GREAT apparently.Currently 235-240# 5'6" 15% BF and i am 37 Years old.
Was doing Incline Barbell Presses on the Smith Machine last Thursday and pulled possibly my bicep tendon at its origin or and my shoulder arount the front delt.5 days later today its a bit better.But cant do a front lateral raise with that arm without pain.I can get to shoulder height then it hurts.I could force it up but dont bevause i know if i irritate it it wont heal as fast.
I have been going to Physical Therapy every other day as well as icing it and taking ibuprofen.
I cannot get into my Dr for 2 1/2 weeks.But ill wait because he is the best around here.I have no problem letting him operate if he thinks he should.He fixed my other shoulder 2 years ago and i was training 100% 3 weeks later.
Anyway do you have a opinion on this injury and the length of time estimated for recovery.

Sincerely,zubbeyboy

[Rsardinia]

Hey Doc,

I recently found out that a 5 cm lump on my chest is a herniated pectoral muscle. I had the lump for a few months and went to a sports medicine doctor to have it looked at in case it was a tumor. I had a chest x-ray taken and an MRI as well. The doctor's assistant saw me the next week following the scans and told me about the herniated muscle. The weird thing is the lump is vertical but pectoral muscles connect horizontally. Anyways, I was wondering if you could tell me some things to do to try and get the muscle back into position. I'm currently icing it every night and wearing a heat patch while working out my chest/shoulders to try to help spur the healing process. Is this a problem you've seen in the past? Is there anything I can do? The lump is not visible unless I flex my chest but for bodybuilding this is very unattractive.

Edit: There is no pain and I never felt pain when the injury occurred (which I don't know when it happened). I didn't even notice the lump til I shaved my chest for the summer. Hence the ability to still train with no problems.

Thanks for your time.

Rob

[alastair j thackeray]

hi doc

your advice would be of great help, i havent been ablet squat or deadlift for the past few years with out pain in my ankle and now i go in for an ankle fusion on monday, how long would you advise befor i would beable go back to these lifts if ever.
have you any advise for speeding up the healing process. i am 51 years young,
any advice would be greatly appreciated

many thanks alastair

[thaAtrain]

Hi Doc,
Ive literally got off the phone with my radiologist who's told me I have an abnormally high level of scarring on my labrum. I had a bankart repair performed a year ago, and recently ive started experiencing pain in the posterior of my shoulder, at rest..tightness and when performing pulldowns or db rows.

Any help would be much appreciated.

[Steve Brydges]

What did you Dr. say? I wrecked my rotator cuff back in November doing flat bench press. I think all the weeks at this new gym unracking the weight from behind my head and a bit lower than normal took a severe toll on my supraspinatus and infraspinatus. Got the results back from the scans (arhtrogram, CT Scan, etc.) and I completely tore the supraspinatus. Dr. says that the only times he'd expect to see someone my age (37) in his office with this type of injury would be if they had been in a severe car accident or had fallen out of a second-story window, such was the force/energy involved in my injury. Sweet. At least I know I was training heavy! LOL.

So, it's surgery for me. Six weeks in a sling followed by several more weeks of rehab. So much for competing this year.

Anyway, I'm curious as to what happened with you? Did you heal on your own or have surgery?

<->


Dr Prisk,

Your opinion on this would be greatly appreciated.i am training for a NPC Show in April and things have been going GREAT.Too GREAT apparently.Currently 235-240# 5'6" 15% BF and i am 37 Years old.
Was doing Incline Barbell Presses on the Smith Machine last Thursday and pulled possibly my bicep tendon at its origin or and my shoulder arount the front delt.5 days later today its a bit better.But cant do a front lateral raise with that arm without pain.I can get to shoulder height then it hurts.I could force it up but dont bevause i know if i irritate it it wont heal as fast.
I have been going to Physical Therapy every other day as well as icing it and taking ibuprofen.
I cannot get into my Dr for 2 1/2 weeks.But ill wait because he is the best around here.I have no problem letting him operate if he thinks he should.He fixed my other shoulder 2 years ago and i was training 100% 3 weeks later.
Anyway do you have a opinion on this injury and the length of time estimated for recovery.

Sincerely,zubbeyboy

[kylemass]

Hello Dr Prisk!

Im a senior student majoring in product design, and Im focusing on a product to prevent injuries. I have a few questions i would like you to answer as a professional.

Thank you in advance for your time.

1. In your profession, what is the most commonly injured body-part during exercise? What caused the injury?

2. Are weight-lifters prone to wrist injuries during exercise?

3. What do knee wraps and elbow wraps prevent?

Thank you.

[naefanne]

A newbie here trying to find a cure!!
I have tennis elbow very bad in my left arm and think it may be from gripping weights compounded with boxing.When I use myt left jab I feel a snap my tricep tendon & forarm muscles that connect to my middle and second finger are tight. I stretch and even Utubed the hammer exercises but all fail.

Any advise or direction would be greatly appreciated.

[FeebSlayer]

First time posting, have a question about rehabin a torn tricep tendon, which did not happen during training. I had surgery to repair my left tricep (3cm tear) on 4/27/10. According to my Doctor I will be imobilized for approximately 6 - 10 wks, dependent upon my progress. I have been training for years and have never experienced an injury like this. I have been unable to train since the injury happened, and I'm going out of my mind!! I want to continue to train my right side with dumbells, however I don't know if I should. Also I don't know what to expect when I am able to begin rehab. Are there specific exercises I should concentrate on, as well as stay away from?? I was advised to take magniseum citrate to assist with the recovery process, are there any suppliments that you recommend that will help in my recovery, and after recovery. Any help would be greatly appreciated. Thanks, get thread btw.