Injury Q & A with Dr. Joe

[Bobr]

Thanks Joe. You have given me some hope.

[freebirdmac]

Don't know if you caught this in my journal Joe, but I apparently have issues with my anterior delts that may be responsible for a lot of my problems. I found out there was a problem quite accidentally. I was leaning on a doorway during a meeting and felt pain at the top of my arm. So I used the doorway to do a little massaging. Discretely of course And to my amazement, pressing on this area released my traps! My ever tight/sore traps! I never felt pain in my anterior delts when exercising or at rest.

My massage therapist worked on them last Friday. Holy freaking heck was there pain! I've worked on them myself this week and my upper body workouts are showing the benefit.

My trigger point therapy book indicates trap issues can be referred to the shoulder, but not vice versa. Weird huh? I also wonder now if my forearm/hand pain wasn't at least in part referred pain from the anterior delts.

My poor massage therapist now has so many upper body areas to work that she can't get to them all. And I can't handle two hours of deep tissue massage My lower body may not get a massage for a year

[joedemarco]

Don't know if you caught this in my journal Joe, but I apparently have issues with my anterior delts that may be responsible for a lot of my problems. I found out there was a problem quite accidentally. I was leaning on a doorway during a meeting and felt pain at the top of my arm. So I used the doorway to do a little massaging. Discretely of course And to my amazement, pressing on this area released my traps! My ever tight/sore traps! I never felt pain in my anterior delts when exercising or at rest.

My massage therapist worked on them last Friday. Holy freaking heck was there pain! I've worked on them myself this week and my upper body workouts are showing the benefit.

My trigger point therapy book indicates trap issues can be referred to the shoulder, but not vice versa. Weird huh? I also wonder now if my forearm/hand pain wasn't at least in part referred pain from the anterior delts.

My poor massage therapist now has so many upper body areas to work that she can't get to them all. And I can't handle two hours of deep tissue massage My lower body may not get a massage for a year

Pam, when it comes to the body, nothing surprises me anymore. I've always been amazed how various areas are connected.

I'm glad you were able to pin point an area to work on that is helping your injuries. Let me know how you make out with your treatment. I hope your trouble resolves quickly so you can get back to feeling 100%.

[KyMuscle]

Well, after 2 months of great training sessions and no major pain or I juries, I appear to have a setback.

I'm self-diagnosing tronchanteric/gluteus medius bursitis. I have the classic pain symptoms for that.

Crazy how that came about. I almost always have a certain amount of tenderness in the area. I squatted Tuesday with no problem. No problem with any pain Wednesday, although I did have some tightness in the area of the greater trochanter.

Woke up Thursday feeling fine. But as I was putting on my shoe, seated cross-legged with my femur abducted and my lower leg 90 degrees to the femur, I felt a searing sensation at the greater trochanter. Been hurting ever since. I'm limping around like an old man and shuffling up/down stairs. Getting into/out of my car really hurts! I'm not optimistic I'll be able to squat Sunday.

Need rest and anti-inflammatories I suppose. Any other suggestions, Joe.

Thank you!

[joedemarco]

Well, after 2 months of great training sessions and no major pain or I juries, I appear to have a setback.

I'm self-diagnosing tronchanteric/gluteus medius bursitis. I have the classic pain symptoms for that.

Crazy how that came about. I almost always have a certain amount of tenderness in the area. I squatted Tuesday with no problem. No problem with any pain Wednesday, although I did have some tightness in the area of the greater trochanter.

Woke up Thursday feeling fine. But as I was putting on my shoe, seated cross-legged with my femur abducted and my lower leg 90 degrees to the femur, I felt a searing sensation at the greater trochanter. Been hurting ever since. I'm limping around like an old man and shuffling up/down stairs. Getting into/out of my car really hurts! I'm not optimistic I'll be able to squat Sunday.

Need rest and anti-inflammatories I suppose. Any other suggestions, Joe.

Thank you!

Sorry to hear this. Obviously, without examining the injured area, it's impossible for me to know exactly what the problem is. However, from what you describe, it does sound like a bursitis of the hip joint.

My first suggestion would be to have it examined. Often when someone comes in to see me with such a problem, I find other aggravating factors that can be corrected and help the injury. For example, I may find a "locked up" S-I joint causing increased stress on the hip. When the S-I joint is corrected, the hip pain will also resolve.

As far as home therapy, your best bet is the use of moist heat (make sure it's moist), non-steroidal anti-inflammatories, light stretching, and rest. Of course, this doesn't mean you have to take 4 weeks completely off from the gym. You can train all other areas and whatever leg movements you can do without pain (e.g. leg extensions?).

Hip bursitis is painful and can be quite limiting in regards to activity. Let's hope it is minor and resolves quickly! Let me know how you make out!

[KevinCouch]

Joe, what's your opinion on using elbow wraps or braces when doing heavy chest pressing movements or even tricep skull crushers? Lately I've had some tendonitis in my left elbow that has hampered my chest and tricep workouts I've had to work thru the pain with a lower weight. Not sure if elbow braces would protect it as I go heavier or hurt them in the long run.

[KyMuscle]

Joe, just wanted to report that my hip bursitis is resolving amazingly fast. I've gone from feeling like a near-cripple 5 days ago to feeling about 75 percent healed. Walking normally again and feel very little pain when climbing stairs.

NSAIDs, rest and moist heat have done the trick. Thanks!

[joedemarco]

Joe, what's your opinion on using elbow wraps or braces when doing heavy chest pressing movements or even tricep skull crushers? Lately I've had some tendonitis in my left elbow that has hampered my chest and tricep workouts I've had to work thru the pain with a lower weight. Not sure if elbow braces would protect it as I go heavier or hurt them in the long run.

I would suggest wearing something like a neoprene sleeve over the elbows to create some slight pressure on them and also keep the joints warm. The braces may only give a false sense of security, thus leading to possible injury.

[joedemarco]

Joe, just wanted to report that my hip bursitis is resolving amazingly fast. I've gone from feeling like a near-cripple 5 days ago to feeling about 75 percent healed. Walking normally again and feel very little pain when climbing stairs.

NSAIDs, rest and moist heat have done the trick. Thanks!

Awesome! Really glad to hear that!

[KevinCouch]

I would suggest wearing something like a neoprene sleeve over the elbows to create some slight pressure on them and also keep the joints warm. The braces may only give a false sense of security, thus leading to possible injury.

Thanks Joe. I check out Walgreens today to see if they have them.

[gman]

Dr Joe, Paula is afraid to ask I think, but she is having pain just to the left side of the tailbone, just below the pants line. Radiates down the leg some and to the knee a little. I have SI joint problems, which are in the same area, but no pain in the leg and knee, so I don't know if Paula's is the SI joint or something else. Her pain goes away a lot when she exercises or walks, worse after sitting for a while. She says it really is bad when she drives home from work and has to sit in the car for 45 minutes straight. She is on her feet 8-10 hours a day as a dental assistant, and I am sure that doesn't help!

[joedemarco]

Dr Joe, Paula is afraid to ask I think, but she is having pain just to the left side of the tailbone, just below the pants line. Radiates down the leg some and to the knee a little. I have SI joint problems, which are in the same area, but no pain in the leg and knee, so I don't know if Paula's is the SI joint or something else. Her pain goes away a lot when she exercises or walks, worse after sitting for a while. She says it really is bad when she drives home from work and has to sit in the car for 45 minutes straight. She is on her feet 8-10 hours a day as a dental assistant, and I am sure that doesn't help!

Hey Mike, it sounds like it could be some S-I joint involvement. However, with the pain radiating into the leg, there is most likely some type of nerve entrapment going on. In other words, for pain to radiate down the leg, something has to be putting pressure on a nerve root somewhere between the lumbar spine and the leg. Often times, along with the S-I joint, I find a tight piriformis muscle. Nerve roots can get compressed as they pass by the piriformis, if the muscle is tight.

She should have the area looked at by a chiro. It's a good idea to get the S-I joint adjusted.

Here's a little home therapy you can try to loosen up the piriformis (if it is contracted). Have her lay on her stomach. Start applying pressure in some different areas over her left buttocks with your elbow. If you find an area that is really sensitive, slowly increase pressure and hold for a few seconds. You can let Paula know in advance, that it is going to hurt! Work the sore areas a few time with the elbow. After applying pressure, use some wet heat on the area for 20 minutes.

Go online and also locate some stretches for the piriformis muscle. It's to hard to explain. You are better off going on line so that you can get some illustrations.

Let me know how you guys make out.

[gman]

Hey Mike, it sounds like it could be some S-I joint involvement. However, with the pain radiating into the leg, there is most likely some type of nerve entrapment going on. In other words, for pain to radiate down the leg, something has to be putting pressure on a nerve root somewhere between the lumbar spine and the leg. Often times, along with the S-I joint, I find a tight piriformis muscle. Nerve roots can get compressed as they pass by the piriformis, if the muscle is tight.

She should have the area looked at by a chiro. It's a good idea to get the S-I joint adjusted.

Here's a little home therapy you can try to loosen up the piriformis (if it is contracted). Have her lay on her stomach. Start applying pressure in some different areas over her left buttocks with your elbow. If you find an area that is really sensitive, slowly increase pressure and hold for a few seconds. You can let Paula know in advance, that it is going to hurt! Work the sore areas a few time with the elbow. After applying pressure, use some wet heat on the area for 20 minutes.

Go online and also locate some stretches for the piriformis muscle. It's to hard to explain. You are better off going on line so that you can get some illustrations.

Let me know how you guys make out.

Thanks a lot Joe! I will try to get her to the chiro that I go to, but she can't get off work, so it will be tough. Definitely will research it some more online and try to do the elbow thing tonight.

[Bobr]

I've read several opinions of how creatine promotes muscle tears/strains. I have been using creatine off and on for many years-more on than off. Within the last 3 years I have torn my rotator cuff and my groin. Two nights ago I was attempting to up my hack squat poundage and on my last rep(#6) of my last set I pulled my inner quad in an area that was pretty close to where my groin tear was. The groin tear happened 18 months ago and is completely healed and my legs are strong but I seem to be much more prone to injury than I used to be. Granted I am 55 years old and that certainly may have something to do with it. Do you think that taking creatine exacerbates muscle injuries? Also, should I now be training differently at my age to try to avoid injury? I've always tried to push my weight poundage up when I can but it seems like this approach may not work for me any more as far as injuries go. I have a goal of competing nationally when I get to the 60+ age level so I am hesitant to reduce my training intensity.

[joedemarco]

I've read several opinions of how creatine promotes muscle tears/strains. I have been using creatine off and on for many years-more on than off. Within the last 3 years I have torn my rotator cuff and my groin. Two nights ago I was attempting to up my hack squat poundage and on my last rep(#6) of my last set I pulled my inner quad in an area that was pretty close to where my groin tear was. The groin tear happened 18 months ago and is completely healed and my legs are strong but I seem to be much more prone to injury than I used to be. Granted I am 55 years old and that certainly may have something to do with it. Do you think that taking creatine exacerbates muscle injuries? Also, should I now be training differently at my age to try to avoid injury? I've always tried to push my weight poundage up when I can but it seems like this approach may not work for me any more as far as injuries go. I have a goal of competing nationally when I get to the 60+ age level so I am hesitant to reduce my training intensity.

There's nothing, from a physiological perspective, as to creatine causing muscle tears. I think the association may be that when people use creatine, they are also trying to squeeze out those extra couple of reps (as well as working with a little heavier weight). Creatine has been shown to be effective in getting that extra rep or two, especially in the 4-6 rep range. Pushing extra hard and heavier often results in injury.

In regards to training, I know everyone on this board has different philosophies. Here's mine: If your body can handle heavy training, then keep training heavy. Others may argue, but I believe it is the most effective way for building size and mass.

If heavy training is resulting in injuries, then it is time to re-think how you train. Listen to your body. There are many effective ways to train with lighter weights. For example, "time under tension" is often discussed on this forum. Slowing the rep speed down so that lighter weight feels heavier.

You want to train in a manner that will work for you. You still have 5 years to go until you are able to compete in the 60+ division. Therefore you want results but you also want to be able to stay injury free so that you can continue to make progress.

Stay healthy and good luck!