​So you have some knee issues after exercising or maybe a lot of walking during work
 
It can feel like general tightness around the kneecap or aching and burning underneath it
 
It's usually there for most of the day, gradually getting worse as the day progresses.
 
You've seen your GP... rest and Voltaren tablets is what he offers you. You try and persist in doing your exercise sessions but the pain is just too great!
 
What you need to do is rehabilitate the knee and improve your walking and running biomechanics

Using a foam roller or massage stick, gently massage the lower portion of your quad muscles (just above the kneecap)
 
These strong muscles can pull hard on your shin if they are overworking and cause increased forces on your anterior knee structures, making them hot, puffy and inflamed.
 
Spending even 1-2 minutes massaging these muscles can make a big difference to how your knee feels
 
They can be VERY tender so be careful with how much pressure you use!

​If you've read my previous blog posts, you'll know that the knee is primarily a hinge joint (it goes forward and back only) and the hips/feet largely influence how it moves
 
So it makes sense to ensure that these surrounding joints are strong and capable enough to control the knee, right?
 
There's a lot more to it but one of the most common deficits we see with our clients suffering from knee pain is a lack of lateral hip stability... this forces the poor knee into a compromised position
 
One of the easiest ways to restore lateral hip stability is with the super-popular Clamshell exercise
 
It's a really effective way to activate the outside part of your glutes so that they can offer more support and stability to the knee. Start with a towel between the thighs with no resistance, and gradually progress if you are able to perform over 15 repetitions easily.

​Your contact with the ground is through your feet (obviously)... so why don't many people pay attention to them when addressing running-related knee pain?
 
Through the gait cycle, your feet has to be able to land in supination, control pronation, and re-supinate in order to effectively absorb shock and create propulsion
 
Using orthotics or shoes that BLOCK pronation is not the answer
 
You need to be strong enough to CONTROL pronation if you want to be an effective runner
 
A simple drill to restore pronation control can be performed by standing on one leg while holding onto the wall for balance
 
Make sure this movement is coming from your ankle/foot, not your knees or hips.
 
Slowly allow the inner arch to drop while remaining in control at all times, then proceed to lift it back up. Play within the “safe range” – can you control this easily throughout the wrong range on one foot?

Try these before your next run... I'm sure your knees will thank you for it
 
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About the Author:
Lawrence Khuu is a qualified Physiotherapist and Movement Specialist. His mission is to help motivated clients perform at their highest level through a combined hands-on treatment and exercise rehabilitation approach. He currently treats clients at Activ Therapy Casula.

​Everyone runs or walks each day... So we MUST be good at it right?
 
Wrong.
 
Doing something for many repetitions doesn't necessarily mean we are skilled at it ESPECIALLY if we are doing it incorrectly
 
For example, if you're running with poor technique over many kilometres, this will reinforce your movement habits.
 
So you're going to be really good at running with poor technique
 
Let's look at a few common examples of why some runners develop injuries:

When running, the most efficient place to land with each step is straight under your centre of mass (usually right below your hips).
 
Anything further in front of this will actually apply a braking force to your body, using up more energy and transmitting more force through your body
 
This is what runners will call "overstriding"
 
A few thousand steps of overstriding is no big deal for most people... they probably won't even notice. But what if you're running upwards of 20km/week and you're overstriding each and every step? Your body isn't going to be too pleased.
 
Have a look at your running from the side - where does your foot land in relation to your hip?
 
If you have this problem, try and focus on increasing your step rate (cadence) which will make it less likely to overstride

​Uncontrolled knee movement on the landing/stance phase of running is a big contributor to running injuries
 
The knee is primarily a hinge joint - it has a small amount of rotation to it, but it's main movement is straight forward and back (like kicking a soccer ball)... it is NOT designed to move side-to-side or to twist inwards or outwards
 
Rather, the hip and foot (surrounding joints) are much better equipped to do this
 
To check out what your hip is doing and if it functions well enough to control your knee, hop on the spot - is the knee motion controlled in line with the ankle, or is it not being controlled well?
 
If you have an unstable knee and add speed/load/fatigue/respiratory demand, can you figure out what happens next?
 
So if you see a runner with knees that move sidewards or twist excessively, then they most likely will run into some problems down the track

​This won't sit well with most podiatrists:
 
I HATE orthotics (when prescribed on their own)
 
Your foot is designed to CONTROL pronation and supination which is what most orthotics tend to block
 
The many muscles in the foot function to absorb shock when running, converting it to elastic energy to propel your body forwards, like springs in a car.
 
Add a physical block (orthotics) and those springs disappear
 
That shock absorption and propulsion disappears and your foot becomes weak and dysfunctional
 
Your super-cushioned, medial-arch supporting, expensive anti-pronation shoes might help you run further for a while, but your foot muscles are still WEAK
 
Just like wearing an ankle brace after a sprain... if you don't rehab it properly, your ankle will still be dysfunctional no matter how many bandages you put around it.
 
So what can you do about it?
 
Strengthen your feet and restore its FUNCTION!
 
If you can't control your foot in a sitting/standing position, can you imagine trying to control your foot when you run and put over 4x your body weight on it through THOUSANDS of reps per run?
 
Lift up all your toes - can you feel your arch lift up as well?
 
Most people DO NOT have a flat foot; rather they have a foot that flattens due to weak intrinsic foot muscles

​So which of these do you need to work on the most?
 
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​Maybe you're new to exercise and want to join your friends at the gym,
 
Or are you just coming back to it after taking some time off?
 
Whatever your situation, exercise is well known to have many health benefits including weight management, improved insulin sensitivity, elevated mood and increased resistance to cardiovascular disease.
 
It is ESSENTIAL for keeping healthy!
 
But before you start, here are a few things to consider so that you can get the most out of your training:

​Before embarking on a mission to improve your health, you need to set some goals.
 
Ask yourself: WHY am I doing this?
 
It's important to have a clear idea and focus on making this goal as specific and personal as possible. Compare the following for example:

• Losing 5kg in the next 3 months
• Losing 5kg of fat in the next 3 months in order to feel more energetic and happy, and to set the best example for my kids.

 
Which of these will resonate more with you when you don't feel motivated to go and exercise?
 
Take some time to really understand the real reason you have decided to start exercising. For some people, starting is the easy part - continuing through with it can prove to be the most difficult challenge...
 
And that's when you remind yourself what's at stake
 
Without setting your intentions, how do you know if your exercise program is effective or not?

Great! So you have set your goals. Now how are you going to achieve them?
 
This is where consulting with a good personal trainer can help you out
 
If your intention is to lose weight, you are (generally speaking) going to be doing more cardio than someone whose goal is to put on some size
 
What type of cardio do you like? Do you prefer running outside or on a treadmill? Or do you enjoy spending time on the crosstrainer? Perhaps you enjoy lifting weights, or doing circuit classes as a group? 
 
Whatever it is (and there is no wrong answer) you need to set a plan of action
 
For most people, your program will look something like this:

• 3-5 days of exercise per week
• Each session lasts between 45-60 minutes
• 2-3 sessions of cardio, and 1-2 sessions of weight training

Is your technique faultless or do you need some help to improve it?
 
Do you need help with the machines at the gym, or advice on the best way to train a certain body part?
 
... Do you know what you're doing?
 
This really important if you are to exercise for a long time!
 
There is NO SHAME in asking for help... the alternative is that you end up hurting yourself because of poor technique which can eventually lead to a a visit to your local Physio or Doctor
 
Save your time and frustration and do something about your technique before starting
 
A quick movement screen that we use in our clinic are:

1. Single leg balance
2. Overhead deep squat
3. Lunge

 
If you are struggling with any of these basic movements, can you think of how that will impact your training?
 
If you're new to lifting weights, we have a few guides for the most popular movements you will do at the gym. Here's one for the deadlift.(http://www.activtherapy.com.au/blog/4-steps-for-a-ground-shaking-deadlift)

Last but not least - be accountable to yourself
 
This means being consistent with your training routine and not missing sessions for crappy reasons
 
Some of the most common crappy reasons are:

• "I'm tired"
• "I don't feel like it"
• "I'm too lazy"
• "My friend isn't going so I won't go"
• "I'm tired"

 
It's harder than it sounds... that's why Step #1 is so important
 
One way to help you stay motivated is the Seinfeld Method
 
The rules are simple:

• Each time you exercise/eat well/etc., you cross out the date.
• See how many crosses you can get in a row
• DON'T BREAK THE CHAIN!

Hopefully these tips helped you out in making your exercise journey more successful, and a big Congratulations for making the effort to invest in yourself and your health!
 
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