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 Massage the lower quads 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! Strengthen the hips 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. Strengthen the feet 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 If you liked this content and would like to find out more, follow us on Facebook @ActivTherapyCasula for the latest updates. 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.
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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: #1 Overstriding 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 #2 Excessive knee rotation 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 #3 Weak feet 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? If you liked this content and would like to find out more, follow us on Facebook @ActivTherapyCasula for the latest updates. 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. 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: #1 IntentionBefore 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:
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? #2 PlanGreat! 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 Technique 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:
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) #4 AccountabilityLast 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:
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:
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! If you liked this content and would like to find out more, follow us on Facebook @ActivTherapyCasula for the latest updates. 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. The squat is performed all over the world in gyms and off couches. They are many variations: back squat, front squat, overhead squat, Goblet squat, box squat, safety bar squat and sumo squat to name a few. It's an awesome test of strength, control and flexibility. There is a LOT of information out there about "the perfect squat" and what it should look like. This article will discuss why some of this information is FALSE and what YOU can do to make your squat better MYTH #1 - Feet Forwards "Feet forwards" might be a good cue for some people but definitely not the majority. Most people will be comfortable squatting with their feet turned out 20-30 degrees. Although feet forward will reduce the incidence of a foot collapse, it will also increase the incidence of excessive foot supination too much pressure on the outside of the foot Turning out 20-30 degrees will allow the foot to be planted in neutral where it's most powerful It also improves hip positioning, allowing for better depth and reducing the incidence of pinching hips. Don't believe me? Try it out for yourself. With our athletic clients, we use a simple "Hip Scour" to find the best position for the hip to be in during the squat. To perform this, lie on your back and flex one hip to your chest. Begin to "scour" or circle the hip to find the position which is most comfortable (usually gives you most hip flexion range). This gives you an idea of the best squat width and foot position for YOUR body - it's not going to be the same for everyone! Pop on up and test your squat with the new stance MYTH #2 - Knees Behind Toes The concern for forward translation of the knee is that it will give you knee pain. It's true that with increased knee-bending, knee joint and ACL stresses also increase. But it's important to consider the role of the hamstrings and posterior thigh during knee flexion. These important group of muscles act to pull backwards on the shin and "balance" out the forces on the knee. If you initiate the squat with your knees bending first, you are likely not to be using your posterior thigh muscles to their potential... this will increase the pressure on your knee joints If you initiate the squat with your hips, this will balance out the forces around your knee joint by loading your glutes and hamstrings first. Maybe that's why the best squatters have big butts? It's impossible to keep your knees behind your toes for a full-depth squat without compensating in one way or another - common examples are going up on your toes, or by leaning your body forwards excessively. Think about it: knees behind toes means your bodyweight is going backwards... so either you fall over on your butt, or you lean forwards a lot (or reach arms forward) to stay balanced. For some of our clients, simply allowing them to let their knees go in front of their toes slightly improves their squat dramatically. Check out this remarkable image below - it explains everything: MYTH #3 - Knees Out! Last but not least, "knees out" is a common cue that we hear everyday at the gym. Its intention is to prevent the knee from collapsing inwards during the squat which increases stress on the medial aspect of the knee. But there are a couple problems: 1. If cued for the wrong athlete, it will cause him/her to excessively supinate the foot 2. Can cause excessive tibial torsion rather than its intended hip rotation Both of these things can cause the knees to hurt during the squat You'll know this cue is for you if you feel excessive pressure on the inner side of your foot/heel or big toe, or your knees travel towards each other (uncontrolled) during the squat. A cue that I've found to work better is "open your groin" (borrowed and modified from one of the best Powerlifters ever, Ed Coan) in order to activate the deep rotators of the hip rather than the lateral thigh (tight ITB and hamstrings, anyone?) However, if you don't have a medial foot/knee collapse, DO NOT use this cue when squatting! This is a really common misinterpretation that can negatively impact your performance. Here is the amazing Barbell Physio himself, Dr Zach Long, demonstrating this idea. It's hard to see with shoes on but he has more weight towards the outside of his feet by overdoing the "knees out" cue. Note: Zach is doing this intentionally to educate his readers in his EXCELLENT blog post here (https://www.thebarbellphysio.com/the-truth-about-squat-depth-injury-rates-the-knees-out- cue/) Do any of these apply to you? There is no one-size-fits-all method to coaching and treating injuries - each athlete is different and must be coached differently! The BEST way to see if any of these corrections are appropriate for you is by TESTING them under a light/no load. If you liked this content, feel free to drop us a Like and follow us on Facebook @ActivTherapyCasula for the latest updates. Happy Squatting! About the Author:
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