rehab

Tune-Up Tuesday - Episode 6: Knee Pain With Lunging

Tune-Up Tuesday - Episode 6: Knee Pain With Lunging

In this episode of Tune-Up Tusday, we are joined by Dr. Zak Gabor of Boston PT and Wellness.  He discusses a simple, yet effective modification to the lunge that will help you train around cranky knees.

Move Better Installment No. 2: Controlled Articular Rotations

Move Better Installment No. 2: Controlled Articular Rotations

This blog post is a follow up to last weeks post on CARs.  Learn how to correctly perform shoulder and hip CARs - as well as some key points needed to effectively perform Controlled Articular Rotations.

What is Kinstretch?

Kinstretch is defined as a movement enhancement system that develops maximum body control, flexibility and USABLE ranges of motion.

So what does this mean?

Unlike other common methods of flexibility training such as yoga and passively stretching muscles, Kinstretch focuses on gaining control of your passive flexibility by using our muscles (rather then gravity) to attain improved mobility.  This serves two purposes, improve usable ranges of motion and strengthen in these new ranges. 

Top picture is the before and the bottom picture is the after, they were taken a week apart. 

Top picture is the before and the bottom picture is the after, they were taken a week apart. 

Simply stated, Kinstretch focuses on training your end range of motion with the goal of improving your movement capabilities and decreasing your risk of injury. 

Why end range of motion?

The human body is a highly efficient organism.  Due to the copious amount of biological processes that go on in our bodies, it has learned to become extremely efficient.  

The body's efficiency allows it to take short cuts when possible to allow it to work at full speed.  This is a reason why we develop habits, which are automatic behaviors that we don't have to think about.  It is also why our bodies tend to the path of least resistance when doing things such as skiping a workout, hitting the snooze button or utilizing movement compensations.

These processes allow our bodies to remove pathways from the body that are no longer used. For example, having a skill when you were a kid that you suck at today (whether you want to believe it or not).  This is because the synaptic pathways that created that skill degrade when rarely used.  This gives way for new pathways to connect to allow you to learn new tasks.

The same goes for movement.  If you haven't moved through a particular range of motion, the joint mechanoreceptors don't get stimulated often. Eventually the lack of stimulus will cause atrophy of these mechanoreceptors and cause decreases in range of motion.

There are other factors involved in this, but this plays a role in our lack of movement variability today.  

Our lives today revolve primarily around sitting ( I am sitting now as I write this post).  We tend to be hunched over with arms in front of us and hips flexed.  This typical posture results in the loss of thoracic extension, shoulder flexion (arm over head) and hip extension.  Therefore, the adage of we lose range of motion as we get older is incorrect.  It really should be, because we don't use it that we lose it. 

Returning back to training end ranges of motion.

In Kinstretch we train end ranges of motion to attempt to restore decreased mobility and improve movement capabilities.  Kinstretch is geared towards creating more active range of motion so you can be better at all the things you love to do most. Whether that is deadlifts, swings, running, sporting events, gardening or playing with your kids.  The better you move, the better you can enjoy life regardless of your goals and what you enjoy in life. 

Move Well, Stay Strong. 

 

Ankle Mobility

Early on in my career, I have had a handful of patients that regardless of what I did, their squat technique was always off.  I would work for months and months and I could only make so much change.  Banging my head against the wall, it took me way too long to start to look at the ankles during my assessment process.  

The ankle joint is one of the most overlooked joints in the body when movement dysfunction or pain exists. Poor ankle mobility can cause poor movement patterns, knee pain, inability to squat to full depth and a slew of other problems.   

HOW TO ASSESS ANKLE MOBILITY

Before you start randomly throwing ankle mobility exercises into your programs, first start with this simple assessment from the FMS/SFMA.

By assessing the ankles you now have an objective measure that will A) tell you if you have a deficit and B) is an objective way to retest your mobility to see if you are actually making improvements.

ANKLE MOBILITY FIXES

There are a ton of very good ankle mobility correctives out there.  The following are just a few of my favorites placed into one location for your convenience. 

Since the calves are always in use with walking, standing, jumping, running etc... they have the potential to develop trigger points and tightness.  In order to address this there are 3 things we need to focus on. 

1) Self Myofascial Release: To Your Calf and Plantar Fascia. 

Using a foam roller or a lacrosse ball (any ball will do really) roll the entire length of the muscle for 30 seconds to 1 minute. If you find any tender points along the way, stop and keep pressure on this area for 5 deep breaths.  

Note: The plantar fascia is part of the superficial back line.  It had a direct fascial connection with the gastroc, therefore rolling both out can offer greater benefit than one alone.  

2) Stretching - There is a lot of chatter going on in the field of health and fitness that stretching is overrated, and we do too much of it.  As there is much merit to this, focused stretching to areas that NEED to be addressed is beneficial.  Bottom line here: Don't stretch a muscle just because it feels tight.  Use objective measures that assure you that what you are stretching (like our DF assessment) is actually improving your mobility and movement. 

There are many ways to stretch this area of your body.  Just make sure that when you stretch, you hold the stretch for 2 minutes without coming out of it.  Research done from Dr. Andrea Spina and the FRC courses suggests that tissues need at least 2 minutes of constant communication to effectively make positive improvements. 

3) Ankle Mobility - These are best served as movement prep for your workouts, and to help improve ankle joint mobility.  Here a couple of my favorites below:

Ankle Mobs to Wall

Mulligan Mobs with Movement

Calf Rock Backs

Whether or not you feel your technique is good or not, take 2 minutes to assess your ankle mobility.  It can potentially help you find limitations that can help improve your technique and performance. 

Hope this was helpful, please leave your comments and feed back below. 

 

How to Get the Most Out of Your Rehab

Just to be clear, Physical Therapists do not fix people.

Um what!?

You read that correctly, physical therapists (myself included) do not fix injuries.  I know you are thinking 'well why do I spend all my time and money on co-payments and deductibles if no one can fix me?'

In an outpatient setting, a PT is able to determine the root cause of your pain through the evaluation process.  By understanding your mechanism of injury, current symptomology, and examination of movement a PT can give you a movement diagnosis that allows them to address any pain, tissue extensibility, mobility or motor control issue that might be present. 

You are probably thinking now, 'hey you just said PTs can't fix me, but they can put me on the road to recovery?'

Exactly! Physical therapists put you on the ROAD TO RECOVERY.  This does not mean we fix you; the hones truth is the only person who can fix you is... YOU.  The bottom line being that a PT alone cannot ¨fix¨ your ailments all by him/herself, the other person in the equation of recovery is YOU. 

Every time I see a patient, any benefit they get from seeing me I call “the window of opportunity.” All tissues in the body have a threshold level that once met, pain settles in.  The benefit you get from PT is increasing your threshold, which improves your pain tolerance.  

So if you see a PT for 20 minutes to an hour twice a week and have your window of opportunity opened, what you do with the remaining 23 hours will have an even greater impact on your window as well. 

What I often see is a person feels much better after leaving PT. These effects lasts roughly a day or two and by the time they return for their next visit their pain has returned.  

 

SO WHAT IS THE BEST WAY TO GET THE MOST OUT OF YOUR REHAB!?

The number one tool a patient has for recovery is their home exercise program (HEP).  Your PT should be giving you, the patient, 2-4 corrective exercises that will maximize your window of opportunity between visits. But more often than not my patients have all the excuses in the world why they can do their home exercises, which on average takes under 10 minutes to complete. 

This boggles my mind because if I told you in 10 minutes a day you can be pain free, would you say yes, I will do whatever it is?  You may be nodding your head yes, but my experience begs to differ.

If you do your exercises as prescribed, you keep the window of opportunity open a little longer, so the next time your PT sees you they can continue to make it larger until your threshold of pain returns to normal. 

Even after being pain free, you must remain pain free for six months before you decide to cut back on frequency of HEP.  Would you rather spend 10 minutes a day now however it fits your schedule for the next 6-8 months or continue to have pain and see PTs for the same problems over and over again. 

HERE ARE A FEW TIPS

  • Do your exercises at a set time every day.  This will help you to develop habits.

    •  For example after you brush your teeth in the morning you do 5 minutes of exercises.  

  • Break up your exercises throughout the day.  

    • If your PT gives you 10 minutes of exercises but between life, kids, relationships, work etc some days you just can find 10 minutes.  No problem.

    • Break up the exercises into smaller time slots.  Do 2 minutes of exercises sprinkled throughout the day on 5 separate occasions.  No one ever said you HAVE to do them all at the same time. 

Hope this helps! Take advantage of this tool and feel better faster!

Hinge Your Way Free of Back Pain

What's your plan of attack when your back aches? Painkillers? Stretching? Ice and heat? While these might provide temporary relief, we're missing the bigger picture if we don't address the way we move through our hips.

Often times when your back hurts it is often due to lack of stability and/or mobility at joints.  This makes sense when we review Gray Cook and Mike Boyle's joint-by-joint approach to the body.

When we look at this model we see that the body alternates segments of stability and segments of mobility.  These areas align themselves so that we can stabilize in certain areas in order to move freely in others. An example of this (not on the chart above) is learning proper scapula stability so we can enjoy all the range of motion the shoulder provides.  If the scapulae aren't stable, compensation patterns inhibit optimal movement of the shoulder joint.  

IMG_0037.JPG

With repetitive stresses or lack of movement over time, bodily joints have the potential to lose their inherent mobility. Once this happens the body has to compensate for this lack of motion by creating motion at the segment directly above or below.  What this ultimately does is flip-flop the order of mobility and stability.  One of the most common examples I see of this is through the loss of hip mobility.  Most people, especially those who sit at work all day lose the ability to hinge at the hips.  This loss of hip mobility causes either the lumbar spine or the knees to move excessively while moving. Whether bending over, squatting, deadlifting, or picking up your child to name a few examples, the ability for your body to maintain the joint-by-joint approach is imperative in order to prevent muscle tightness, stiffness, weakness and pain.  

Based off this information, one of the first things I assess when having a patient with low back pain is their ability to hinge.  Most often than not, their hip hinge is not up to par... and that's putting it nicely.  Even if you don't have pain, the inability to hinge from the hips will rob you of strength, power, mobility, and overall quality of life.  

Check out the video below to see some hip hinge hacks.  They will make you a better person.  

If these helpful tips helped you out, or if you just plain hated them leave me a comment below and tell me all about it!

Feel Better In 5 Minutes A Day

If I told you that in 5 minutes a day you could decrease pain, increase energy levels, and decrease stiffness in muscles and joints, would you do it?

Is this some sort of magic pill that will make you feel like you just drank from the fountain of youth? No, not quite. The "pill" I speak of is what I like to call movement variability.

Movement variability is defined as, "repetitive movement that is not repetitive" (insert confused emoticon here).  To simplify this definition, you should simply move in ways that are different than what you are currently accustomed to. 

For most people, sitting at a desk is a reoccurring stimulus on an everyday basis. For marathon runners, this repetitive movement is constant running in one direction without ever moving within any other planes of motion.  Over time as we continue to load the same patterns over and over, pain can develop due to multiple factors.  If we spent time moving with variety throughout the day it is possible that both our perception of tightness and pain can be diminished.

Here's the crazy part. 

In order to start moving and feeling better, all you need to start with is five minutes of movement.  For those of you who follow me on Instagram, you know that I love Max Shank's 5 Minute Flow.  I've done this since June and honestly feel better now than I did in my college days.  Since initiating in a daily five minute flow, I've dramatically decreased pain in my lower back. I feel much more limber and mobile throughout the day, which has boosted my confidence when lifting weights. I also feel more energized to start my day, after just five minutes of free and random movement!

Max Shank states that you should, "move for five minutes in a way that gently pushes your flexibility but keep moving.  Don't worry if you get stuck somewhere, retrace your steps while you think of the next movement.  If you're into martial arts or yoga throw your own blend of that together."

Everyone can find five minutes in their day, whether it be in the morning, during a lunch break or sometime in the evening.  If you claim to not have time to flow, you need to take a better look as to why you really are not doing this. Not having time is an underlying translation for, "I don't want to do it." Give it a chance, I promise you, in just a few days, you'll feel like you're reliving your youth.

HOW TO:

  1. Set a Timer for 5 minutes. If you have a favorite song that's exactly five minutes, use it.
  2. Find an open space where you don't have to worry about banging into tables, or having anything fall on you.
  3. Just move continuously. Do any stretches, mobility drills or yoga poses for 5 minutes straight. The only rule is to constantly move. 
  4. Commit to 30 days.  Try it for 30 days, see how you feel, and keep doing it afterwards if it makes a positive change. 

Below is a 5 minute example.  The video is time lapsed, if you would like to see a full version you can click here

Get your Joe Flow on and let me know how you feel in the comments section below. 

 

Why Squatting Hurts Your Knees

Your form sucks.

You're trying to lift more weight then you can handle.

               You've injured your knee doing something that was not squatting.

You're a combination of the three scenarios above.

It is unfortunate that the same myth continues to slap me in the face on a daily basis. I feel like I'm surrounded by it day in and day out at the clinic, with a potential client and/or a novice trainee under my guidance.  "My knees hurt when I squat".  My teeth cringe and my blood pressure rises every time I hear this said to me.  

If your knees hurt when you squat, it is time we stop blaming the squats for the pain and start looking into why our knees are bothering us.  We have been squatting since we were babies, why is it that all of a sudden squatting is the culprit behind our pain?

If "squats hurt you", here are a couple of things you might want to look into to figure out why you may be having pain.  

  • You lack full ankle dorsiflexion. 
    • That is the ability to point your foot towards your head.  If you lack dorsiflexion, you will have to compensate at other joints to make up the lack or range.  This often comes from the knees, or the low back (and possibly both).  
  • You lack core stability. 
    • Whether the abdominal wall, the lats or the hip musculature is weak, (all of these make up the core) abnormal forces will be transmitted through joints rather then through contracting muscles and tendons.  This will cause excessive shearing at the knees and even the low back, which overtime can cause pain and dysfunction.
  • Transverse/Frontal plane deviations. 
    • As athletes, gym-goers and sedentary individuals, we train and live mostly in the sagittal-plane (think front and back movement like walking).  Squatting is a sagittal-plane movement. Often time when some one squats, we see them sit more towards one leg than the other or rotate their bodies.  This is common especially when someone is trying to lift a weight that is too heavy for them.  This becomes a sure fire way to cause an angry knee or low back.  

Watch the video below to see how I teach the squat and how it may help you squat pain free. 

Leave some feedback in the comments section and let me know if this helps!

Until Next Time.