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What can you do for knee pain?

4/26/2021

 
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I spent the last 2 weekends digging out weeds and prepping the ground for our new garden space. I used my right leg a lot to push on the shovel when I worked with the weeds and soil.

By the end of these heavy duty, all day gardening sessions, my right knee felt so stiff and painful I needed to address the tension around the knee.

I felt so good after my "knee rehab" session that I thought that I would share what I did.  I am not pain free yet, but I know that if I keep this routine up through the week, I will be good to go in no time!


How to get rid of a painful & stiff knee

  • Decompress knee with a band
  • Release with balls: quadriceps, hamstrings, calves
  • Work the tissues surrounding the knee with Gua Sha tools (or a butter knife)

Decompress

Release Around Knee Joint

Gua Sha Tool to Tissues Around Knee Joint

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.

Movement Practices to Settle Your Body

9/29/2020

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I have been reading the book, My Grandmother's Hands by Resmaa Menakem.  This book "is a call to action for Americans to recognize that racism is not only about the head, but also about the body.  Menakem introduces an alternative view of what we can do to grow beyond our entrenched racialized divide and takes readers through a step-by-step healing process based on the latest neuroscience and somatic healing methods." Quote from the back cover of the book.

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I have been taking time with the second part of Menakem's book, which is titled "Remembering Ourselves".  He says, "The place to begin the all-important healing of trauma is with the body.  Your body.  Each of our bodies."  He provides body and breathing practices to get to know, experience and understand the body.  I have been enjoying these practices and have incorporated some of the ways to settle into a movement practice.  The movement sequences shared below bring in novel ways to move the spinal chain and mobilize the joints.  "Sometimes trauma energy can get stuck in the joints," Manakem states.  The momentum and rotations can help to release the energy and reduce the tension along the kinetic chain. 
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.
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Disclosure: I only recommend programs and products that I would use myself.  If you use these links to purchase something, I may earn a small commission at no additional cost to you.
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Glute Strengthening

12/9/2016

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Glut Max strengthening
This October I attended a continuing education course: Functional Biomechanics of the Lower Quarter taught by Christopher Powers, PT, PhD, FACSM, FAPTA.
I walked away from the weekend with much more appreciation for the gluteus maximus.  The glute max works in 3 planes at the hip: extension (moving leg back behind the body), abduction (moving the leg away from the body out to the side), and external rotation (rotating the thigh so the knee moves outward).
The glute max is key to controlling the trunk over the pelvis, to the stability of the pelvis and to the lower quarter.  When the glutes are weak, you will see increased leaning of the trunk, excessive pelvic drop on non-weightbearing leg, and poor femur control (medial collapse of the knee & internal rotation of the femur).  Dr. Powers says, "If something isn't being used, something else is being overused."  If you have pain in your back, your hip, your knee, or your foot, stop right now and do this self assessment of your glut max.  Video yourself and observe your trunk, your pelvis and your knee as you step down and back up from an 8 inch step.

Step Down Test

My glutes need some work on both sides, but notice that I have less control with my right leg in this test.  I have a harder time keeping my trunk upright, my pelvis drops, and my knee collapses in and is wobbly.  What I really like about Dr. Powers program is that he provides a systematic 8 level training program for the glut max.  You cannot go to the next level until you are able to pass the lowest one with ease and control.  I have provided the first level of glute training here. Have fun, and may you be blessed with buns of steel!

Glute Max Activation

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.
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Get up and down from the floor with ease

10/19/2015

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Can you get up and down from the floor without using something sturdy for support like the coffee table or your knee?  A few years back there was a Longevity Test hot in the news that predicted mortality risk.  The test participants were told:  "Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed.”
The study found that those who needed to use their hands and their knees to get up and down were almost seven times more likely to die within six years, compared with those who could get up and down without support.
This study tested 2000 subjects ranging from ages 51 to 80.  Now I don't know about you, but I know a lot of 20-30 year olds who need to use their hands and knees for assistance!
Lack of joint mobility and decreased strength plague our ability to move well.  In order to get up/down from the floor easily we need toe extension, ankle dorsiflexion, knee and hip flexion and leg strength. Below I share with you two movements that are great for your lower extremity mobility and strength.

Split Lunge

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Step into a stride position. Allow your back heel to be off of the floor. Make sure your feet face forward (think railroad tracks).
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Drop straight down so your front knee bends at a 90 degree, and your back knee is bent at a 90 degrees. Hover just above the ground and then come back up. Repeat 5 times each leg.

Kneeling Toe Extension

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Come down into a crouch position with your weight into your foot pads.
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Begin to move your knees toward the floor taking your toes into an extension stretch. Moving nice and slow. Shift your weight down and back up 5-10 times. Stand back up and repeat the split lunges. Repeat the sequence at least 3 times.
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If it is too intense to come all the way down to the floor you can use a prop to bolster with.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.
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Hip Mobility

6/19/2015

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Improve Hip Mobility with this kneeling lunge stretch
Kneeling Lunge
The hip is simple in it's joint configuration, but very complex in its function.  Like the shoulder, it is a ball and socket joint.  That means that the thigh bone has a spherical head (femoral head) that fits into a cup-like socket (acetabulum) of the pelvis.  This type of joint offers high freedom of motion to allow us to get down into a squat, high kick, dance, karate, etc.  Compared to the shoulder, the hip has a little less motion in order to provide stability, and the femoral head can sit deeper in the socket of the acetabulum in order to prevent dislocation.
Because the hip is ball and socket, the joint is multi-axial, meaning it can move in many many planes of motion. When the foot is not touching ground (open chain) these actions are:
  • Abduction- moving the thigh away from midline
  • Adduction- moving the thigh toward the midline
  • Flexion- moving the thigh toward the chest
  • Extension- moving the thigh toward the back
  • Internal Rotation/External rotation- rotation about the femoral axis
  • Circumduction- moving the joint in a full circle

As I mentioned above, the joint is simple, but the function is complex because the hip joint, like any other joint in the body, does not work/move in isolation.  Lack of hip range of motion can effect the health of the shoulders, spine, pelvis, knees and feet.  Improving hip joint motion is one of the key steps to ensure proper mechanics of the extremities and the spine.  How are your hips?  Try these moves for better movement.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.

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Decrease Knee Pain

12/13/2014

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Decrease knee pain with therapy balls
I love using Yoga Tune Up® therapy balls!
Knee pain affects 25% of the adult population.  Most knee pain is blamed on arthritis.  Arthritis is joint pain, stiffness, inflammation. But what causes that?  How you move and use your body every day can increase joint loads, friction, and compression at the knee, and can eventually lead to pain, stiffness and inflammation.  So, below is a series of movements to decrease the tension in the muscles surrounding the knee. This sequence is designed to improve blood flow and connective tissue hydration which can help decrease the tension in the muscles surrounding the knee and help to decompress the knee joint.
Save your joints and give yourself some quality ball time!

4 movements to release the muscles around the knee:

The last two videos don't show it, but you will want to continue to move the ball down the calf.  Repeat on both sides, or just on your side of pain.  If your knees are too stiff and painful to bend as shown in the last two videos, roll up a towel and place it on top of the balls and then sit back.
You can by the Yoga Tune Up® Balls and DVDs if you want to explore the amazing products from Jill Miller and Yoga Tune Up®.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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Refining the Quad Stretch

8/14/2014

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The quadricep muscle group is comprised of 4 muscles that all share a similar attachment to the lower leg bone, the tibia. The muscles converge at the knee at the patella (knee cap) and inserts onto the tibial tuberosity.  The muscles are named for their location on the thigh:
  • Vastus Lateralis -spans from the outside of the thigh to the tibial tuberosity
  • Vastus Intermedius -spans from the center of the thigh to the tibial tuberosity
  • Vastus Medialis- spans from the inside of the thigh to the tibial tuberosity
  • Rectus Femoris- spans from the front crest (anterior inferior iliac spine) of the pelvis to the tibial tuberosity

The main action of this group is to extend (straighten) the knee and the rectus femoris will also flex the hip.  Quadricep control is important for walking, running, going up and down stairs, lunging, squatting, basically every move we make.  Having supple quadriceps is key not just for healthy knees, but for healthy feet, hips and spine.  Restrictions in the quads will affect proper loading of the foot and knee during gait.  Tightness in the rectus femoris can pull the pelvis forward into anterior rotation which increases lumbar extension and spinal compression, and can limit hip extension (being able to bring the leg behind you).


How to stretch the quadricep

Let's face it.  Many of us are super tight, and it feels good to pull on the leg as far as you can to get a deep stretch. The stretch always feels good, but the muscles never fully let go and we have to keep stretching forever and ever.  One possible reason why the muscles don't make lasting changes is that we have a stretch reflex within the muscles that serve as a protective mechanism:  if the muscle is stretched too far beyond its limit, it will contract to prevent injury.  During stretch sessions, you may be moving beyond your tissue limit so the muscles never change!  One way to refine and meet your tissues is to scale back and use alignment markers to guide you into your stretch.
Alignment Markers:
  • Maintain level shoulders and pelvis
  • Keep thigh in line with hip: don't let it move out to the side, or out to the front 

Typical quad stretch

Standing Quad Stretch
Notice in the first pic that in order for me to grab my shin I had to move the thigh out to the side, and you can see that as I hold my ankle my right shoulder has totally dropped down. In the pic on the right you can see that due to the tightness I have had to move my thigh in front of me, rather than behind me.

Refined quad stretch

Standing quad stretch refined
Here I am using a strap to help me meet my tissues. On the left you can see that my shoulders have leveled out and my thigh is straight down from my hip. You can see in the pic on the right that I can barely bend my knee as I keep my leg straight down rather than out in front of me.

How to release the rectus femoris (hip flexor and knee extender)

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I am pointing to the ASIS landmarks on the pelvis.
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The half cylinder (rolled yoga mat or towel) will cover the ASIS landmarks. The pubic bone will not touch your prop.
Quadricep release on the floor
Lie on your stomach with the bolster under your pelvis markers. Make sure that it does not touch your pubic bone. Breathe here and relax for 3-5 minutes.
Assessing new motion after quadricep release
After your release remove the bolster and see how far you can bend your knee. Make sure that you keep your pubic bone touching the floor.
quadricep stretch on the floor
See if you can reach for your foot, ankle or shin. Make sure you can keep your pubic bone down. Hold for a stretch. If you can't reach with your arm, grab the strap.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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How to Squat

3/20/2014

19 Comments

 
Posterior Chain muscles used during the squatPosterior chain muscles used during the squat.
If you didn't know already, the squat is hot. Everybody is doing it..... The squat is one of the most effective ways to strengthen your glutes.  But.... not every body is ready to bust the move and go deep into the squat position without losing their balance or hurting their knees.  
This post demonstrates how to perform a double leg squat and a single leg squat with a vertical shin.  A vertical shin helps take the load from the knees and puts the weight back into the posterior chain: hamstrings and glute max.  The single leg squat also engages the gluteus medius, which is important for stabilizing the pelvis.


Double Leg Squat

Single Leg Squat

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
19 Comments

How to release the inner thigh muscles

8/20/2013

11 Comments

 
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The inner thigh (adductor group) is made up of five muscles:
  1. Pectineus
  2. Adductor brevis
  3. Adductor longus
  4. Adductor magnus
  5. Gracilis

When the foot is not planted on the ground, the adductors will bring the leg toward the midline, and flex the hip when the thigh is in an extended position as in the swing phase of the gait (walking) cycle.
The adductors play a significant role during walking and are active in all phases of the gait cycle. The adductors are a part of two important functional kinetic chains:
  1. Lateral Sling: comprised of the adductors, same side gluteus medius/minimus, opposite side quadratus lumborum.  This chain is responsible for frontal plane stabilization of the lumbo/pelvic/hip complex during single leg stance (stance phase of gait), squatting and lunging.
  2. Anterior Oblique Sling: comprised of the adductors, same side internal oblique, opposite side external oblique and hip external rotators.  This chain is responsible for transverse plane stabilization during trunk rotation in gait, throwing, swinging, twisting activities.


Dysfunction within the slings can result in overuse of the adductor group leading to over facilitation,  increased tension and bound up connective tissue, and potentially pain.  Here is a videoblog demonstrating how to release the adductors using a foam roller.

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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Gluteal progression for back, hip and knee health

3/20/2013

23 Comments

 
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Photo by Gesina Kunkel 
Weak gluteal muscles can be blamed for many low back, hip and knee pain/injuries.  Without the muscular support, the back, hip and knee are subject to increased loads and excessive motion leading to friction and wear and tear. The 3 gluteal muscles: maximus, medius and minimus assist in controlling the trunk and the leg as it is loaded during foot contact to the ground as in walking, running, jumping, going up/down stairs, as well as moving from a sit to a stand or bending. 
When the gluteal muscles are weak, you will notice increased movement of the trunk toward the side of weakness, and the knee will cave in toward the midline.  Are your glutes weak or strong?

Gluteal assessment:  Step down from a stool. 

Start to observe what you do when you go up/down stairs: do you turn your foot out to give yourself more support, does your knee drift to the midline, do you shift your torso over to the planted leg to make it easier to step up? If yes, then your glutes are weak
What happens when you bend down to pick something off of the floor or transition to get in and out of a chair:  do your knees come together?  If yes, then your glutes are weak.  ​​
Gluteal strength assessment: step down from a stool
Stand on a stool. Slowly begin to lower one leg down, tap the floor with your heel and then return back up. Repeat 5 times. Notice if your standing knee collapses toward midline, or if your torso leans to the side. If either or both happens, you need to strengthen your glutes!

Strengthen your glutes: standing progression

Single leg standing balance
1. Start by standing on your left leg. Keep your thighs parallel and bend your other knee so your foot can tap down on the floor like a kick stand if you need it to balance. Check yourself in the mirror. Make sure that your pelvis does not rotate. Keep your ASIS facing forward (that is what I am pointing to). Ideally you want to have your pelvis level. Check your waistband: if the right side is elevated then you are using your back muscles to compensate, if it has dropped, then you are not activating your left glute! Work toward standing for 1 minute. Switch sides.
Single leg balance with vertical leg
From a side view, try to maintain vertical alignment: midpoint of shoulders and hips over ankle bone (I am not quite there, helps if you have a mirror to look into). Keep the standing leg straight, and your quads in front of the thigh relaxed!
Single leg balance with opposite knee flexion
2. Next progression begin to bend your knee as far as you can and then return to start position. Perform 10 reps and then on the last one, keep it bent as you balance for the final minute. Again, make sure that the pelvis doesn't rotate or drop.
Standing hip abduction to strengthen gluteus medius
3. Stand on your left leg. This time your pelvis will elevate because you won't be bending your right knee. Keep your leg straight as you move it out to the side and in. Work toward 1 minute and then switch sides.
Side step with monster band for gluteal strengthening
4. Side step with a light resistance band (if you have had a hip replacement do this without the band). Make sure to keep feet straight ahead and plant your foot with the outside edge straight.
Hip strengthening with resistant band
Make sure not to bend your knees. Most people cheat by bending the knee because the glutes are weak. Don't do it!
Monster walk with band glut med strength
Make sure to land your foot with the outside edge straight, this position engages your glut med and min. Return to normal hip width distance. Make sure to relax your quads between steps!
Standing balance with hip extension
5. Now for the glute max finale! Standing on your left leg, extend your rlght leg behind you. Begin to lower your torso as you hinge at your hips bringing your hips behind your ankle, and then return.
Hip strengthening: standing arabesque
Make sure the movement is coming from your hips, not your spine! Pelvis should stay level. This is challenging, mostly from a balance perspective. If this is hard for you, then get into position and hold.
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
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Contact:  Susan McLaughlin, PT 801.859.4142
susan@alignforhealth.com