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hip

A Plea For Your Knee

In our physical therapy clinics, we treat patients with knee pain on a daily basis.  It has become more common to train younger clients with a history of knee injury and ongoing knee pain.  Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems.  I have some further suggestions and clarifications.

Less Mass

The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy.  Carrying extra body fat creates an environment that invites knee wear and tear.  The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat.  If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball.  Start with strength training and low impact cardio.  Lose the fat first, and even then, the lower impact activity will be healthier for your knees.  From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest.  I am sorry, but fat loss is primarily a function of dietary alteration.  Exercise has very little impact on body fat levels if you do not eat properly.

Train the Way You Wish to Play

A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity.  The training must be tailored to your activity goals.  If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program.  Yoga will not prepare your knees for tennis.  If you want to water ski, then you must perform strength training for your back, hips, and knees.  Distance running will not prepare your knees for water skiing.  If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion.  Long duration recliner intervals will not prepare your knees for hockey.

Look Above

If your hips do not move well, your knees will pay the price.  In this age of all day sitting and minimal physical activity, hip function is at an all time low.  Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength.  If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement.  Learn how to perform some remedial gluteal activation drills.  Learn a proper hip hinge, squat and a pain free lunge pattern.

Think First

Participation in a single inappropriate activity can produce a lifetime of knee trouble.  That box jump workout of the day- maybe not.  The warrior, electric shock, mud hole, death run–bad idea.  Trampoline with the grandchildren–what were you thinking!

Be Proactive and Seek Treatment For Knee Pain

“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper.  The presence of pain changes the way your brain controls movement.  Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved.  Live with enough cycles of inefficient movement and you develop early breakdown in the knee.

Michael O’Hara, PT, OCS, CSCS

*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017

Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0

Keep your shoulders and spine happy and strong by following Mike O’Hara’s advice in “Pushing Up Performance”.  Video explanation and performance of pushups and their variations included.  Jeff Tirrell discusses the proper performance of pull ups in his article. “Movement You Should Master”. Is your mobility limited?  Try massage sticks or foam rollers with the information provided in “Pain, Pressure, and Pliability”.

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Train your hip adductors and bulletproof your legs by following the advice in Mike O’Hara’s article Adductors Galore.  Video demonstration and explanation included.  Mobilize your upper body by foam rolling.  In Foam Roll T W I, Mike explains the importance of adding foam rolling to your exercise program.

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Very Short Term Running Preparation

I was recently asked by a fitness client to post exercise recommendations that would prepare her for outdoor distance running.  This person was two weeks away from being out on the road, running two or three miles a day.  She is middle aged, has a prior history of lower back pain, and her goal was to lose fifteen pounds and “tone up”.   Given such short notice, these are my recommendations.

Perform soft tissue work on a daily basis.  Foam roll the legs and use a lacrosse ball on the plantar fascia.  The vast majority of overuse injuries in runners happen in the lower legs and feet.  Attempt to unwind the myofascial distress created by 600-700 foot impacts a mile.

Improve your reciprocal hip pattern–one hip goes back and the other goes forward.  Most general fitness clients have glaring deficits on one side.  Perform some split squats, posterior lunges, step ups, and or walking lunges.  If you struggle with these activities, I would reconsider running as a fitness activity.

Wake up your gluteals.  Every day, perform fifty or sixty bridges, hip lifts, or leg curls.  You need super gluteal strength / endurance to run distances and avoid lower extremity injury.  If your butt gets sore from fifty bridges, you need to do them more often.

Running is a skill and most recreational runners need some practice.  Running hills will improve gait mechanics, enhance hip extension, and decrease deceleration forces.  Find a fifty-yard hill.  Run up the hill and walk back down.  Perform five hill runs.

You are always better to run too little than to run too much.   Start with very short runs– no more than half a mile.  Increase your total weekly mileage by no more than five percent a week.

You can’t do this in two weeks, but this is my big recommendation to all future runners.  Lose the extra weight before running.  As a method of fat loss, distance running has a poor track record.  It tends to elevate the hormones that make you hungry, and physiological adaptation to distance running happens fairly quickly.  Extra adipose makes you far more likely to develop a running related injury.  I know the guys and gals you see running miles and miles every day are lean.  Please remember that lean runners are successful with running because they possess the optimal body mass to run long distances.  They did not start heavy and become lean.  Put a fifteen pound weight vest on that guy or gal and everything will change.  Their gait will lose efficiency and become less graceful.  The extra fifteen pounds of load creates the biomechanical overload that makes them much more likely to suffer an injury.

My final recommendation is that you not become disappointed if you develop pain.  A runnersworld.com poll conducted in 2009 revealed that 66% of respondents reported a running related injury that year.  The statistics indicate that one third of the participants at you local 10k fun run will require medical attention for a running related injury over the next year.  Have the good sense to stop when the pain begins.

Michael S. O’Hara, PT, OCS, CSCS

PDF

Hamstring injuries are on the rise.  In this month’s newsletter, Mike O’Hara, PT provides information on preventing hamstring injuries and includes videos of the recommended exercises.  Learn what it is to be “farm boy strong” and what you can do to become a “functional farmer”.

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PDFStanding desks are great for posture and health, but many people have difficulty when they first start using them.  In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time.  Watch the video for instruction on these exercises.  In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill.  Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.

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Renegade Rows and SHELC

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.  

Renegade Row-SHELC Combo

Renegade Rows
The renegade row starts in the top position of a push up.  Rubber hex dumbbells work the best for this exercise since they do not move on the floor.  Place the dumbbells on the floor and position the hands on top of the dumbbells.  Try to align the dumbbells directly under the armpits.  Maintain a strong grip on the dumbbell handle during the exercise.  Spread the feet at least shoulder width.  Tighten the shoulder blades down the back and create total body tension.   Without allowing the torso to turn, row one dumbbell up so the thumb approaches the armpit.  Lower the dumbbell in a controlled manner and repeat with the other arm.  Perform five repetitions on each arm.

Supine Hip Extension Leg Curls
shelcSet the TRX straps so the bottom of the strap is at the mid-calf level of your leg.  Lay supine and place the heels in the foot straps of the TRX.  The feet should be directly under the overhead attachment point of the TRX.  Place the arms on the floor at a 45 degree angle.  Brace the abdominal muscles and keep the head down.  Push the arms against the floor for stability.  Lift the hips off the floor and keep them up for the duration of the set.  Bend the knees so that the feet travel toward the body.  Keep the hips up and extend the knees in a controlled manner.  Perform ten to fifteen repetitions.  Common mistakes are turning the feet outward and allowing the hips to fall toward the floor as the knees flex and extend.

The anti-flexion and anti-rotation core stabilization demand created by this pair of exercises produces some interesting next day abdominal muscle soreness.  The ability to link the hips to the shoulder and produce movement is what everyone tries to accomplish with functional training.  Move through three sets of the Renegade Row – SHELC combo and let me know how it goes.

View video of Mike performing these exercises here: https://youtu.be/2_fT0zShTSo

-Michael S. O’Hara, P.T., OCS, CSCS

Hip Lifts and Roll Outs

When designing programs for rehabilitation patients and fitness clients, I often pair up exercises.  This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.  
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.  
Lose weight—Fat loss is a primary goal of most fitness clients.  Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.  
Move better—Training neurologically related movement patterns improves motor control.  

Hip Lifts and Roll Outs

An intricate system of muscles holds the spine upright over the top of the pelvis.  This pair of exercises coordinates and strengthens this support system.  If you sit all day long, have postural problems, or a history of lower back pain this pair of exercises is worthy of your training time.

Hip Lifts
hip_liftThis drill coordinates hip extension and lumbar spine stability.  It is very beneficial when progressed to the single leg version.  Lay with your shoulders across a bench with the head supported.  Place your arms out to the sides.  Plant the feet on the ground with the knees bent 90 degrees and the shins perpendicular to the floor.  Drop the hips to the floor and then push back up with the gluteals and hamstring muscles.  Hold at the top for two counts and repeat.

Roll Outs
The roll out can be scaled to serve any fitness level.  Beginners can start with a large 65 centimeter physioball, and as they become more proficient, progress to a smaller 55 centimeter ball.  The closer the hands get to the floor the more challenging the exercise becomes.  If you get strong enough, you can perform the forward roll out with a Power Wheel or Sorinex roller.

Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned perpendicular to the floor and the hips are hinged at 45 degrees.  Place the hands on the front of the ball and the elbows directly under the chin.  Brace the abdominal muscles and roll out onto the ball until you feel a challenge through your midsection.  Hold in the challenging position for three counts and then return to the starting position.
Perform twelve repetitions of the hip lifts, rest 30 seconds, and then perform ten roll outs.  Rest and repeat the cycle.  Work up to three sets through this exercise combination.

View video of Mike performing these exercises here: https://youtu.be/Xf08rFU7A4w.

-Michael S. O’Hara, P.T., OCS, CSCS

PDFIn this month’s issue, Mike O’Hara, PT provides information on Achilles tendinopathy with exercises that will help prevent this painful condition. Watch the video for the exercises by following the link in the article “Achilles Recovery”. Mike also demonstrates and describes the combination of turkish get ups and waiters walks–paired exercises that can help you train efficiently. Video for this article can also be seen on our youtube channel; just follow the links in the article.

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PDFEver wonder how many sets and repetitions of an exercise you should perform? Mike O’Hara, PT helps answer this question in his article “Old School Effective”. Jeff Tirrell discusses the importance of changing only one element of your fitness program at a time in order to determine its effective in “Be The Tortoise”. Exercise description and demonstration of single leg hip hinges are included in “One Leg At A Time”. Don’t forget to check out the youtube video that goes with the article.

 

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