Why your knee pain isn’t getting better.

Have knee pain but didn’t suffer some kind of injury?  You’ve probably tried the standard interventions Rest, Ice, Elevation, Compression, maybe even a brace or KT tape.  Airrosti anyone?  Chances are, this hasn’t done anything for your problem, the pain keeps coming back, or any time you try to go without the brace/kt tape the pain comes right back.

Right behind back and neck pain the most common area I seem to treat in the clinic is the Knee.  The above is how the story usually seems to go.  The aggravating factors?…Squats & Stairs.  So why isn’t your knee pain getting better or why does it always come back?  Because you’ve been treating the symptoms rather than the cause.  We can’t just ice the knee without asking WHY is it inflamed to begin with?  What caused the damage?

The answer: Poor Movement Patterns. 

When your tires are wearing weird on your car do you just replace the tires or do you check the alignment?

Why?  – Inward Rotation of the Knee
This can happen either because of hip weakness, foot weakness, or both.

from: https://goo.gl/images/cALrnH

1. Weak Hips
   • It is very common for people (even frequent gym goers) to have weakness in the hips, specifically the muscles that rotate the leg outward. When these muscles are weak the thigh will rotate inwards as the hip flexes, causing the knee to ‘turn in’ or move inward in relation to the foot and hip.  If these muscles are very weak, this will happen when a person is standing on a single leg.
     

     From: netter atlas of human anatomy

2. Weak Feet
   • If a person has weak foot muscles their arch will collapse when put under increased strain.  If the foot collapses, the knee will again move in relative to the foot and hip.
     

     From: Netter atlas of human anatomy

• Summary: The knee is the joint caught in the middle of two very problematic areas and when there is dysfunction, its often the knee that takes the brunt of it.

So the question is, when traditional methods fail what do you do?

1. Form Check – Try squatting in front of a mirror or film yourself performing a body weight squat. Does it look like the picture on the left?  If so we’re talking about a movement impairment problem.

http://www.aphysio.com.au/runners-knee/

2.  Strengthen

• Hips – 
  • Clam Shell

    Position: Laying on side, knees bent, feet together
    Heels, shoulders and hips aligned
    Tilt body slightly forward (pointing navel toward the floor)

    Action: Squeeze through your glutes (buttocks)
    Keep your heels together and lift top knee up.
    Hold 5 seconds, slowly lower to starting position. (In this photo I have a resistance band around my knees, this is a simple way to increase the challenge but is not necessary to benefit from this exercise)

    Form: Do not arch your back.
    Do not allow hips to rock back & forth.
    –You may want to perform with a wall or other straight surface behind you
    Keep glutes contracted the entire time.

    To increase the difficulty you can add a resistance band around the knees or hold for a longer period of time.

    

  • Glute Bridge

    Laying on back, knees bent about 100 deg,feet on floor & close to the buttocks. Squeezing your glutes and ab muscles, push through heels & raise hips off the floor until hips and knees are in a line. (if you feel your back working, don’t lift your hips quite as high)

    Hold position 2 seconds

    Slowly lower hips back towards the ground and repeat. (you can add difficulty by placing band around knees.)
    Feet – 

• Foot Muscle Energy Technique 
  • Sitting upright, curl toes passively, using hand.
  • Remove assistance of hand and continue holding toe curl with muscles in foot.
  • Hold for 10 seconds.

       Toe curl and point

• Sitting upright, leg extended out in front of you. Curl your toes around a small towel (dish cloth), you may need to bunch up the towel a little.
• Keeping toes curled/holding towel with toes, extend your foot as if pushing a gas pedal. Try not to drop towel. Hold for 1 second and return to starting position.

from: HEP2go public

Towel Curls

• While seated, place a towel on a smooth floor under the arch of the foot (heel is in contact with the floor). Curl your toes in pulling the towel back towards you.
• Be sure to keep your heel in contact with the floor the entire time.
• Place a small weight or bag of rice on the towel to increase difficulty

3.  Stretch

hep2go public

Standing calf stretch

• Start by standing in front of a wall about an arms reach away, feet about hip width apart.  Step one leg back about 3-4 feet, keeping the leg straight.  Point the toe of back foot slightly in, plant the back heel.
• Lean forward towards the wall as you allow your front knee to bend until a gentle stretch is felt along the back of your leg.
• Hold for 1 min each side, repeat 2x.

– Credit to: www.enhancephysiotherapy.net

Lunge Stretch: Start in a lunge position, with the hip you are stretching as the back leg. Move your hips and torso as far forward as you can and make sure your back knee doesn’t slide forwards. Keep your torso upright and chest forwards. You can add more of a stretch by incorporating an anterior pelvic tilt – by tucking your buttocks underneath you and moving your pelvic bone towards you.

TFL Stretch – kneeling

• Kneeling position, extend leg closer to the wall back and to the outside of the outer leg.
• Bend front knee and lean hip that is being stretched into wall.

The backfixer.com

5. Support

• If your feet are an involved component I highly recommend addressing your shoe-ware.  Unstable/soft shoes allow the arch to collapse if these are the shoes you wear when you lift, this compounds the problem.  Try buying a pair of “stability” shoes and using a pronation orthodic insert to help correct this.

The above interventions should get you on your way to correcting the ACTUAL problem rather than just treating the symptoms.  Fair warning: This is NOT a quick fix. Its not a magic pill.   It takes weeks for your body to build real strength and it takes many repetitions of doing something properly to make it habit.  The question is, is it worth it?  If the old methods aren’t working, isn’t it time to try something else?

Dr. Mims  PT, DPT.

 

 

 

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Stretching to Fix YOUR posture: correcting for rounded shoulders

Ever wonder why your shoulder or neck hurts when you reach overhead or while you’re lifting weights? Chances are good that posture is a contributing factor. One of the most common postures I see across age groups is where the shoulders (where the upper arm meets the collar bone and shoulder blade) are slightly rotated in. This happens often for 3 main reasons. 1) some muscles are long and weak 2) some muscles are short and/or stiff 3) You habits feeding into the above.

So we know that this can be an issue, the next question is “how can I fix this?”

Check out my video below where I target the flexibility portion of this question.

stretching to fix rounded shoulders

If you think you might have poor posture, you may find a prevous post helpful as well which addresses Forward Head Posture .

I hope this is helpful.

Best,

Nicole Mims. PT, DPT.

Stretches to fix YOUR posture. – correcting ‘forward head’

As I discussed in a post a while back, its important to stretch muscles that are short or stiff on you, not just what you learned in high school gym class or what feels “tight.” Often muscles which give the sensation of feeling tight are actually overstretched already.

So how do you decide what to stretch? In PT we often do special tests in order to confirm our suspicions; however, without doing this one can still get a good idea of what they need to do based off of posture.

Here are some common postures and their corresponding muscle groups which tend to be short/stiff.

Next post will be a video specifically on what to stretch to address “forward head” posture.

Forward head

Short/stiff: SCM & Scalenes

Weak/elongated: Deep neck flexors

 

 

Rounded Shoulders

Short/stiff: Pectoralis minor, shoulder external rotators

Weak/elongated: Middle/lower traps. Internal rotators of the shoulder.

 

Rounded Upper Back

Short/stiff: pectoralis major and minor, lats

Weak/elongated: Traps, Rhomboids

 

Increased curve of low back

Short/stiff: spinal extenders (erector spinae), hip flexors

Weak/elongated: abdominals, glutes

 

Anterior Pelvic Tilt:

Short/stiff: hip flexors, hamstrings

Weak/elongated: glutes, abdominals

 

Feet turned out:

Short/stiff: gastrocnemius, soles, posterior tib (muscles that point the toe)

Elongated/weak: anterior tibialis, toe flexors

 

 

Now that we know which muscles we need to target, we’ll dive into HOW to actually do this.

Please check out my next post where I discuss how to stretch the muscles which are short and contribute to bad neck posture.

With love,

Dr. Mims

 

Flexibility Training – Part 1 (why do I care?)

Safe Strength Training – Classic Squat alternatives

Exercise for maintaining function

 

 

Keep Striving, You’ll Get There

At some point everyone has had goals that seemed impossible. Keep moving forward and eventually they will just be milestone in your rearview.

With love,

Dr. Mims

Flexibility Training – Part 1 (why do I care?)

Flexibility Training – what is it and why do I care?

I used to be highly inflexible, the first year of PT school it became somewhat of a joke where classmates would practice special tests on me to see what the “abmormal” result was. However, it was something that I worked on regularly. Now I’m fairly limber, often having clients and patients frustrated at how “easy” i make things look. Flexibility tends to be an underrated aspect of health and wellness as it can contribute to movement impairments and thus injury.

What is flexibility? Flexibility is the combination of soft tissue extensibility and control of the nervous system. This allows muscular control through a full range of motion for a given joint. What the hell does that mean? It means that if you are suppose to have a 180 degree range of motion for a given limb, you can control that limb from 0 to 180 degrees of movement and back.

Why is flexibility training important? – Flexibility training is important, because most people in our society lead sedentary lives. The resulting poor posture and movement patterns increase risk for injury and at the same time decrease the efficacy of workouts. This means that one who is inflexible is not only wasting time while they are working out (let’s be honest, who has time for that?) but also increasing their risk of injury which is of course the opposite goal of health and fitness.

Please stay tuned for a video post on how to determine what you should stretch and how based on your postures.

Best,

Nicole Mims. PT, DPT

Fitness does not = Wellness

It’s easy to get caught up in trying to lose that last 5 pounds or get that one pose in yoga. Remember that exercise is an investment in your future self.

You’re in it for the long haul!

Best,

Nicole Mims. PT, DPT

About the Author:

This is NOT one of “those sites” where the author gives advice without evidence or confuses their opinions with fact. My name is Nicole Mims. I am a Physical Therapist living in Austin Texas. I was an RRCA certified running coach and a NASM certified Personal Trainer before going to school for my Doctorate in PT. I plan to discuss health and wellness with a holistic perspective. My life and education have equipped me to do this. I believe that people should have access to evidence based information to better their lives. In my effort to give back, this site is free and non ad driven.

I walk many different paths in my day to day. I’m an avid gym goer, PT, artist, advocate for sobriety, dog mom, lay buddhist, and often simply a human with all the related strengths and foibles. Advice here will be fact based with resources, but it will also be a sounding board for what I’ve found to be true in my life. Some articles are just personal expression of feelings that need a way out (located under personal). Hopefully we’ll both find something we can use here.

With love,

Nick

Safe Strength Training – Classic Squat alternatives

Yesterday I saw a tweet from BodyBuilding.com that claimed they would discuss the safety of an exercise known as a “pistol squat.”  I was disappointed to find that a total of 3 sentences mentioned that pistols could be risky, none of which explained why.  The rest of the article was on how to do/progress to a pistol squat (as if this exercise isn’t well covered already). The author finished by insinuating that those who warn against pistols were ‘fearmongering’ and that he wanted to empower people.

After leaving an encyclopedia for a comment, I got to thinking. How much quality information is available to the regular person regarding safe strengthening exercises and how is a person who doesn’t have a medical background supposed to sort through the din of misinformation and bait & switch articles to find the truth? As a Physical Therapist (Doctor of Physical Therapy) I feel I can help to fill this gap.

So what is wrong with the classic exercises for lower body? The answer is, it depends.  Are you already healthy with good movement patterns and joint mechanics? Great! Nothing is wrong with those exercises.  If the answer is no, then it might be time to look at some alternatives. Barbell squats put a great deal of pressure on the knees, lumbar spine, even the junction where your neck and upper back meet. if you have existing issues, this exercise will compound them. Are squats a bad idea? No, not necessarily.  Are other alternatives worth your attention? Absolutely!   Below I am going to provide 5 good exercises to build lower body strength (that are not traditional squats).  Several of these I wrote/did the pictures myself.  The other two are videos from a reliable source with good information.

Sit to Stands

Position: Sitting near the front of chair/stool/box
Feet positioned back, knees in line with and almost over toes
Draw navel in towards spine and lean forward from the hips
                            (nose over toes)
Back straight, head in neutral

Action: Squeeze through your glutes and the front of the legs
Push through the feet and come to standing
Stop just before knees and hips are fully extended
Reverse steps and return to starting position without ‘flopping down

Form: Do not arch your back.
Do not allow self to “flop down”
Push evenly through foot, not only heels
Keep glutes contracted the entire time

                            -To add difficulty you can try holding a weight in your hands (goblet squat), stop just before sitting down so that there is no rest between reps (this becomes a body weight squat), take a longer period of time for the “eccentric” phase of the exercise.  (This is when you are lowering yourself down.)

RDL’s / Single leg RDL’s –  I could explain how to do this exercise.  But here is an awesome video.  Credit to Coach PJnestler on youtube. 

Glute Bridge

Position: Laying on back, palms up
Knees bent ~100 deg, feet flat and about hip distance away from eachother
Draw navel in towards your spine and flatten your back

Action: Squeeze through your glutes
Push through your heels
Raise bottom up until shoulders, hips and knees are aligned
Hold 5 seconds, slowly lower to starting position

Form: Do not arch your back.
If you feel this in your back decrease how far you raise your hips.  Do not allow the knees to come in towards each other, keep them straight up and down.

To add difficulty try placing a band around the knees and don’t allow this band to pull knees towards each other.  You can also place a barbell across your hips (hip thrust exercise), or switch to a single leg.

Clams

Position: Laying on side,  knees bent, feet together
Heels, shoulders and hips aligned
Tilt body slightly forward (pointing navel toward the floor)

Action: Squeeze through your glutes (buttocks)
Keep your heels together and lift top knee up.
Hold 5 seconds, slowly lower to starting position. (In this photo I have a resistance band around my knees, this is a simple way to increase the challenge but is not necessary to benefit from this exercise)

Form: Do not arch your back.
Do not allow hips to rock back & forth.
–You may want to perform with a wall or other straight surface behind you
Keep glutes contracted the entire time.

To increase the difficulty you can add a resistance band around the knees or hold for a longer period of time.

Monster Walks/ Band walks.  – Here is a great video to show how to do band walks.  Credit to Coach Pj nestler

 

Stay tuned for more credible information and correctly titled articles.  Lets sort through the misinformation together and focus on the purpose of strength training.  To live healthier!

You may like:

Changing your training

Exercise for maintaining function

Best,

Nicole Mims. PT, DPT

 

Exercise for maintaining function

 

 

http://lolsnaps.com/funny/50398

Physical Therapists often work with older patients whose diagnoses have an underlying cause of either stiffness, weakness, or both.  Tragically, many times a loss of independence could have been prevented by a person having maintained their strength into later adulthood.

As we age we can lose muscle strength, bone density, skin elasticity, and metabolism. Balance can even become an issue. This results in a higher risk for obesity, fracture, wounds, poor posture and resulting pain or disability.  The forecast isn’t all doom and gloom though! Exercise can improve all of the above AND it’s never too late to begin.

You don’t need to be bodybuilding grandma to benefit from strength training and you don’t need to go to extremes.   Here are a few things what I recommend to help safely build strength. Everyone who has weakness, but especially older people can use this advice maintain function and prevent injury.

*THIS IS NOT A PRESCRIBED/PERSONALIZED HOME EXERCISE PROGRAM. THESE ARE GENERAL RECOMMENDATIONS BASED ON WHAT I COMMONLY SEE*

 

Sit to Stand: 

Position: Sitting near the front of chair/stool/box
Feet positioned back, knees in line with and almost over toes
Draw navel in towards spine and lean forward from the hips
                            (nose over toes)
Back straight, head in neutral

Action: Squeeze through your glutes and the front of the legs
Push through the feet and come to standing
Stop just before knees and hips are fully extended
Reverse steps and return to starting position without ‘flopping down

Form: Do not arch your back.
Do not allow self to “flop down”
Push evenly through foot, not only heels
Keep glutes contracted the entire time

Sets/Reps: 2-3 sets, 10-20 reps

Glute Bridge:

Modification to increase difficulty

Position: Laying on back, palms up
Knees bent ~100 deg, feet flat
Draw navel in towards your spine and flatten your back

Action: Squeeze through your glutes
Push through your heels
Raise bottom up until shoulders, hips and knees are aligned
Hold 5 seconds, slowly lower to starting position

Form: Do not arch your back.
If you feel this in your back decrease how far you raise your hips

Sets/Reps: 2 sets, 10-20 repetitions (increase hold of this gets easy)

Seated marching:

Position: Sitting upright, Using fingertips for balance. Engage your stomach muscles. Pulling your navel in towards your spine

Action: Pull knee up toward ceiling
Hold 5 seconds
Slowly lower
Perform, alternating sides

Form: Keep your body upright without leaning side to side.
Keep leg straight up and down without rotating in/out.

Sets/Reps: 2 sets, 10-15 repetitions on each side (total of 20-30 per set)

 

Clamshell:

Position: Laying on side,  knees bent, feet together
Heels, shoulders and hips aligned
Tilt body slightly forward (pointing navel toward the floor)

Action: Squeeze through your glutes (buttocks)
Keep your heels together and lift top knee up.
Hold 5 seconds, slowly lower to starting position. (In this photo I have a resistance band around my knees, this is a simple way to increase the challenge but is not necessary to benefit from this exercise)

Form: Do not arch your back.
Do not allow hips to rock back & forth.
–You may want to perform with a wall or other straight surface behind you
Keep glutes contracted the entire time.

Sets/Reps: 2 sets, 10-20 reps (to challenge further, add a band around the knees or increase hold to 10 seconds)

 

Bent knee fall out:

Position: Laying on back,  knees bent, feet together
Draw navel in towards spine, contracting abdomen
Flatten back
Place hands on pelvic bones

Action: Keep hips and abdomen still
Allow one leg to fall out to the side, while keeping the other vertical.
Slowly return the moving leg to starting position.  Perform on opposite leg.

Form: Do not allow hips to rock side to side
You will be able to feel this movement through your hand placement
Keep abdomen contracted and still.

Sets/Reps: 2 sets, 10-20 reps each side

 

Push Up Modified: 

Position: Begin on hands and knees, knees together,
Feet extended back behind you
hands under shoulders
Keep back straight, head neutral
Knees, hips, shoulders in a line

Action: Slowly lower yourself toward ground/mat
Stop just before chest touches ground.
Push evenly through chest and return to starting position

Form: Do not arch your back.  Stomach should not touch before chest.

Sets/Reps: 2-3 sets, 10-12 reps

____________________________________________________________________________________________

Try performing the above exercises 3 to 4 days a week and see how you feel!  Feel free to ask any questions in the comments below.  Also, stay tuned for flexibility for older adults and cardiovascular exercise.

Best,

Nicole Mims.  PT, DPT

outtakes –  Zoee decided to try helping

 

 

 

 

 

 

Giving of yourself when you have nothing left. (my recent challenge as a health professional)

This is definitely one for the personal column.

I recently went through a loss (which I don’t have the distance from to discuss yet.)  What I will say is that by the time I got to work yesterday, I felt like I had absolutely nothing in the tank. I literally began the day wondering how I was going to manage to get out of bed.  I’d had about 3 hours of sleep, no food, and had been crying for so long it looked like I was trying to throwback to my teenage years, when red eye shadow was an acceptable  a thing.

Dame fate has a cruel streak as this was also one of those days where there were endless fires to put out, and my patients needed everything I would have had on a good day.

Being a patient in general is a scary experience and it is crucial that they feel like they can be vulnerable with you, that you won’t judge them, and that you actually care.  To quote one of my favorite Buddhist speakers Ajahn Brahm: “you must be a dust bin with a hole in the bottom.”  One should be able to listen to concerns and help or advise without holding on to how this affects them personally. This takes a balanced mind, discipline, and patience. If ever there was a day this was not it…

And yet there they were.   One person had a breakdown within 5 minutes of arriving.  An evaluation came in with red flags for a severe nerve problem termed Cauda Equina Syndrome that had somehow been missed by her primary care doctor and VA doctor.  Another person twisted their newly surgically repaired ankle… and so on.

As the day progressed, each time I thought to myself that I didn’t have anything else to give, I managed to find something.  People who know me know that I am nicer than I first appear.  I have an extremely abrasive layer covering an annoyingly soft heart.  With each new crisis I dug a little deeper and found a little more empathy, cajoling, advice, and caring.  By the end of the day I’d come to a half realization that a good deal of meditation and a bit of ice cream solidified.   I had been considering my own state a sign of weakness.   And yet weakness would have been giving up.

Yesterday, today…I imagine quite a few of the days in my near future are going to be miserable.  They are going to be dark in the dead of summer. But a tiny little part of me knows I just found a slightly stronger version of myself.

–With love

Walking up to my best friend’s place for TLC yesterday.