There’s Noise in my Knees
** This is an excerpt from my upcoming course for trainers on knee rehabilitation. If you are a trainer reading this and would like to know more, please feel free to contact me. If you are a client with knee issues and have questions also feel free to contact me.**
The knee is one of the most complex joints in the body in terms of demand. It is asked all day long to help propel us in various directions, sit down and stand up, climb stairs or even bend down to pick things up. It is a small wonder that over time the mechanisms within this joint tend to wear down over time.
Osteoarthritis is defined as degeneration (over time) of joint cartilage, which is the protective coating that surrounds our joints and keeps the joint surfaces gliding over each other. In the knee there are two of these – articular cartilage at the end of the long bone (ie the femur) and the meniscus which is a padding between the bones of the knee. For the knee, osteoarthritis is the degeneration of articular cartilage, which leads to degeneration of the meniscus (kind of a chicken and the egg issue). Once these two components wear down over time or are subjected to too much stress it creates inflammation, pain and eventually the joint in question usually needs to be replaced.
In my practice, there are what we call “warning signs” that knee degeneration is taking place. This actually begins long before things like pain. The issue with most regular exercisers and especially type A personalities is that unless there is pain associated with the movement, it gets ignored and simply leads to further damage.
Osteoarthritis has 5 stages. The first of which is a healthy knee joint, or stage 0. Stages 1 and 2 are generally very mild with only bone spur growth. These result from impact between the bones. By the end of stage 2 a person may start to experience stiffness and tenderness or pain after a long run or walk.
What I’m going to point out is that the usual symptoms that one would start to notice come at the END of STAGE 2. By this time synovial fluid has degenerated, there may be mild narrowing within the joint space and there are bone spurs.
Something to listen for when your knee joint is moving is something called crepitus – which is a popping, cracking or grating sound in the knee during movement. This is really your first warning sign that joint degeneration is taking place. So you’re wondering what that noise is or if you should be worried if your knees are “talking to you”? Yes, you probably should and can think about addressing it at that stage, not waiting until stiffness or pain kicks in. This noise typically means you are already in stage 2 of osteoarthritis.
Again, by this point you should definitely be addressing the issues in your knees.
Stage 3 and 4 of osteoarthritis are the point where pain and stiffness are fairly constant, and medical intervention in terms of cortisone shots and surgery become options. Hopefully you’re not at this stage yet and can avoid it as long as possible.
Now – another thing I’m very blunt about is that degeneration of this joint is inevitable over time. Especially for active people it is a reality – and the more active, the more likely the degeneration is going to be progressed. But how can we slow down the process and not progress through these stages as quickly? There are two main ways and the good news is that both of them are fairly easy to accomplish:
Maintain a Healthy Weight
Obviously less load on the knees over time means less degeneration. From a loading perspective, for every 10 pounds of weight loss the knee is subjected to 48,000 pounds LESS compressive load – for every mile walked. Considering most people should walk 4-6 miles per day, that’s 88 MILLION (or over 40,000 tons) pounds less load per year.
If you’re not at a good weight for your body then focus on whatever weight loss you can accomplish and every little bit will help reduce the degeneration in your knees.
Strengthen Your Muscles
The more your muscles can take pressure off of the joint during movement, the less load they are taking – especially during exercise – but even with regular walking. The knee has many muscles that cross it and give support to it. Strengthening them all and maintaining a good strength ratio between muscles like the hamstring and quadriceps is also important. Progressive loading of forces is also important so that you’re not doing too much too soon and making things worse rather than better.
In terms of what exercises are best, studies have shown that the most stressful knee forces come from lunging, whereas a dynamic squat is the least stressful. And yes, your knees can come in front of your toes IF THEY SHOULD. Restricting forward movement of the knees does reduce shear through them – but then transfers it into the hips and lower back, which can cause other problems. Loading appropriately is essential.
Work On Balance and Stability
This is not a major way to avoid issues, but having a stable joint means that one side or direction is not constantly wearing down more so than another. Another major source of knee trauma and major loads that cause problems is things like falls and sudden shear movements through the joint. Developing the ability to avoid these things, especially as you age is vital for good knee health.
You need your knees. You need them as long as possible and once the degeneration is there, it can’t be reversed. Current studies do show that there are cells in the knee that could potentially regenerate cartilage but there has been nothing found to stimulate this. So if you already have noise inside your joint, please take some steps to counter the onset of this. For prevention of pain down the road of life, it is important to give your knees a healthy amount of strength and make sure your weight is in line.
If you need any more information or want to know my best ways that have worked with my clients, please feel free to contact me here, via email at firstname.lastname@example.org or via social media @strengthottawa. And feel free to like and share! Until next time, keep your joints happy and healthy!
One Big Benefit of Strength
This title is a bit of a misnomer, because there are probably about a hundred or more benefits to additional strength. That’s the reason I primarily focus on it within my practice. Over my many years of working with people and improving their situations after injuries and special conditions I’ve seen some pretty cool things. However, recently I was treated to not only one, but two big examples of improved quality of life and the ability to deal with situations physically.
About a year ago I wrote about the success that one of my clients Randi S had after recovering from severe SI Joint dysfunction to the point that we couldn’t even move her during her initial month of training. She progressed to the point where she was able to bike for 26 km in the mountains and achieved a big goal. You can read about it here.
Randi recently experienced more issues starting in February and had some neck and heel issues as well. After several months of hard work, and even some competent physio work on her as well we were able to get her back up to speed. For her trip this year, Randi not only biked the full 46km – on a mountain bike (not an upright) which would previously have been unheard of for her back, she did paddleboarding, and even some cave climbing into cramped spaces. Again, all of these things two years ago would have caused Randi enormous pain and put her into bed for a week. Today due to being stronger she can do activities that excite and motivate her. The following week she even tried a spin class and has found a great yoga class.
One of the great things about my job is when clients get to the point where they don’t need me any more except for advice and maintenance. It sounds counter-intuitive, but I do believe that once people can do what they want or need to then I’m just a guide after that.
Success Story Number Two comes from Chris J. Chris came to see me about a year and a half ago due to back trauma from a car accident. He had worked with another trainer and had physio and seen little progress beyond more irritation. With a combination of MAT and proper strength work his back has been great for a while. He has been able to work as a volunteer lifting heavy things and walking a ton without any issues.
About four weeks ago coming home from Bluesfest with his mother in the car, Chris had a car run a red light and hit the car broadside at 60 kilometers an hour.
Everyone was fine, thankfully to airbags. But the amazing thing to me was that not only was Chris okay, he walked away completely unscathed except for a headache. His back was basically unaffected with some minor stiffness. I’d like to think that because he had more strength in his trunk, hips and shoulders that the impact (and think about hitting another object at 60km/h) didn’t cause any severe trauma. We have taught his system to kick in when it is needed to provide support at a time when it receives stress or load, and that happened in spades when he hit another vehicle.
I was astounded and quite happy to see such an obvious result simply from strength work. Think about applications for people who fall, play sports or simply want to do high impact activities like motorcycle riding. Being stronger overall helps with many situations and conditions.
Over the years I’ve managed to have an excellent track record when it comes to helping people who have conditions they previously thought were unmanageable. If you know of anyone who needs help or even just has questions about an injury or special condition feel free to send them to http://www.srottawa.com or to email me at email@example.com. You can also follow me on Twitter @strengthottawa.
Recovery – The Red Headed Stepchild
This article is in no way intended to offend any red haired people. Just a quick disclaimer because hey, I’m Canadian and I don’t want to offend anyone.
When I talk to people about fitness it is usually about an overall picture of wellness. This includes strength training, cardiovascular work, mobility, stress reduction and of course nutrition. There is another component that frequently gets ignored, ostracized and sometimes even laughed at by some athletes even though it is usually one of the first thing I recommend to many people:
This means rest, of course. A lot of people don’t understand the concept. It also means other things though.
I tell my athletes all the time that the workout is one part, but how your body responds to the workout is another thing entirely. Your tissue starts adapting to whatever stress you have put it under immediately. Often, if the workout is quite intense even your CNS will have taken on quite a bit of stress and need time to adapt and recover. Muscles have micro traumas that need to repair, inflammation is generated and even organs like your heart can have taken a bit of a beating. The actual deep science is well explained here.
Does this mean you can’t train the same muscle or movement daily? Of course not. The body will adapt over time and if you are an experienced exerciser then it is easier to frequently subject the body to load and force and have it respond in a positive way. The body is a remarkably adaptive thing. However, if you want it to improve, then you have to give it a chance to get stronger and sometimes this means doing nothing at all.
The time it takes to sufficiently repair tissue varies according to a bunch of variables, but here are a couple of the criteria I use with clients to give them a checklist to see if they need more recovery:
Is it SORE? This doesn’t mean that you can’t work it again, but if your muscles obviously can’t control the movement or you have restrictions then it is probably a good idea to let them rest. I always suggest a long warm up process and see how things feel – if after this you still feel sore and tired then let it go.
Are you FORCING the workout? You may need a rest day if you feel like you can’t give 100% effort and you’re just driving yourself further into the ground. Instead of making things better often this will actually make things worse.
Can you CONTROL your movements adequately? This means you can use good form in a weightlifting movement, achieve proper cadence or turnover in an endurance workout, or maintain position if doing a static pose as if in yoga. Lack of control means either your nervous or muscular system can’t work as hard and likely needs more rest.
This also does not mean that recovery can’t be ACTIVE. My athletes often do a short recovery run or bike after their long workouts. This moves the tissue in question, puts extra blood flow through it and can actually speed the recovery process. Taking a day to focus exclusively on mobility and release work can also help this process, and if you’re planning on working out intensely I’d actually suggest that it is mandatory to have at least one day devoted to this process.
This can mean warming up the tissue that needs attention with light movement, then working on adding blood flow into the fluid. Massage is an excellent technique for this. Many people make the mistake of going too hard into their tissue with hard foam rolling and really hard stretching, which can often be counterproductive over time.
Strength and mobility does not disappear overnight or even after a few days. However, if you over train and cause an injury this can set you back for weeks. Think of it as a risk/reward scenario and that it simply isn’t worth the risk for a possible minor short term gain. Too many athletes force themselves back into exercise too soon without taking the proper care and making sure that things have properly healed.
Always remember that exercise should be a life long endeavor and you can’t force things to heal faster. Taking the time to recovery properly as part of your program means that you will be able to improve more frequently and make progress without any setbacks. This essential part of fitness should not be overlooked by any serious athlete.
If you want to know more about recovery or have any feedback feel free to contact me, comment or find me on Facebook and Twitter at @paradigmottawa. Also, please share this with any athlete you think might need help with the recovery side of things. Thanks for reading!
Does Your Back Hurt? Part Two
Last time we discussed the origins of back pain and some quick fix solutions if you have issues in this area. For this article I want to get into a bit more detail on what you can do to be more aware of your back issues and some real solutions in terms of restoring mobility and keeping your muscles firing well.
First of all, most people will tell you that the reason you have back pain is because you have a weak “core”. What does that mean?
In simple terms this means that the muscles that support your spinal column, especially as it relates to your pelvis in the lumbar area, are weak and need strength. Most practitioners will have you start to work on things like spinal bracing movements, hip stretches and lower back strengthening. However, this brings me to my first point when it comes to back pain, and one of the most important principles:
You need to know what the source of the issue is!
Imagine a person with a weak ankle due to spraining it several times as a kid. This person stops being active and loses a lot of their ability to fire their leg and back muscles, and eventually every time they take a step their body is slightly tilted to take load off the ankle. This throws off the pelvis slightly each time, and this throws the lower back out of line and therefore causes the supporting muscles on one side to fire too much. If the ankle is the source of the issue, strengthening the muscles in the midsection will help, but it doesn’t ultimately fix the problem. It’s like taking an Advil for a headache.
So rule number one is get properly diagnosed. I don’t diagnose, I tell people what in my experience things are and (99% of the time I’m right), but it is always confirmed by another party preferably with doctor in front of their name after they get referred. Many practitioners will not look past the pain area – find one that will.
I’ve had clients come in with back pain that we have resolved by treating their shoulders. Or feet. Or even simply practicing walking properly. It can be that simple.
So what is the “core”? Well, the way I explain it to clients is that you want to stop thinking of “core” and start thinking of SPINE. More specifically you want to start thinking of how it relates to your pelvis (mostly) and also things like your rib cage and shoulder complex. There’s many more muscles involved than just your TVA, or just your lower back. In the deep abdominal area alone there are five layers mostly overlapping each other. And, when you move one joint, you affect every muscle that crosses over it – and your spinal column is made up of lots of joints. If you move your hip, you’re affecting your spine. If you move your shoulder, you’re affecting your chest, back and shoulder (and a bunch of other things). Take this into consideration when performing any type of mobility movement.
Before I get into how to strengthen these areas (which will be for Part 3), I want to instead address mobility. This is the ability to move these joints without strain or compromising the muscles that control them. Typically this requires movement without a ton of load or force behind it. One of the biggest pieces of advice I can give here is:
Respect your body and allow it to move (or not move) as it wants to – don’t force it.
One major flaw people make with mobility work is that they push their muscles too hard and create even more strain. Instead of thinking of it as stretching, I invite my clients to instead think of it as allowing their muscles to achieve a longer range of motion within the involved joints. This goes across both sides of the muscle, the long and the short. If you lengthen or shorten a muscle too much, it is weak in that position and will often fire in order to try to get out of that position – which defeats the whole purpose of lengthening one side while you shorten another.
For example, if you are in a typical hamstring stretch you are lengthening the back of the leg, but you are also shortening the front (allowable to a certain extent until your knee reaches terminal extension). Always move within a point of mild resistance – never pain.
With the lower spine, the usual culprits for lack of mobility are the hip complex (especially in the front of the body) and the spinal erectors. General ranges that are restricted are spinal extension, pelvic movement, hip rotation and extension and lateral flexion (ie side bending – but be careful here – I don’t side bend anyone until they are much better).
So here are the top 5 mobility movements I prescribe to pretty much everyone with back pain as a start. Remember that as with any exercise program, a mobility program also needs to be tailored to you specifically – don’t necessarily take this as gospel. It is a good start for most of the population. As with anything else, if it makes your body uncomfortable or causes pain – DON’T DO IT.
Number One: The McKenzie position.
Stuart McGill, who is one of the most prominent back care specialists in the world advocates this as the number one movement, and I do as well. Place the hands under the shoulders and extend up, moving slowly until pressure is felt in the lower back and focus on dropping the hips into the ground. Repeat with movement but can also be done as a static hold if you have facet issues.
Number Two: Cat/Camel position
This can also be a good transition into childs’ pose for upper back mobility. Focus on moving the entire spine starting from the tailbone, not just the upper back as many people tend to do.
Number Three: Kneeling Hip Flexor stretch with movement
This movement may be difficult for those with knee problems. If you cannot get onto one leg a good modification is to do it standing up with one leg behind you. Oscillate the hip forward and back. Another fantastic stretch along this line is one popularized by Kelly Starrett – you can see it here but it is very advanced and should be modified for most people.
Number Four: Windshield wipers with feet on the ground
For some people with advanced back problems this gets removed immediately because it can cause tilting. Also, if you have diagnosed SI Joint issues please take this one out until they are resolved. This puts rotational torque through the hips, which for many is a good thing but for some is not.
Number Five: Standing Glute/Piriformis stretch.
This movement can also be done lying down, but is more effective standing. Again as with the others, don’t hold position, lift and lower the knee until a pull is felt in the hip/glute area. If one side is tighter, do that side twice. For example, if your left is tighter you would go left, right then back to left.
This covers 85% of the bases for most people who have issues. Again, for some with severe mobility issues all of these might have to be modified. Feel free to comment or message me for modifications if you need them.
So the next question begs – how often? My recommendation is always twice a day to start, ideally morning about twenty minutes after rising so you have moved a bit and established blood flow, and then before bed or after work – whatever works for your schedule. It can be a great way to decompress at night and focus on yourself after turning off all of your electronics and is a great way to establish good sleep hygiene. Think of this as general maintenance and even just by doing these movements – within what your body will allow – you can experience some relief almost immediately if you have the beginnings of problems in your spine.
Oh, and if you tell me you don’t have time, this whole routine takes about 5-10 minutes. You have the time. You choose not to use it in the right way. Choose to help yourself.
In Part Three I will be going over exercise. Again, we often think about “core” work as something simple and straightforward but for most people finding out what area needs the most help is essential. This can allow us to build an exercise routine that will work for that individual and bring a solution to the issue. Like I said in Part One here, if you’re at Stage One then these should help a lot. Stage Two or Three might need some help. but you’re starting in the right place.
If you liked this please feel free to subscribe on my main page, comment and share on Facebook and on Twitter at @paradigmottawa. I look forward to any feedback you may have.