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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.

kneeosteo

By Stage 2 – it can be too late.  

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.

two-types-of-squat

As you can see, restriction of the knees causes more lower back and hip moment.  You’re taking from Peter to pay Paul. 

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 strengthrehabottawa@gmail.com or via social media @strengthottawa.  And feel free to like and share!  Until next time, keep your joints happy and healthy!

 

 

5 Ways to Reduce (Or Prevent) Injury

In my practice I deal with injured people on a daily basis.  As a result I’ve compiled a pretty extensive knowledge of not only injuries but what causes them – and therefore how to prevent them.  Many of you out there right now are walking into a major injury and are simply ignoring it or don’t know any better.

It is in the nature of athletes and people with certain personalities to embrace hard work.  There’s nothing wrong with that.  However, when it results in a setback or the loss of ability to move forward in a program then it can bring frustration and the worst situation – having to stop working.  I always tell my clients that the only way progress will stop is if they stop it.  Well, having a bad injury is one way that you don’t have a choice.

I’ve compiled a list of the top 5 ways that you can reduce or prevent these types of injuries.  I hope that you take them to heart and use them to be mindful so that you don’t end up having to call me.

  • Warm Up Thoroughly

This should really be a no brainer, but one of the worst habits I see from any athlete is that they simply neglect warming up their joints before subjecting them to loads.  In order to be able to fire properly, muscles need both blood flow and also neurological input.  If you’re lifting weights, this means moving the joints you’re planning on using and also practicing the movements.  If you’re doing cardio work this means doing a dynamic movement pattern sequence and also taking it easy for the first little while if you are doing a hard workout.

Athletes typically warm up for AT LEAST 15 minutes.  This also doesn’t mean static stretching or cardio – it means dynamic movement and preparation.  Factor this into your workout time and give it the attention that it needs, don’t ignore it or rush through it.

While you’re doing your warmup, you can also take stock of how you’re feeling, which leads us to:

  • Acknowledge your Readiness.

Remember that ability to perform is fueled by nutrition and other factors.  Did you sleep well or not?  Are you hydrated?  Is it the end of the day or the beginning?  How focused are you on performing today?  Is there something else stressing your nervous system?  Are you distracted or focused?

Not every workout has to be a top level workout.  Some days you’re going to be able to give 100%, and some you’re simply not.  Being smart and realizing this before you start hard work can save you a big problem during and after the workout.  If you’re not able to give it all, then save yourself for the next workout.  You can still do what you need to do, but realize that pushing yourself at that stage may not be the most prudent thing.

Along with this important tip follows:

  • Don’t Ignore Warning Signs

Your body will tell you clearly if there is something going on you need to pay attention to.  If you warm up and something is still stiff or restricted, or if you are feeling acute pain through a joint range, you may want to think twice about working that area hard.

So many athletes think that if they aren’t sweating and killing themselves then it isn’t worth it.  I’m here to tell you that’s false.  High level coaches realize that it is the long road that makes a difference so if you have one of these signs starting to crop up – or have a chronic issue – you’re better off addressing it now and taking care of it, because your body is literally telling you to slow down or stop.

  • Work Smarter, Not Harder

There is a lot of misinformation in the fitness world, and probably one of the top ones is that you need to train to failure.  I can cite multiple sources where improvement comes with much reduced load, and others where rep ranges don’t factor into progress.  You can stop after 1 set or a few less reps and the difference in results are minimal – but the reduction in injury potential is large.  A good strength coach knows the signs of good lifting and not overloading their athletes, and you can learn this too.

Your progress should be linear and programmed as much as possible, factoring in the above from workout to workout.  A short delay for one workout is much better than a long one for a 6-12 week recovery period.

Also realize that progress is long term, not short term.  Many of us want results right away and think mistakenly that forcing something to adapt to change is the right approach.  Your body doesn’t work that way.  Instead of wanting results in two weeks, focus on two months or even two years.

  • Recover Properly

Recently I wrote another article HERE on the Red Headed Step Child of recovery.  In summary, most people neglect things like sleep, nutrition and even proper cooling down and taking care of their tissue post workout.  This also means maybe taking an extra rest day if it is needed in between hard workouts.

This is a component of good fitness just like nutrition or anything else that can contribute to the well being of your body and improving it.  Yet it gets ignored on a regular basis.  Please make sure to factor recovery time into your schedule and adhere to it.

By following these simple principles you should be able to continue to improve, feel good with each workout and not have to go through the ordeal of rehabilitation.  If you have already gotten there, feel free to message me for ideas on how to enhance your recovery and make sure that it doesn’t happen again.  You can find me on Facebook, my web site http://www.srottawa.com and on Twitter @strengthottawa.

Have a healthy and injury free day!

So You’re Injured – Now What?

Any active person has had it happen.  You are doing whatever activity you enjoy and suddenly feel a bit of a pull, cramp, sharp pain or something not quite right.  Hopefully you’re smart enough to stop what you are doing and not push through the pain to complete whatever you are doing, but maybe not.

Then the inflammatory feeling starts kicking in.  Your tissue will feel full, there may be lingering low level pain or sometimes acute high level pain when you move.  Sometimes you can’t move without your body telling you not to through a jolt of pain.  Often this is a bit indicator of the severity of whatever injury has happened.

So you realize that this is beyond a simple pull, mild strain or simple fatigue.  You’ve done something that may require intervention and some sort of attention.  You’ve injured yourself.

First things first: if you have acute high level pain and can’t move a limb or joint please GO TO A HOSPITAL.  You will wait a while because musculo-skeletal injuries aren’t triaged as a priority but at least you will likely get some imaging immediately.  There may also be things going on underneath the surface you have no idea about so better safe than sorry.

injured

If that’s not the case, what is your next step.  Well, there is a simple routine that you should follow, and it can be done in this order:

Care

This is what you do immediately.  The biggest thing to do with any injury is STOP MOVING IT.  Don’t stretch it right away, don’t think that you can “push through the pain”.  You will make things worse.  Stop what you’re doing.  Your body is very intelligent and is already doing what it needs to in order to start fixing things.  Give it a chance and don’t make things worse.

Don’t ignore pain.  Pain is a signal saying “QUIT IT”.  Your body is literally telling you to stop what you’re doing just like taking your hand off a hot stove.  Once you have stopped moving, the next step is…

Evaluation

Some questions to ask yourself:

  • Is the pain acute with movement or does it come and go, for example it stiffens up during sleep or is painful at different times of day?
  • Is my strength compromised for certain movements, ie can I not pick something up, reach over my head or extend my leg without a problem?
  • Is there soft tissue damage?  Swelling is one thing, but bruising typically means a much more severe trauma that requires attention faster.

The more you have information, the easier the next step will be because you can figure out which practitioner to see first and not waste your time.  Have a soft tissue problem?  Massage might be best?  A serious joint issue?  Maybe an osteopath or chiropractor (more on this later in the article).  Arming yourself with answers and figuring things out on your own can be valuable in not wasting your time.  That leads us to…

Diagnosis

This does NOT mean going to someone like me and asking them what it is, because I have no authority to diagnose anything even with my years of experience.  What is does mean is going to someone with the words Doctor in front of their name and ideally getting some testing and/or imaging.  I always tell my clients to push for imaging because ultrasound and x-ray can reveal things simple testing cannot.  If MRIs were more easily accessible that would be my default for many things.  For those of you in Canada, remember that some provinces (ie Quebec for those of us in Ottawa) do allow paid MRI’s – you just have to pay for it.

As much as I appreciate the access to General Practitioners or walk in clinics, regular MD’s have little to no experience with bone and joint injuries and often will suggest exactly what I just said anyway, so don’t waste your time.  And if a GP does give you a “maybe it’s this” diagnosis please get it confirmed by someone with experience and ideally imaging as I said.

Be proactive – once you have a diagnosis, learn everything about it that you can.  It will not only educate you on what the injury is, hopefully it will make you realize WHY it happened and how to prevent it in the future.  Often during my initial consultation I have found that clients have never had their injury properly explained to them by anyone and have no idea what happened to them and why.  Knowing the why is very important for any recovery model.  And that allows me to discuss…

sports-massage-therapy

Recovery

After you have a diagnosis, depending where you get it the first suggestion is always physiotherapy.  It’s covered under benefits, didn’t you know?  The only problem is that there are lots of other ways to treat an injury and in my experience physio yields the worst results overall for my clients and others I have spoken to.  If I was going to suggest the order you should look into things and why, here’s my list.  Again, not to knock any practitioners – there are lots of good and bad ones out there – this is simply my experience in dealing with all of them frequently.

#1: Osteopath.  These people frequently have had experience in another modality and decided to move into osteopathy.  From an assessment and treatment perspective the results from these practitioners seems to be consistent, and they don’t ask to see patients frequently.

#2: Massage Therapist.  With the disclaimer that this is for soft tissue injuries only, a good massage therapist can help with things like scar tissue, blood flow to improve tissue and relieving stiffness and immobility.  This should be included with any recovery plan.

#3: Chiropractic – Again, with the disclaimer that this does NOT mean back cracking or neck cracking.  A good chiropractor who knows other treatment protocols like ART or myofasical release, or even relieving nerve entrapment are usually your best bet.

The thing with chiropractors is that a lot of them are salespeople who try to lock you into long term treatment plans where you see them three times a week – please don’t fall for this and if it is suggested, find another practitioner.  This generally doesn’t have any interest in your recovery, it has interest in your wallet and benefit plan.  If you need to see a practitioner three times a week they need to justify it.

#4: Physiotherapy.   Again, there are good physios out there.  The problem is that in my experience they are few and far between.  Look for someone who doesn’t use outdated methods, someone who will actually spend time with you individually (not hook you up to a machine and walk away or leave you with an assistant), and who will progress you session to session properly.

How long does it take for proper recovery?  The general rule for serious soft tissue injuries is 6-12 weeks, more serious damage like tendons and ligaments can be up to 3-6 months. Anything requiring surgical intervention can be 6-12 months.  This is not carved in stone, but it will give you some perspective in that you need to assume that this is a long term fix and not a temporary thing.

In my opinion surgery should always be a last resort.  It is done when there is no other option for restoring tissue.  Full tears, severe arthritis, and things like broken joints often carry this load and it is totally necessary.  If you have the option, see how well you can get first without it and then see about surgery if all else fails.  Realize that if you meet with a surgeon, they are going to likely push for an operation – that’s their job.  You have options, consider them all wisely before making a decision that can affect your body for the rest of your life.

As a final note, the number one thing I see that causes injuries to recur is that the person rushed back into exercise and doesn’t do what they need to do to fully recover.  This just makes things worse and more often than not will result in a worse injury down the road.  Listen to your body and ease back into exercise.  Sometimes my clients have to start off ridiculously easy and it drives them crazy, but it takes time for recovery and having a guided path is absolutely essential.

 

 

So you’re hurt – there are lots of options for you to pursue and the good news is an injury doesn’t have to be the end of the world.  If I told you the laundry list of injuries I’ve had (including a disc herniation and multiple tears in various places) you would be surprised – but I can still move easily and lift heavy things without a problem.  Be smart, apply things properly and keep moving forward.

If you liked this article feel free to SHARE it on Facebook and follow me on Twitter @strengthottawa.  And of course if you have any questions you can contact me at any time via phone or email.  Stay mobile!

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.

Randi Paddle

Randi paddleboarding – notice the forward flexion and rotation under force, which with an SI Joint issue is usually quite painful.

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 strengthrehabottawa@gmail.com.  You can also follow me on Twitter @strengthottawa.