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PostPosted: Mon Jun 09, 2008 4:37 am 
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My essay is a basic corrective exercise approach to specific knee pain caused by lack of ankle mobility. Most individuals will either have knee discomfort underneath the knee, also known as ‘Jumper’s Knee’ or ‘Runner’s Knee’ e.g. discomfort on the side of the leg/knee. Please recognize the difference between ‘discomfort’ and ‘pain’. As I always tell my clients ‘we do not work through pain’ but discomfort is a red flag. Stop the exercise and learn how to address and prevent the pain.

The discomfort is the precursor to a bad situation becoming worse. Fortunately, attending to the discomfort and applying some exercise science and commonsense we usually can reverse the ailment.

If you have had consistent knee pain then I would suggest seeing a medical professional. Lastly, I highly recommend getting an assessment of your posture, flexibility and muscular strength imbalances by fitness professional. The information will help you become more efficient in your workout and prevent any joint dysfunction. Your goals will be easier to attain because you will recruit more muscles for your workout and not be sideline by injury.

This is part 1 of my ‘Got Knee Pain?’ essay. In this essay, I will discuss the importance of ankle mobility and muscle balance in the calf/shin muscles. Visualize what you do when you get out of bed. The first part of our body to touch the earth is our big toe followed by the other toes, the ball of our feet then heel. If you ever stumped your toe, you will quickly notice the importance of our ankle mobility and how it affected our posture. We will compensate the pain in the toe by changing the way we walk, unconsciously leaning on one side of our body which stresses other muscles and joints.

Most knee pain is the result of sedentary lifestyle (8-10 hours of sitting or inactivity per day), muscle imbalances, poor form while performing exercises and lack of rest (overuse). There are other possible factors such as flat feet, posture, age, type of shoes, past surgeries etc…

Knee discomfort usually springs from a disruption of the ACL or MCL (Anterior Cruciate Ligament- front of knee, Meniscus Cruciate Ligament –both sides of the knee). View the ligaments as the ‘shock absorbers’ of the knee. There are other ligaments in the knee joint but I will only address the most common injuries. The knee is a marvel when you think how much pressure/shock it absorbs from our regular walking to work, walking up stairs, jogging and even abrupt stopping. Without a stable knee, our easiest everyday tasks become a challenge. Did you know that the foot moves in all anatomical planes, unlike the knee, which primarily moves in the sagittal plane (flexion and extension).

Generally, people who sit all day will have tight hamstrings, hip flexors, calf muscles, weak gluteus (buttocks) and underactive inner thigh muscles. Please note, other preventable muscle imbalances and joint dysfunction may arise from overuse or a sedentary lifestyle e.g. low back pain, hip drop/hike, neck pain. FYI, when you have tight muscles, its primary functional movement might be altered. For example, tight hamstrings and tight lower back usually signal a weak gluteus muscle. The weak gluteus (buttocks) muscle function of being an extensor muscle will be dominated by the hamstring and lower back. This will limit your range of hip joint movement and affect the joints above and below: spine, shoulder blades, rotator cuff and also the knee.

The joint below the knee is the ankle. Tight calf muscles, whether from sitting down all day or wearing high heels may alter you ankle mobility. The shin muscles will be unable to perform it primary role because its’ opposing muscle ‘the calf’ is overpowering it via its tightness. Many people get shin splints and plantar fasciitis because of tight calf muscles and weak shin muscles ( posterior tibalis).

It’s important to note that no muscles work independently. Secondly, if you have tight muscles its’ opposing muscles are usually weak and needs to be strengthen. Remember, muscles wrap around our joints. When they are tight our joints range of motion is affected and it travels throughout our posture and human body kinetic chain.

Some symptoms from tight calf muscles and weak shin muscles:

· Jumper’s knee- underneath the knee

· Runner’s knee- muscles on the side of your hip/leg down to you knee. (ITB,TFL)

· Plantar Fasciitis

· Shin Splints

· Achilles Tendonitis

· Low back pain

· Feet externally rotate

Basic assessment tests for hamstring and calf muscle flexibility and extensibility: I highly suggest asking a fitness professional for assistance.

Sit and reach: Sit on the floor with your legs together and straightened. Sit upright, exhale and reach for your toes. Measure the results. How far away were your fingertips from your toes? Note: You can have flexible hamstring muscle with tight calf muscles. This is generally a hamstring flexibility test. If you can touch your toes then go to the tube stretch drill.

Foam Roll: Foam roll (Self Myo Fascia SMR Roll) are everywhere. Most gyms have them but few people use them. I use them for muscle recovery/regeneration and for assessment of muscle tension. Place the foam roll underneath your calf muscles. Lift your body off the floor with your hands so your can have more pressure between the foam roll and calf muscles. Breathe and draw in your navel. Lastly, cross one foot over the other and check for tension. If on a scale of 1-10, 5 being uncomfortable, you score higher than a 5 then you have tight calf muscles. For more information on foam rolling techniques visit http://www.fitnessfoundry.net

Resistance Tube Calf Stretch: This is a sure way to check for tight calf muscles. Obtain a resistance tube or thera band with 15lbs-20lbs of tension (towel can also be used). Sit on the floor and place both handles over the bridge of your foot. NOTE: Make sure to secure it over the bridge of the foot or it can become loose and slap you in the face. After the handles are secure grab the opposite side of the tube with your hands and lay flat on your back. The leg that does NOT have the handles on the foot should be straightened with the knee touching the floor and toes pointing up.

Next slowly lift the leg with the handles over the foot. Bring the leg towards your hip and make sure your leg is straight. Once you reach the maximum flexibility of your hamstrings, point your big toe downwards toward you face. You should feel the calf muscles being stretched. If you feel a stretch behind the knee or in your hamstrings then this may be the cause of your knee discomfort. Hold for 1mintute and 30 seconds, breathe and keep your shoulder, head and lower back on the floor.

There is no silver bullet when it comes to lessening the knee discomfort. If your discomfort persists for then please see a medical professional.

Suggested corrective exercise drills for tight calf muscles and ankle mobility:

First and foremost: Foam Roll your calf muscles including the sides and shin muscles. Find a tender spot and hold it for 45 seconds. One technique is to place the foam roll underneath your calf muscles. Lift your body off the floor with your hands so your can have more pressure between the foam roll and calf muscles. Breathe and draw in your navel. Lastly, cross one foot over the other and check for tension. If on a scale of 1-10, 5 being uncomfortable, you score higher than a 5 then you have tight calf muscles. For more information on foam rolling techniques visit http://www.fitnessfoundry.net

Tennis Ball Roll: This is similar to foam rolling. While seated place a tennis ball under the bridge of your foot (no shoes/sandals). Roll the ball under the foot while simultaneously gently pressing downward. Once you find a tender spot, hold it for 40 seconds. Repeat as needed.

Tube Stretch: This is a sure way to check for tight calf muscles. Obtain a resistance tube or thera band with 15lbs-20lbs of tension (towel can also be used). Sit on the floor and place both handles over the bridge of your foot. NOTE: Make sure to secure it over the bridge of the foot or it can become loose and slap you in the face. After the handles are secure grab the opposite side of the tube with your hands and lay flat on your back. The leg that does NOT have the handles on the foot should be straightened with the knee touching the floor and toes pointing up.

Next slowly lift the leg with the handles over the foot. Bring the leg towards your hip and make sure your leg is straight. Once you reach the maximum flexibility of your hamstrings, point your big toe downwards toward you face. You should feel the calf muscles being stretched. If you feel a stretch behind the knee or in your hamstrings then this may be the cause of your knee discomfort. Hold for 1mintute and 30 seconds, breathe and keep your shoulder, head and lower back on the floor. Repeat as needed.

Stepper or Tri-Stepper: Steppers are a convenient way to stretch your calf muscles. There is now available a Tri-Stepper that allows you to stretch your calf muscles in all anatomical planes (left, right, back, forward). They might have a different name but a fitness professional will understand and be able to assist you.

Shin Muscles Strength Drills: These drills are best when done with a partner but can be done alone. You will need either a resistance tube, band or cable machine. You want to exercise your shin muscle from (3) different angles. It is very important you perform these drills with diligence and go for the full range of motion instead of speed/increased tension.

1. Sit upright on a bench with one leg resting on top of the bench. Your ankle and foot is slightly off the bench. Note your toe is point up. Place a resistance tube (10lbs-20lbs tension) over the foot. Your partner will pull the handle and foot down and away from you (plantar flexion)…you will dorsi flex or bring your foot back into a 45degree angle. Repeat 12-20 times ..hold for dorsiflexion for 2 seconds. Repeat as needed.

2. Repeat instructions above…but your will now evert your foot (turn foot outwards). Your partner will gently pull the handle over the foot in the opposite direction. . Repeat 12-20 times ..hold for dorsiflexion for 2 seconds. Repeat as needed.

3. Repeat instructions from #1 drill…but your will now invert your foot (turn foot inwards). Your partner will gently pull the handle over the foot in the opposite direction. . Repeat 12-20 times ..hold dorsiflexed foot for 2 seconds. Repeat as needed.

Trainer tip: Use only one resistance tube handle for the first couple of sets. Learn the complete range of motion of the drill then increase tension.
Standing calf stretch with rocking (ankle mobility): Stand in front of a wall with a stagger stance. Stretch your arms out and place your hands on the wall- directly in front of shoulders. Back leg is straight (do not lock knee) and leading leg is in a 90 degree bend with both heels on the floor... This drill resembles a calf stretch but you will rock back and forth for 45 seconds. Perform drill on opposite leg. Repeat as needed.

Bosu Ball foot compression (ankle mobility): Great for plantar fasciitis and promoting ankle mobility. Stand on top of a Bosu ball (Dome up and flat piece on the floor). Once on top of the dome learn to balance, stay upright with knees slight bended and navel drawn in. With hands on your hips begin pressing the ball of your feet down on the ball and then shift your weight to your heels. Go back and forth and alternate feet compression. Perform for 45 seconds. Repeat as needed.

After you relaxed your muscles with foam rolling and lengthened them via stretches do the following.

Single Leg Stance with leg abduction on Airex Balance Pad: This drill can be done without a Airex balance pad but I prefer the instability to promote neuromuscular efficiency and inter muscular coordination..Stand on top of a Airex Balance Pad. You are upright with hands on your hips and navel drawn in. Remember to think tall and relax the shoulders. Lift one leg off the floor and to the side for 8-12 repetitions. Keep the toe inward and slowly perform the exercise. Repeat for 3 sets

By the way, consider the following as possible culprits to your knee pain:

· Do you wear high heels on a regular basis?

· Check your footwear for arch support.

· Do you have a workout that promotes joint health and muscle recovery/regeneration? E.g. foam roll, ankle mobility drills

· Are you performing hip dominated exercises to balance out your knee dominant exercises? e.g. single leg deadlifts

These are a few suggestions but there are many other modalities that can assess and alleviate most common knee pain. Integrate a corrective exercise routine into your program and your will be amazed on the positive results. It is time to take your fitness to the next level!

In my next essay, I will discuss how muscles imbalance above the knee leads to knee discomfort and pain. Feel free to contact for pictures and videos of the drills or more information on strength and conditioning training.



Be well and stay ACTIVE!!

Julio A. Salado, AFAA & NASM C.P.T.

Fitness Foundry, designed for healthy living©

Certified Personal Trainer
Assess, Initiate, Motivate

Email: juliosalado@fitnessfoundry.net

http://www.fitnessfoundry.net


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PostPosted: Wed Apr 28, 2010 10:05 pm 
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I had knee pains when I was 13 after an accident while riding my bike home. I started becoming immobile coz I couldn’t stand the pain. I tried several exercises and even knee braces but it didn’t work. My mom made me drink As what I researched, It’s a daily supplement drink to comfort, lubricate and rebuild joints.has only 30 calories and only 4g sugars so it also helps you lose weight [I lost weight too! I LOVE IT! :))] and fits into the energized lifestyle you need to get your joints back in top condition. After drinking for 2 days, i felt amazing relief. I continue drinking it until now. I recommend you guys to try it. It really is effective :D


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PostPosted: Thu Apr 29, 2010 2:30 am 
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SPAM
Not the knee essay, the reply.


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PostPosted: Thu Apr 29, 2010 5:05 am 
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Jungledoc wrote:
SPAM
Not the knee essay, the reply.


jas is a frequent contributor.


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PostPosted: Fri Apr 30, 2010 3:32 am 
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I didn't see a spam link. Did it get removed? Or was there another reply in addition to that one?


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PostPosted: Thu Jul 21, 2011 7:55 pm 
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Good day,

I am posting a question from a reader regarding this post. I have trained clients with similiar tight achilles/calf muscles along with flat feet/pronation. Without a thorough movement screeen and fitness assessment I can only suggest some basic approach to lengthening, strengthening and improving mobility in the ankle joint (also addressing muscle imbalances throughout the chain).

This is where it's important to "Train Smarter" not harder.

Subject: I saw your topic on exrx.net
Date: Fri, 10 Jun 2011 10:06:49 +0000

Hi Julio,

I saw your topic in http://www.exrx.net/forum/viewtopic.php?t=4847. Basically I have this problem but I also have flat feet and short Achilles tendons. I have tried these exercises but they don't seem to work. Is it because of my feet and tendons. Some days it's very hard from me to even walk because of this problem. I'm slim, 27 and very active. Yet I can't do a simple thing like walking. I used to walk on my tip toes but over the last few years I corrected that an now walk on my feet but I think that is probably the cause of the problem. Do you have any suggestions of what should be done?


Regards,
Precious

Date: Wed, 20 Jul 2011 14:11:54 -0400


Good day,

Sorry for the delay of my email.

I have a few questions then I can reply accordingly.

Do you have a job where you sit for more than 5 hours a day?
Have you ever used a foam roll ( myofascia release)?
Is one leg significantly longer than the other?
Any current back pain?
Upper back/neck tightness?
Shoulder injuries?
Do you wear orthodotics?
These questions might seem odd but it will help me help you...

Thanks for your patience and please advise.

Date: Wed, 20 Jul 2011 18:49:47 +0000

Hi Julio,

No I don't have a job where I sit for more than 5 hours but I was unemployed for a year. I'm now self employed.
Never used a foam roll
I saw a podiatrist and he looked at my legs and said they were the same length
I have a stiff back, always slouching. I think it might be heditary my Dad and aunty slouch or have a curved spine. Flat feet and short tendons come from my fathers side of the familly. Will be checking my future husbands feet. lol.
Do have neck and shoulder stiffness i think due to the way i sleep
Yes I wear orthotics
Also I was have ankle pain when I lie down and after lots of walking my achilles tendons really flare up. I used to get really bad calf cramps in the morning that is now better and not as painful.

I hope I answered your questions enough for you to help.

Regards,
Precious

Date: Thu, 21 Jul 2011 07:10:04 -0400


Good day,

Consider the following...you hamstring,calve extensibility is also affected by tight hip/low back/mid back and lats muscles.

If you have access to a club/gym ask a trainer how to foam roll the following.

1) Glutes- piriformis muscles
2) TFL- Tensor Fascia Latte
3) Lats
4) Midback-Rhomboids

Once you find a spot where there is significant tension/pain ( on a scale of 1-10 anything above a 5 deserves attention) and stay on the spot for 15-20 seconds.

This is called myofascia release. You can google foam rolling or search on youtube too.

After you foam roll your muscles become more pliable or extensible - which can then be manipulated with stretches and corrective exercises.
Think of the foam roll as your own personal massage therapist.

Try this and give me some feed back....

JAS

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Be well and stay ACTIVE!!

Julio A. Salado, NSCA C.P.T.
Fitness Foundry designed for healthy living.©
Kettle Bell & TRX Instructor
USAW Level 1 Coach
Assess, Initiate, Motivate


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PostPosted: Mon Oct 31, 2011 1:26 am 
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It took me a while to read such long article. but this is very useful information.
My yoga instructor keep emphasizing the importance of our posture when practicing yoga.
Once we hurt our knees, it is going to take very long time to recover and most of the time it will have some side effects.


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PostPosted: Mon Oct 31, 2011 2:58 am 
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KarenH wrote:
It took me a while to read such long article. but this is very useful information.
My yoga instructor keep emphasizing the importance of our posture when practicing yoga.
Once we hurt our knees, it is going to take very long time to recover and most of the time it will have some side effects.


Hi
Are you for real?

In case you are, welcome.


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PostPosted: Mon Oct 31, 2011 6:55 am 
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What are side effects of hurt knees?

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PostPosted: Tue Nov 01, 2011 10:24 am 
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How are your knees when you run?


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PostPosted: Tue Nov 01, 2011 11:42 am 
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awa33 wrote:
How are your knees when you run?


usually facing forward, on a good day.


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PostPosted: Thu Nov 03, 2011 4:40 pm 
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Oscar_Actuary wrote:
awa33 wrote:
How are your knees when you run?


usually facing forward, on a good day.



LMFAO You are ridiculous.

hahaha too funny.

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PostPosted: Mon Nov 07, 2011 11:37 pm 
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Hmmmm,

Not so sure about seeing a medical person. Chances are you'll just get a pain killer to mask the pain, or worse still, the knife!

Knee pain is a symptom of leg bones that are out of alignment. The solution, get them back into alignment.

How to do that? Find out which muscles have taken the bones out of alignment and get them back on the job.

The problem may start with feet that are out of alignment so you have to find the muscles that have forgotten that one of their jobs is keeping the feet in alignment.

Going up the leg, if you notice knees are either knocked in or knocked out, again, there are muscles that have fallen down on the job. Re-activate them so the leg bones get back into better alignment.

Then again the problem may be a pelvis that's out of alignment so you need to determine which muscles have been the cause of that. As reported in the article it's usually hamstrings, buttock and hip flexor muscles.

BUT I've noticed that when people stand with their back to a k-word bench and put the toe of their shoe on the bench and lean back, the leg with the sorest knee will have the tightest quadriceps muscle. Plus the sorest knee will be further away from the knee of the leg the person is standing on - reinforcing the view that the leg bones and pelvis are out of alignment.

Actually this is a very good exercise for knee pain.

The principles are plain:

1. muscles move bones out of alignment. (Get muscles to move the bones back into alignment.)

2. the cause of the pain is rarely at the site of the pain. Rubbing, crunching, heating. vibrating sand strapping the knee doesn't go to the underlying cause of the problem.

In a nutshell, square yourself up using a set of strength and flexibility exercises.

So, it's not a medical problem, it's a fitness problem and you can't solve a fitness problem with a medical solution.

In the meantime stay tuned, highly tuned and work out which exercises you need to do to get your body back in better alignment.

Regard and best wishes

John Miller
Canberra


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PostPosted: Mon Nov 07, 2011 11:58 pm 
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I suppose you will tell us about these exercises to realign the bones?

All in all, I like what you have to say

welcome


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PostPosted: Tue Nov 08, 2011 10:02 am 
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John, you're replying to an old post that is largely hypothetical so take this in the same light. A knowlegable personal trainer can help in some situations, particualiry if it's obvious that the result of pain is due to a muscle imbalace or it's a stability or mobility issue. However, in most cases where pain is involved, it's outside their scope of practice. The proper next step is to see a GP who should evaluate the injury and determine the proper method of addressing the issue whether it's a Physio Therapist, Chiropractoer, etc. It's largely up to the injured person to make sure that the treatment is what they are looking for. I'm sure JungleDoc could expand on this.

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