Rehab Trainer – DEACTIVATING HAMSTRINGS FOR GRUMPY KNEES #1

Today – a quick video with some Rehab Training ideas for deactivating your Client’s and your own Hamstrings. This is great for clients with hyper extending knees – turn down those whammies before turning up their quads and glutes!

Keep reading here and for the video: Article

Rehab Trainer – Medial Tubing Pull for Grumpy Quads GQ13

I hope I didn’t confuse you last week with the ball-squeeze debate… let me say clearly that I believe it is better for activating VMO to have the tubing AROUND THE OUTSIDE of the knees.

This actually increases the activation of the VMO, which shows itself in increased EMG readings (see todays video from 2011 in Iceland where we were trialling different techniques with Physio friends Stefan and Einar). Up to 25% increase in VMO activation happened simply with applying tubing in a medial direction.

Click on the Link to read article and watch video:

Grumpy Quads GQ13

 

Rehab Trainer – Ball Squeezing for Grumpy Quads? GQ12

Uh ohhh look out…  this one might mess with a few heads because a “sacred cow” is being threatened ….and this one is controversial! Friends, we are talking about whether or not to squeeze a ball together between the knees during squat to help with knee pain. Many fitness and health professionals swear by this.

Research was done in the early 1990’s that kickstarted the idea that co-contraction of the hip adductors and knee extensors may elicit greater VMO activation, as apparently the majority of VMO’s fibers arise from the tendon of adductor magnus. Indeed, this has been previously researched with some encouraging results… whilst other have shown no effect at all.

Keep reading the article and video here:

BALL SQUEEZING FOR GRUMPY QUADS

 

Rehab Trainer – Early Fx Integration for Grumpy Confused Quads 11

In all my Physiotherapy days treating knee pain, I was never more grateful for any piece of equipment than for the Leg Press they had in the massive gym next door to our Sports Medicine Clinic at Lutwyche in Brisbane. It was perfect! – the kind that moves your body away from the platform, not the platform moving (less functional I think). 

I used it almost every day with all knees – for assessment of everything from 1-5RM strength, though to activation at a basic level, post-operative baseline strength; etc.

Please click on the link to keep on reading and watch the video.

Grumpy Confused Quads

 

Rehab Trainer – Firing UP Grumpy Quads 10

Thank you if you sent in your personal experiences for Switching ON your own quadriceps! Really, really appreciated some of the insights and superb ideas from you.

To begin, here is a small selection that the whole group offered (some very smart Personal Trainers and Injury Specialists out there in our family!):

Please click on the link to keep on reading and watch the video.

Rehab Trainer – Switching ON Grumpy Quads 9

 

Let’s just pause for a deep breath in this series on Grumpy Knees…we have spent a good few newsletters now on Quad releasing, trigger points, R1/R2, and stretching, and how have you found this? Anything new for you? What do you find hardest to do if you have Grumpy Knees?

No video today, instead just want to intro a new direction for us: activation and strengthening of Quads. 

The challenging reality we face and discussed earlier was that “Stubborn Quadriceps are surprisingly vulnerable to inhibition and atrophy, and doesn’t like operating when pain and swelling is present. It’s a real Catch-22…weak quads result in knee problems, which result in weak quads. Chicken and egg.”! 

And of course we all have some confusion around these issues, like Marissa from Indonesia wrote a while back:

Go to the Rehab Trainer website for the full article:

http://www.rehabtrainer.com.au/cafe/switching-on-grumpy-quads

Wednesday Rehab – Passive Stretching R2 Mobility for Grumpy Quads 8

Hahaha I love bringing some fun into the rather serious world of Rehab  – I’m hoping R2D2 might be feeling a lot looser since last session of Myofascial release ;))…. how about you?

 

But now to KEEP some of that looseness, we need long periods of holding on stretch near the R2 limit. Straight after myofascial release. Use that window of freedom to lock in some longer term changes.

 

These two passive Quad stretches should be absolutely taught to every client with knee, hip, and low back issues. They each have slightly different values, can you feel the differences?

 

A few key elements to enhance these intense stretches:

  • Check your knees are supported under soft padding if kneeling
  • Check your knees don’t feel pain during Quad stretching (although I do sometimes think that the pain felt can be stretching of fascia near the lateral patella..) tricky to know.
  • Use pelvis posterior tilt to further enhance the stretch. KEEP your chest up for maximum value.
  • Breathe; relax and let go of tightness,
  • Hold 30sec at a time, no less! Do 3-4 reps.

How often – Well, how much time you got? No limits, really to how much you do. You could easily do 5 sets per day you know that? Ohh the changes would happen so much faster

Check the Video:

http://www.rehabtrainer.com.au/cafe/grumpy-quad-r2-passive-stretch

Hopefully your Quality Quads start to loosen before R2D2’s ever will….

Wednesday Rehab – Myofascial R2 Mobility for Grumpy Quads 7

 

R2 mobility? WTF? Sounds like a technique on a certain Star Wars character 😉

All it means is the very limit of a tissue’s extensibility; its true passive end range. Probably some discomfort associated with holding it at this point but not painful (unless you are stretching nerve tissue without realising it).

Muscle and fascia are at full stretch; any “knots” (read Trigger Points aka “Landmines”, or scar tissue) in muscle, fascia and ligaments are holding back the ability of structure to fully lengthen.

Hence today’s big message for loosening muscles effectively:

…do R2 (end range) Myofascial Release FIRST BEFORE before doing R2 Passive Stretching. 

Reduce Myofascial “knots” (today’s video) then learn how to do Stretching immediately after (next week) . This rule applies to ANY myofascial tissue, as a matter of fact – if you don’t R2 myofascial release the tissue before R2 stretching, you simply lock in the trigger points further. The knots in the rope analogy applies perfectly:

 

 

 

 

 

“Try lengthening that out by pulling at both ends!”

 

And it applies really well to joint and neural mobility work as well. Myofascial release first, then see what you are left with before attempting the deeper layer of loosening of joints or neural tissue.

So, take yourself up to full stretch of your Quads somehow, listen to how they feel; then do your myofascial work for 3-5 minutes, then repeat and see how much range of movement you have gained!

 

http://www.rehabtrainer.com.au/cafe/grumpy-quad-r2-release

Wednesday Rehab – VMO Trigger Activation for Grumpy Quads 6

Without wanting to get lost in the science and research around muscle inhibition, knee pain and how to fix it, you can trust us that some muscles get overactive, tense and dominant in response to Trigger Points, and others do the opposite: become inhibited, elongated and weaken.

This is the essence of what we have always banged on about: “Muscle Imbalance” and one of the easiest to understand is the imbalance between overactive Vastus Lateralis, and underactive Vastus Medialis Oblique (VMO) that occurs so easily with Grumpy Knees.

So, a novel idea, also taught by other high level rehab institutions (e.g. Kinetic Control see here), is that of doing Trigger Point work on VMO in order to activate it. Later on we can do activation through carefully targeted exercises and the use of theraband tubing, but to begin with it can be so powerful and effective to release this small muscle area from inhibiting Trigger Points!

Not only that, but as you can see from the diagram, if those Trigger Points are “active” their referral patterns of pain may actually be the source of some of the Grumpy Knee feelings! Could it be that some or all of your Grumpy Knee pain is directly coming from Trigger Points in your VMO?

 

 

 

 

 

 

 

 

Watch Ulrik demonstrate VMO Trigger Points in the video in order to activate it!

Watch the Video:

http://www.rehabtrainer.com.au/cafe/vmo-activation-for-quads

Wednesday Rehab – Hypersensitive Fascia Grumpy Knee 5

Don’t you hate myofascial rolling through those sore areas in your Quads and ITB? Areas that are not necessarily the deeper lumpy “Landmines” (Trigger Points) we discussed last week, but rather areas where the surface is simply sore to touch?

My theory is that those areas are fascia that is hypersensitive. In the same way that scar tissue can be hypersensitive to touch. And because there is soooo much fascia in and around the hip, thigh and knee, it stands to reason that most of us are likely to have super-sensitive areas. Especially if you have Grumpy Knees!

So to assess this tightness on your client I recommend the simple method in todays video – check left and right difference to see if it is tighter on the sore knee. If so, that’s your green light! Go hard with myofascial rolling in order to relieve niggling knee pains (well not too hard initially because you don’t want to scare off your client 😉

IT WILL HURT because if its tight, there will be areas of hypersensitivity in the fascia preventing easy expansion and movement of the local tissues down to the knee (the fascia that wraps from the ITB into the patella is termed the “Lateral Patellar Retinaculum”).

 

 

 

 

 

 

Connective Tissue is prone to hypersensitivity when tight or tethered

 

One Personal Trainer mentioned scar tissue on her lateral quad where a dog bit her a while back. Same side as her knee pain. Could there be hypersensitive ITB fascia and scar tissue contributing to her knee pain? Guilty until proven innocent I say!

Our assessment today then is more about end of range flexibility testing (R2), than early tension testing (R1).

And so the myofascial release looks different – more dynamic and superficial than deep and slow. For some this rougher approach is excrutiating, for others its a lot less sore. And nothing works as well as the Posture Pro!

Perhaps it depends if your Grumpy Quad is more trigger point infested (primarily “tense”), or fascially tight and sensitive (primarily “tight”)?

 

Or both?!

Watch video here:

http://www.rehabtrainer.com.au/cafe/hypersensitive-fascia-grumpy-knee