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

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 – Triggered Quads Grumpy Knee 4

Good Afternoon,

Last week we looked at our Quadricep R1 (subtle tension that kicks in due to neuromuscular tension rather than tightness), so now it’s time to get out your favourite myofascial release tools and have some fun!

We are searching for “landmines” (or Trigger Points)!

How to know you have a Landmine?

You will roll over a lump that can be exquisitely painful. It may refer an ache to another part of your leg, when you are compressing it. You may even experience an involuntary ‘jump’ or twitch every time you roll over it. That’s the truest sign of an angry trigger point!

Don’t be worried about working deeper into Trigger Points once you start to get used to the pain. You will increasingly tolerate it, and the good news is that you can do yourself no harm, and instead there will gradually follow a releasing of that tense pain, less of the twitch and increased knee mobility and strength.

Surprisingly, trigger points seem to happen in predictable areas of the muscle:

 

 

 

 

 

In the self-myofascial release video today, your Quad and ITB are not on stretch, so you might get painfully deep into your Vastus Laterals and Iliotibial Band without much effort.

http://www.rehabtrainer.com.au/cafe/grumpy-triggered-quads-grumpy-knee

Be warned: ease into it gradually, gently, firmly. Hold tense trigger points for 10-15 secs, and watch them “melt” under the sustained pressure. Do 4-5 reps on each trigger point you find. Don’t go so hard on them you have to twist your face into knots!! Breathe through it.

You can use heat pack before or after if you so desire – it helps relax muscles and feels great.

So – it’s time to go searching for Landmines in those Quads!

 

Wednesday Rehab – Grumpy Quads, Grumpy Knee 2

Hi there, Have you started to focus a little more on your Quads? If you have knee pain, it ultimately will come down to this, and if you don’t it’s the ultimate knee injury prevention strategy!

And while it is true that other aspects of the knee may also get in the way of a happy knee (e.g. poor movement control, training error, ligamentous instability, and joint surface changes, and more), ultimately the quality of your Quads will determine long term knee grumpiness. We will deal with some of these other things (that we can change) in the future.

But don’t let these issues stop you digging deep, and doing the hard work of getting quality quads. That’s what you CAN do, what you can control.

R1 Tension from Trigger Points in Quads – Heel to Butt

First question is: how tight and / or tense are your quads? Is there an appreciable difference in restriction from grumpy knee to happy knee? Is it hard to get your heel to your butt – are you even close?

The R1 for a muscle is an angle measurement that will tell you how much tension it is under. For the Quads, it is the first tension you sense as you bring your heel to your butt. Lie down and try it: swing your foot gently back up towards your butt and see how close you get. Ideally you want an even amount of freedom on this movement between L and R, and certainly on your grumpy knee this is critical to improve!

If you are tense on one side, you are likely to be riddled with tender lumpy spots are you in your Quad. Go digging to find out. Deep digging. Do some of the lumps make you jump?

Trigger Points in the Quad causes tension that pulls the patella north to the hip, and laterally towards the outside knee. Therefore, the knee cannot easily bend without tension, the patella is restricted in movement, and compressed onto the groove underneath that it slides in.

This assessment of R1 is on our video today, with more info on trigger points and why they are so bad for your knee!

In summary today, first element is to accurately assess your own Quads with a view to achieving:

  • Good mobility of Quad (anterior thigh) and ITB (lateral thigh), and
  • Free of trigger points in Quad – “landmines” hiding in your quads causing tension and inhibition.

Enjoy the video

http://www.rehabtrainer.com.au/cafe/grumpy-quads-grumpy-knee-2

Wednesday Rehab – Grumpy Quads Grumpy Knee week 1

QUADRICEPS FUNCTION 
Here’s the crunch: the focus should stay clearly on the stuff we can change. And you CAN CHANGE how the Quads work, slowly and steadily, over a few months. Many have done it.
Jenny McConnell the famous knee Physiotherapist concludes from much research: “Poor quadriceps function, as well as increased body mass index have been associated with increased OA knee pain”. Paul Hodges again: “decreased quadriceps strength is strongly correlated with increased knee pain, patellofemoral cartilage loss on MRI, and tibiofemoral joint space narrowing.”

Here’s the rub: The Quads are extremely difficult to improve (to quote Paul Hodges again), because even the “fear of knee pain decreases quadriceps function”.

WTF?? Even anticipating that a Squat or Lunge will hurt, will decrease your Quad function, and increase the likelihood that it will hurt?

Talk about a dysfunctional muscle! Weak, extremely pain and swelling sensitive (even a teaspoon of saline injected into the knee has been shown to reduce Quad function), prone to tightness, muscle imbalance, fascial dysfunction, and of course inhibition, atrophy and weakness.

If you have a Grumpy Knee, you MOST DEFINITELY HAVE Grumpy Quads. Guaranteed. So how can we break the cycle for ourselves and our clients?

Now if you wrote in to me about your knee pain…. make your Quads the focus, NOT your pain. Not your “OA” or other diagnosis you’ve been given. Ultimately it all comes down to Quad function – that’s your journey; that’s the work you need to focus on. A ton of things like pain and swelling might get in your way, and you’ll need more patience than you think you have capacity for, but stay ON THAT BUS until eventually you reach your destination. Pain-free, loose, balanced and functionally strong Quads.

HOW to improve Quadriceps function? There’s a ton of ways to slowly overhaul your Quads if you really have what it takes. And many don’t, it’s sad to realise. Certainly not clients who are scared of any pain and hard body work. You will have your work cut out convincing them to do their homework!

Next week we begin a series of videos showing you how to get the tightness and trigger points out of your Quads. Nothing is more important for rapid improvement of this muscle’s function, and consequently how your knee feels. [If you only start with strengthening, you will get there, but you are taking the harder road in my opinion.

START your Grumpy Knee rehab with loosening, releasing, triggering, de-sensitising the Quadriceps.

So why don’t you step up this effort before I see you next week? Can’t do any harm trying….Quadriceps.

Wednesday Rehab – Grumpy Knee Diagnosis

In this series, we are all about “Grumpy Knee Syndrome” – a highly technical term 😉 – that perfectly describes one of the greatest challenges for Strength and Conditioning Coaches and Rehab Specialists ( Trust me on this one!)

Have you done what I asked you to do last week? If you have knee pain you need to honestly answer each the 4 Q’s before you go any further (actually they kind of apply to any pain or body problem you might be challenged with..):

 

 Q1 Have you prepared yourself for the long slow road, or are you hoping for a quick fix? 

 

 Q2 Have you assessed and begun working
on your feet and / or hip function?
Work on those weaknesses above or below.
 

 

 Q3 Are you listening closely to what your knee is saying about
changing your habits – in lying down, standing, walking, running, lunging or squatting? Are you making changes?
 

 

 Q4 Have you found any ways to strengthen your Quads that
a) don’t aggravate your knee, and that 

b) really make your Quads burn and come alive?

What’s the Diagnosis of your Grumpy Knee?

I’m going out on a limb here when I make the call that as an industry, we have focussed too much on the Q: “What’s the Structure That is Causing the Pain?”, rather than doing what we know will help, and doing it really well.

On the chronically painful knee, have we perhaps made it too big a deal whether the pain is Patello-Femoral or ITB or Meniscal?? Don’t misunderstand me here, though – if your knee is acutely injured, or swollen, or under management by a Medical Professional, then fair enough discussions around diagnosis are relevant.

But if the statistics (as quoted by Specialist Australian Physiotherapist Jenny McConnell) are anything to go by…”15-30% of patients report little or no functional improvement 12 months following a knee replacement..”. That’s with a TOTALLY NEW KNEE. What about all the 1000’s of arthroscopes done daily in the western world to “clean out” rough joint surfaces…the odds are even worse that all these knees will be fixed by a diagnosis and operation! 

To look at it from another perspective, to quote Jenny: “Most individuals over 50 have structural abnormalities consistent with Osteoarthritis (OA) on a knee MRI, but only 1/3 will actually have knee pain”! So, a lot of knee OA is potentially from other sources; less structurally significant sources.

 

Wednesday Rehab – 4 Realities for Grumpy Knees (Rehab Knees are hard work)

Thank You for your replies! No doubt it forced you to think about your knee(s), where the pain, clicking, or swelling is, how long it has been going on for, how it started, and what aggravates it. Your story is valuable and I will try and extract useful trends from it over the next few weeks.

Some stuff can’t be said in a quick paragraph – and many of you really need hope and clarity urgently as your knee/s really affect your functional movement and exercise and state of mind.

I hope I can do your trust justice and give you knowledge and hope that will carry you through the inevitable hard work that lays ahead in rehab.

Rehabbing KNEES is particularly hard work – why?

4 Realities and 4 Questions for you…)

Knees have lots of bits to get Grumpy – Lots of non-muscular tissues like bones, ligaments, articular cartilage, tendons, tightly wound connective tissue and meniscus – and all these things take more time than we would like to heal (3 months minimum, up to 2 years!). Patience and endurance is required.

 

 Q1 Have you prepared yourself for the long slow road, or are you hoping for a quick fix? 

Tip of the Iceberg – Knees are affected by what’s happening north (hip / low back) and south (ankle / foot) – more often than not if you do hard work on the areas you will reap benefits at the knee. At least 5 shared stories of how improving their foot function altogether fixed their chronic knee pain! And the research is full of info on how improving strength and control of Gluteus Medius and other hip muscles can improve the knees.

 

 

 

 

 

2 Have you assessed and begun working
on your feet and / or hip function?
Work on those weaknesses above or below.
 

Hard to unload Knees – We load them all day whether we realise it or not; even when we sleep they may lie in a loaded position: hyperextended when lying on your back or stomach, or twisted in side-lying. A few mentioned pain being present even before getting out of bed in the morning! And when we stand and walk there are multiple positions that the knee might be pinched to its end of range, twisted, or crushed – unknown to us often! Most of it revolves around habits that are hard to change.

So the fragile inflamed structures of the knee never can truly heal because we unwittingly continue to load into them, completely unaware. We react after because it is sore or puffy, but can you grow in your awareness to prevent the trigger? Takes a lot of “listening to your knee” – hearing what it is saying and what it wants with a mind to preventing; rather than reacting afterwards.

Imagine your finger joint constantly being bent back to its limit through the day and night, or twisted or made to carry loads for long periods – you would have a chronically grumpy finger Joint!

 

 

 

 

 

 

 

Q3 Are you listening closely to what your knee is saying about
changing your habits – in lying down, standing, walking, running, lunging or squatting? Are you making changes?
 

Stubborn Quadriceps – this muscle is 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.

 

 

 

 

 

 

 

 

 

 

 Q4 Have you found any ways to strengthen your Quads that
a) don’t aggravate your knee, and that 

b) really make your Quads burn and come alive?

Feel the challenge of Grumpy Knees? .. for those of you who wrote with your Grumpy Knee Story which of the 4 Realities most relates to you?

 

Wednesday Rehab – Grumpy Knees

Greetings following the last series on Upper Body we now switch our attention to our lower body, it’s about time we dealt with one of the most common of client, trainer and even physiotherapist complaints – grumpy knees! We will devote a good series to this challenging and vast topic. Today I need you to tell me quickly about YOUR sore knee so be prepared!

We are about keeping it practical, but with some intelligent, researched, creative and compassionate opinions from colleagues who are Rehab Trainer Educators (some of who have Grumpy Knees!).

The kind of topics I see us tackling over the next month (or three) are:

  • Common Pain Presentations of the Modern Personal Trainer – YOU 😉
  • Knees – the Icebergs of the lower limb!
  • Knees over Toes in squat and lunge?
  • Common functional movement dysfunctions of the knee to correct
  • Latest relevant knee rehab research. 
  • Understanding noises and swelling inside your knees.
  • Novel new Cues for enhancing inhibited quads
  • Building balanced quadriceps
  • Athletic late stage knee rehab

On the ground research about the common types of pain that fit people like you get.

Please fill in the attached Survey and send it back:

 

Quick Knee Questionnaire for You to do right now

 

I want to hear about YOUR knee pain – email me back right now:

  1. Where it hurts on your knee/s (front, back, inside, outside); any click?

    Answer: ____________________

  2. How severe the pain is out of 10 (e.g.. 8/10 if it really stops you doing the movement)

    Answer: _/10

  3. When (how long ago?) and how it began (what activity)

    Answer: ____________________

  4. What makes it worse?

    Answer: ____________________

 

Thank you!

Looking forward to your quick reply on Knee Pain summary so we can all be wiser as to how to deal with this scourge on the fitness industry. This info tells me what types of topics might interest you in this Grumpy Knee Series…