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I just finished up my winter run with my son and my dog.
While I was running I started thinking about the number one mistake that run leaders make with their clients when it comes to running injuries.
I will get to the number one mistake, but first let me give you a little background.
I just wrapped up my Exercise Rehabilitation of the Knee course at Douglas College.
I learn so much from the fitness professionals that attend. They all have great questions and I wanted to share one with you.
I got a great question from one of the registrants about knees passing the toes.
Commonly taught in fitness certification is the fact that you should not have the knees passing the toes. My response to this is, it depends on the situation.
What to do if you Have Knee Pain if your Kness Pass Your Toes [2:47m]: Play Now | Play in Popup | DownloadToday, Eric Cressey has a guest blog post for you.
I am so excited about the blog post and Eric’s upcoming course at the Fitness & Rehab Conference on March 27 & 28 in Vancouver. I have Eric presenting the whole weekend on corrective exercise for rehabilitation and performance.
Now lets get to the blog post.
One of the most common issues we see in both athletes and our general population clients is a lack of ankle mobility – and more specifically, dorsiflexion range-of-motion.
For just about everything in life – from sprinting, to lunging, to squatting – we need a certain amount of dorsiflexion (think of how far the knees can go over the toes, or the positive shin angle one can create without lifting the heel). If we don’t have it, we have to compensate.
One of the most common things we see in people with a lack of dorsiflexion ROM is an “out-toeing,” as this opens up the ankle and allows for them to get to where they need to be – even if it isn’t the most biomechanically correct way to do so. This out-toeing may also be caused by hip internal rotation deficit (HIRD), so it’s important to assess both. Check out this video for more information on how to assess for HIRD.
The knee is the focus of an exercise program when it is injured but often ignored any other time. More and more research has come out showing that the goal of the client should determine the knee exercise program compared to the presence or absence of injury. If your client’s exercise goal is prevention of knee injuries, the exercises program differs from a client that is recovering from a knee injury. If the client has had a knee injury and would like prevent a future knee injury, there is an exercise program that focuses on overcoming knee injuries. It is important that the fitness professional know which exercises and exercise programs are best for their client depending on the goal of the client. In this exercise and knee injury webinar, the fitness professional will learn three different knee exercise programs to help their clients that want to prevent a knee injury from occurring, rehabilitation a knee injury and overcome knee injuries by preventing them from happening in the future.
- 12 exercises to help prevent knee injuries
- 37 exercises to help your client recover from a knee injury
recommendation for fully rehabilitating you client from an ACL injury
- Why you should be getting your knee in jury clients doing leg extension exercises
- If all you are focusing on is squats to recover from a knee injury, then you are not helping your client fully recover from their injury
- 6 month exercise rehabilitation program for recovering from a knee injury
- Disccover the 3 reasons why you should have your clients have their knees pass their toes
- Learn 2 areas fitness professionals should be focusing on more than the kness passing the toes
- the most frequent knee injuries you will see
- Video of the webinar that you can watch in the convenience of your computer at your own pace and as many times as you would like
- MP3 of the webinar so you can listen to the webinar and learn the exercises for knee injuries while in your car or listening to you iPod
INSTRUCTOR:
Rick Kaselj specializes in exercise rehabilitation, post-rehab, active rehabilitation, exercise therapy and corrective exercise. He works in one-on-one and group rehabilitation settings, training people who have been injured at work, in car accidents and during sport activities. His clients and group exercise participants include a wide variety of individuals from healthy and special populations. Rick has given over 233 presentations to 4531 fitness professionals and consumers across Canada while continuing to work in rehabilitation centers, physiotherapy clinics, fitness clubs and personal training studios. Rick recently completed his Masters of Science degree focusing on corrective exercise and therapeutic exercise for the rotator cuff. To reach Rick or learn about his exercise rehabilitation courses please visit http://www.ExercisesForInjuries.com
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Ankle injuries are huge.
That is why I have chatted so much about them on the blog. If you dig in the archives of the blog, you will find a hiking stretch to prevent ankle injuries and why your clients ankle exercise rehabilitation program is not working.
Now back to this post.
My 23 month old son suffered an ankle sprain.
Ya! 23 month old.
He was playing in the playground and came off the slide funny.
I was there and watch it. It was a classic inversion sprain.
I think it was because of the over-sized running shoes he was wearing.
It slowed him down but he was able to continue playing.
We noticed it even more later that night.
His gait was off and his ankle was sloppy.
He bounce back very quickly.
I will keep an eye on that right ankle to see what happens over the next little while.
Now to the interview.
I interviewed Jimmy Smith, who is a personal trainer in Stamford, Connecticut.
Jimmy shared a number of tips on how he used exercise to over come his ankle injury plus his approach to clients with injuries.
- His story of ankle injuries
- Ankle injuries and low back pain
- Exercises he did to overcome his ankle injury
- Stretching exercises that helped his ankle injury
- How he approaches a client that has had an injury
- Advice for trainers that are afraid of client’s with injuries
==> CLICK HERE to watch the Jimmy Smith interview on exercises and ankle injuries
Thank you so much Jimmy for the great interview.
To get more information on Jimmy Smith make sure you visit http://jimmysmithtraining.com/
P.S. – If you are looking for exercises for your clients with ankle injuries, I would recommend attending these courses for fitness professionals:
Exercise Rehabilitation of the Ankle & Foot
Balance Training for the Rehab Client
That is it for now.
Rick Kaselj, MS
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I have the second part of an interview for you on post rehab of the Knee.
I interviewed Kevin Yates who is a personal trainer in the East Bay, California .
Kevin is a personal trainer that focus on post injury rehabilitation.
In the first part of the 18 minute interview, Kevin Yates shared with you where he got his experience working with client’s with injuries, his approach to clients with nagging knee pain and how he got into post exercise rehabilitation.
In the second Part of Kevin Yates Post Rehab of the Knee Interview, you will learn:
- Tips for fitness professionals on what to do if they have a client with a knee that bothers them
- What Kevin includes in his knee assessment
- Quadriceps dominance and knee pain
- Resources on the knee
- Books Kevin recommends for exercises and injuries
- Other weak areas that knee clients have
- How the squat is the key to knee and low back pain
==> CLICK HERE for the Part 2 of the Post Rehab of the Knee Interview with Kevin Yates
==> CLICK HERE for the Part 1 of the Post Rehab of the Knee Interview with Kevin Yates
I hope you enjoyed the second part of the interview.
Kevin Yates also has a Post Rehab Exercise blog where he has some great articles on post rehab exercise solutions to quickly bounce back from injuries, and eliminate nagging aches & pains.
P.S. – If you are a fitness professionals and have clients with knee injuries, if you are interested in new exercises for them, I would recommend attending these courses:
Exercise Rehabilitation of the Knee
Exercise Rehabilitation of the Hip
That is it for now.
Rick Kaselj, MS
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I have an interview for you on post rehab of the Knee.
I interviewed Kevin Yates who is a personal trainer in the East Bay, California .
Kevin is a personal trainer that focus on post injury rehabilitation.
In the first part of the 18 minute interview, Kevin Yates will share with you how he got into post exercise rehabilitation, where he got his experience working with client’s with injuries and his approach to clients with nagging knee pain.
- How he got into post injury rehabilitation
- Why he got into post injury rehabilitation
- His story in post injury rehabilitation
- Where he trains his post injury rehabilitation clients
- How he approaches clients with nagging knee injuries
- Why knee pain may not be the problem
- His approach looking past the knee plan
In the second part of the interview, Kevin shares some of his best tips on how he deals with common knee injuries plus how he assess the knee in a client with knee injuries. Lastly, Kevin share how there are very few resources on exercises and injuries but he has found one book that he refers to often to help him with exercises & injuries.
Watch for the second part of the interview, very soon.
==> CLICK HERE for the Post Rehab of the Knee Interview with Kevin Yates
Kevin Yates also has a Post Rehab Exercise blog where he has some great articles on post rehab exercise solutions to quickly bounce back from injuries, and eliminate nagging aches & pains.
P.S. - If you are looking for exercises for you clients with knee injuries, I would recommend attending these courses for fitness professionals:
Exercise Rehabilitation of the Knee
Exercise Rehabilitation of the Hip
That is it for now.
Rick Kaselj, MS
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I had a running client that was wanting a tibialis anterior stretch because he was feeling a lot of tightness in his shin.
I showed him how to modify the good old quad stretch to be a tibialis anterior stretch.
The tibialis anterior gets tight in people that walk, run and hike so it is an important area to stretch.
Let me go through how to turn the good old quad stretch into two effective stretches for the knee and runners.
The good old quad stretch focus on rectus femoris and the new quad stretch on tibialis anterior.
- grab something for support in order to eliminate balance so you can end up focusing on the stretch
- lean your weight onto one leg
- grabbing the forefoot
- pulling the heel towards the seat
- now move the knee back a touch
- you are looking for a stretch in the quadriceps or the rectus femoris
- take your footwear off
- lean your weight onto one leg
- shift your hand position more towards the toes and pull your toes back
- bring the heel towards to the seat
- then bringing the knee back a touch
With the toes pulled back, you get a tibialis anterior stretch and a rectus femoris stretch.
If the stretch ends up being to strong of a stretch, I can bring the knee more forward and just focus on the tibialis anterior stretch.
Now here is a video where I go through the two quadriceps stretches. The first one focusing on a rectus femoris stretch and the second on a tibialis anterior stretch.
==> CLICK HERE for the tibialis anterior and rectus femoris stretch
If you are looking for more stretches to help your running clients, I would recommend attending these courses for fitness professionals:
Exercise Rehabilitation of the Knee
That is it for now.
Rick Kaselj, MS
I love to be out hiking.
I think I am out hiking right now!
It is my favorite thing to do in the summer. Nothing beats being outside in the mountains, looking at amazing mountain peaks and walking in a sea of wild flowers.
I love it so much that I spent 5 months hiking from the Mexico/USA border to Canada (Manning Park). The trail we hiked was the Pacific Crest National Scenic Trail and was an amazing 4300 Kilometre hike. We saw it all and climbed it all. It was EPIC!
Now getting back to how you can help your client get ready for hiking season.
The first video I talk about the importance of dorsiflexion in hiking which is affected by the achilles tendon. I did the video during one of my training hikes for this years hike which was the Stein Valley Hike. Enjoy the video from Lincoln Mountain, high above Yale, BC, Canada.
==> CLICK HERE to learn the best hiking injury stretch
In the above video I talk about the importance of dorsiflexion in the ankle of you hiking clients. In the next video, I talk about how I use the heel drop exercise to improve on my clients dorsiflexion and get them ready for hiking season and keep them injury free.
==> CLICK HERE on how to do the Heel Drop Exercise for your Achilles Tendon
If you are a fitness professional and would like more information on how to help your clients recover and prevent ankle, knee, hip and running injuries. Theses courses will help you out:
- Exercise Rehabilitation of the Knee
- Exercise Rehabilitation of the Ankle & Foot
I think that is it. When I get back from hiking, I am sure I will have more tips and exercises to help your client recover from injury.
See you in the mountains!
Rick Kaselj, MS
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I was in the recreation centre and a patron asked me:
Before I could answer the question, I need more information. I needed to get a better idea which is best for him.
- What is your fitness goal?
- What is your previous fitness experience?
- What is your present fitness level?
- Are there any injuries that may prevent you from reaching your fitness goal?
- What have you done in the past that was successful in reaching your fitness goal?
He let me know that he was trying to get fit, he had exercised frequently in the past but was inactive as of right now. Plus he had an old knee injury and in the past he liked using the elliptical machine.
I told him to give the elliptical a go and see how it feels. If the elliptical trainer starts to bug your knees then switch over to the treadmill.
He asked me, “Why might my knee bother me while using the elliptical trainer?”
This was the answer that I gave him:
The distance between the pedals or hip width is built for the average individual. It is suppose to be okay for someone that is 5 foot or 6 foot. The hip width maybe too narrow or wide depending on the brand, design, style and pedal of the elliptical machine. If the hip width is outside of your normal hip width, this will change the biomechanics of your leg. This will lead to undue stress to your knee, hip and back.
Fixed Foot will Affect the Position of the KneeIf your client fixes their heel on the pedal, it will affect how their knee tracks. If the knee is not tracking properly this will put greater stress on different parts of the knee and this will lead to knee irritation or knee injury. Try to get you client to keep their heel off the pedal and get them to pivot on the ball of their foot until they have a position that makes their knee happy.
Some people should not have their heels off the pedal, make sure you read the next tip to find out why.
When one shifts their weight onto their toes, this creates greater quadriceps or thigh muscle activation. This will creates greater force on the knee cap (patella). This excess stress may lead to knee irritation and pain in some clients. If your client has knee irritation, get them to use the elliptical with their heels down and see if this modification changes how their knees feel.
Those were my thoughts on which is better, elliptical trainer or treadmill plus a few reasons why your client’s knee maybe irritated by being on the elliptical machine.
I wonder if there is any research of the topic. The above is my opinion on things, I wonder what the research says.
I will dig into the journals and get back to you.
Have a great day!
Rick Kaselj
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A common recommendation of someone that is obese is to begin an exercise program. The type of exercise that is often recommended is a brisk walking program. Since the main preventable risk factor in large joint osteoarthritis is obesity it makes sense for obese individuals to exercise. This recommendation of brisk walking may make sense on helping to manage obesity but it maybe increasing the risk of injury especially in the knee. With the knee being the primary site for obesity-related osteoarthritis, it creates a tough dilemma.
- Peak ground reaction forces (GRF) were 60% greater in obese (BMI of 30 to 43) group compared to normal weighted individuals. This is how it broke down per walking speed:
o 1.0 to 1.75 m/s / 63%
o .75 m/s / 71%
o .5 m/s / 85%
- GRF was significantly smaller for obese subjects versus normal-weighted subjects walking at 1.0 m/s
- Body mass was 48% greater in obese subjects versus normal-weight subjects, whereas tibial articulation area was only 8% larger. How you can visualize this is like have dine amount of surface if you are 100 lbs and a penny amount of surface area if you are 148 lbs. This would lead to obese individuals having greater mechanical loads across tibial articulating surfaces.
- Normal weight subjects preferred to walk at a speed of 1.4 m/s but if obese subjects reduced their walking speed from 1.4 m/s to 1.0 m/s the GRF decrease by 40%.
- During normal walking, the resultant GRF causes an external adduction moment at the knee which puts greater force on the medial aspect of the knee. An increase in external adduction correlates to osteoarthritis severity and progression.
- Obese adults walk with externally rotated leg or may be valgus knee alignment which acts to reduce external knee adduction.
- Preferred walking speed in normal-weighted adults is 1.4 m/s (3.1 mph) and obese adults 1.1 m/s (2.46 mph). With the slower walking speed, obese individuals have the same GRF as normal weight individuals walking at a higher speed.
- Bonus Note – After 4 minutes of treadmill walking or a familiarization period, the kinematics of walking on a treadmill are the same as ground walking.
Brisk walking may not be the best weight loss solution for obese individuals. Having your obese clients walk at a slower speed which is often preferred by obese individuals is the solution to decreasing stress on the knee joint. Other weight loss strategies will need to be explored in order to manage BMI in order to decrease the risk of osteoarthritis and osteoarthritis progress.
If you are a fitness professional and would like more confidence working with clients with osteoarthritis and a great varity of knee rehabilitation exercises, I would suggest attending Exercise Rehabilitation of the Knee Course.
Plus I had done a past post on anterior knee pain and squating that my interst you. CLICK HERE for the article.
For More Details:
Browning RC, Kram R. (2007). Effects of obesity on the biomechanics of walking at different speeds. Med Sci Sports Exerc. 2007 Sep;39(9):1632-41.
I was up early this morning.
What I try to do once a month is to see what is new in the exercise rehabilitation world.
There are a lot of okay places to go but I have a list of journals that I try to visit to see what is new and if there is any new information that will improve my courses or new exercises for my clients.
Let me share with you a little of what I found:
Curve Progression in Idiopathic Scoliosis: Follow-up Study to Skeletal Maturity
Spine: 1 April 2009 – Volume 34 – Issue 7 – pp 697-700
This is article is at a great time. I am just wrapping up the scoliosis and exercise manual. It shows that Cobb angle is still the best predictor of long-term curve progression. This content is already in the upcoming manual and if you have subscribed to the exercise and injuries manuals, you will learn more about Cobb angle and a pre-screen for scoliosis, next week.
Take Home Message – Know what Cobb Angle is and it is the besting indicator of the scoliosis getting worse in a client.
Patellofemoral Joint Force and Stress during the Wall Squat and One-Leg Squat.
Medicine & Science in Sports & Exercise. 41(4):879-888, April 2009.
This was very interesting article. The research is nice but what I am looking at is how can it help with my clients. I have a number of clients that report anterior knee pain with a wall squat. I modify their technique in order to decrease that stress. I never knew that I could change the joint angle of the squat in order to decrease the stress on the knee joint.
This is a nugget of information I will be adding to them Exercise Rehabilitation of the Lower Body courses:
“When the goal is to minimize patellofemoral compressive force and stress, it may be prudent to use a smaller knee angle range between 0[degrees] and 50[degrees] compared with a larger knee angle range between 60[degrees] and 90[degrees].”
Take Home Messages:
1 – Wall squat creates more force on the patella than a single leg squat.
2 – Having the foot a short ways or a long ways from the wall created equal force on the patella in the wall squat except between 60 to 90 degrees of knee bend.
3 – A wall squat between 0 to 50 degrees of knee bend creates less force on the patella than one performed at 60 to 90 degrees of knee bend.
Breakdance Injuries and Overuse Syndromes in Amateurs and Professionals
Am J Sports Med April 2009 vol. 37 no. 4 797-802
Sometimes there is some fun research out there. I thought breakdancing died in the 80s. I do know one friend that goes and competes in breakdancing. I have yet to rehab a breakdancer but I will remember their recommendations:
“Breakdance injuries and overuse should not be underestimated. Physicians should be aware of the common risks in this highly acrobatic kind of dancing.”
Take Home Message – Breakdancing is dangerous like every other sport.
I only got to three journals, I guess I will have to do a little more reading.
Let me know what you think of the above, leave a comment.
Have a great weekend.
P.S. – I have the Exercise Rehabilitation of the Upper Body courses that I am presenting at the end of the month. For more information, click here.
- Rick Kaselj
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