Here are some answers on knee pain when you lunge, plus checking in with a few answers from EFI readers.

Over the week, I received a bunch of questions from readers and I want to take some time to answer them.  I can’t answer them all but I will do my best to get back to everyone.  If you don’t hear back from me after a few days, just send me a reminder email.

Knee Pain When You Lunge

Rick,

I purchased your muscle imbalances revealed package on the weekend and I
just wanted to say I love it so far!! Extremely informative.

Just one question. I have a client right now whose left knee is really
bothering her. It makes cracking noises every time she flexes her knee. She
is alright for hip flexion exercises like squats but for lunges she cannot
perform anymore because of her knee.

I just watched the Maximizing Strength and Stability of the Knee and I am
curious if those exercises will work for her condition.

The doctor gave her exercises like the Bulgarian lunge on the bench but
that is putting too much pressure on her knee. I do not agree with that
exercise choice and I was wondering if you could help me.

My client is overweight so I’m thinking there is too much pressure on her
knee joints but how do I get around this? I have her do squats on the Bosu
ball and leg extensions on the TRX, to really focus on her knees to make
them stronger but are there other exercises that I could be doing?

Thank you for your time!

–
SB

SB,

I am so glad that Muscle Imbalances Revealed has been such a benefit to you.  It is a bit of a labour of love.  Glad it is helping you out.

Yes,  a lot of the exercises in the knee component will help out.  Many of the exercises are in my Knee Injury Solution program.  There are all kinds of levels of exericses plus videos and descriptions of the exercise in Knee Injury Solution.

Here are some videos that I have done that may help you.  You can see more on the YouTube channel.

Video #1

Video #2

Video #3

 The Bulgarian Squat is a good exercise but I would call it an advanced exercise that the average person cannot do.  It puts a lot of  load on one leg.  Often times the weakest point in the leg will give way and with most clients it will be their knees.  With the client being overweight, this makes the situation even worse.

I am a big fan of regressions.  The more you can modifiy an exercise, the happier the client will be.  The more regression exercises you have the more you can change things up to challenge them, keep them guessing, doing new things and keeping them pain free.

One quick thing you can do for knee pain when lunging is decrease the distance between the feet with the lunge and also move the trunk in a forward position.  This decreases the range of motion of the lunge which make the knees happy plus the forward trunk activates the gluteus maximus more which decreases the stress on the knee extensors.

When it comes to other exercises, try the modified lunge that I talked about above.  You can also try bilateral ball squats against the wall or unilateral ball squats.  This decreases the stress on the knees.  You can also try lunging onto a risor or a back lunge.

Let me know how this goes.

If you have something else to add, just leave a comment in the comment box below.

Here are details on my Knee Injury Solution program:

Thanks for the question, SB

Minimalist Shoes for Day to Day Use

Hi Rick,

Great article on minimalist shoes. I’ve seen them around but had no information as to their benefits. I just simply thought it was another fad shoe.

On that note, I was wondering if minimalist vs traditional shoes are good walking or work shoes (for nurses and/or massage therapists who work on their feet often).

Your insight is appreciated,

CI

I headed off to ask Curb, and this was his reply.

Take it away Curb:

I’d look at a couple of things for shoes that you use for standing in for long periods of time:

1. Wide toe-box.
2. A lower heel drop than regular shoes; you don’t need zero-drop (level heel and forefoot) though you can certainly try this but 4-8 mm is fine.
3. I would add a bit of cushioning and not go with a completely cushion-free sole.

Hope that helps!

Curb Ivanic, MS, CSCS

Thank you CI and Curb.

Tips for New Grads

When the spring comes, I always get asked about tips for new grads.  I will be doing an interview in the future about this.  I just got in touch with an old colleague of mine and he has agreed to do an interview on tips for those going through a human movement or exercise science degree.  Watch for it.

Exercises After Hysterectomy

Hi Rick,

Do you have anything for clients returning to exercise after abdominal
hysterectomy?

Best regards,
JE

Janice,

I do not have anything for that specific condition.

I often times start people off with the exercises in Core Stability of the Back ebook. You can check it out here.

Make sure the person has medical clearance to start an exercise program and the medical team supervising has provided you with exercise guidelines.

Heads Up – Live Courses and Internship

I am working on a bunch of live presentations and an internship.  I will have more details on them soon.

I will put them up here.

That is it for this week.

Have  a great weekend and stay injury free.

Rick Kaselj, MS

.

I get lots of email. Let me answer some of the questions that came in over the last week or so.

What to Do About Bootcampers with Painful Knees?

Brenda found me on Facebook.

“Hi Rick, I’ve got a couple of clients with dodgy knees and a lot of my boot camp has running, which is too painful for them – can you offer suggestions that will give them just as good a workout and that are safe? Thanks, Brenda”

If you are looking for a program to help you out, I recommend this:

Working Towards 10,000

I mentioned this in last week’s questions from readers.  I am working towards helping 10,000 health and fitness professionals help 1,000,000 clients become pain and injury free by 2020.

It is an ambitious goal but you got to have big goals to bring the best out of you.

I think I am on the right track especially when I get emails like this:

“Hi Rick,

Thank you very much for the free gift!

I am just starting out as a personal trainer.

However, I have been involved in physical fitness, getting in shape, nutrition for quite a number of years. Your website is really incredible!  You’ve opened my mind up to things that I did not know about.  This will definitely help me out when I train people.  The last thing I want to do is hurt them when they’re coming to me for help.  The information you provide will definitely help me do that.

I now feel better ‘armed’  to train people properly if they have an injury.  Thanks, Rick.
Larry”

Thank you so much, Larry. I am glad all the free stuff on the website has helped you and your clients out.

This is what Larry was talking out, yours free.

Yes, free.  Click here to get it.

Even Fit Pros Get Injuries

A few years back, I got chatting with another fitness professional on injuries that fitness professionals have.

After that conversation, I asked other fitness professionals about their injuries.  I was shocked to see how many of them had some little ache and pain that was not forcing them to stop working, but slowing them down a little.

Here is an example.

“I love learning more about how unbalanced I am.

I just ordered the Achilles tendinitis package last night from your site and am going to get started on that right away.

I went out and bought new shoes and that seem to help a bit, but I’m going to work through the exercises so that I can avoid any future problems.

I can’t remember if it was Eric Cressey or Mike Robertson that recommended your site, but I think that’s how I found about you and your site.

I like the name Exercise for Injuries and the concept behind it… I just don’t like being injured.   Thanks for your help,

EK”

Thanks EK, let’s get  you uninjured.

Seniors in a Care Home

A neat trend that I have seen over the last 12 years of teaching fitness education courses is more fitness professionals in senior care homes.

This is very cool and exciting.

From talking with the few that are in them, what they do is an activity class, stretch classes, core classes and some personal training.

I know these seniors are getting a lot of benefit from exercise at their age.

One thing that they all said was a big issue for seniors is shoulder injuries and many of them have come to my Exercise Rehabilitation of the Shoulder course.

If you do work with seniors, it may be an idea to come out to the class.

Muscle Imbalances Revealed – Upper Body Edition – Exam

Things are rolling with MIRU and people are getting their CECs and CEUs from it.

I have just got approval from NSCA, BCRPA and BCCMT.

Here is a specific question as it relates to the MIRU exam.

“Hello Rick,

How do I go about in submitted MIUB in order to receive .7 credits through the NSCA?

I won the product a few months ago and I do not have a receipt for them for approval.

What do you suggest?

AZ”

It is really easy.

The exam is in the membership area in the exam and there are no plans on taking down the membership ares so it is there when you need it.

Print the exam out and fill in the answer sheet.

Send me the answer sheet and I will mark it.

If you get over 80%, I will send you the certificate for NSCA CEUs.

That is it, pretty easy.

Some More Kind Words about MIRU

“MIRU provided a different perspective about movement.

First, because of the different background of each presenter and second was a sort of the “holistic” approach, meaning that, breathing and myofascialtraining aren´t  too common findings in other materials related to exercise.

Best,

Please do send me your questions via Facebook or email.  I will do my best answering them and please do not be angry if I do not get to it.  I get a few hundred a day.

Plus, here are some more videos that may help when it comes to bootcampers and knee pain:

Today I have a solution for you on what to do if you have knee pain with kneeling.

Give me a minute to chat about this past weekend.

This past Saturday, I presented at the BC Fit 11 Conference.

I had presented 2 sessions.  One was on muscle imbalances and the other on SI Joint injury.

I was very surprised to see 91 people in the Muscle Imbalance Training session and 72 people in the Sacroiliac Joint Pain and Exercise session.

It shows how excited fitness professionals are about muscle imbalances and injuries.

The feedback I got after the sessions was great.


One fitness professional attended the SI Joint session because she wanted to create a dedicated class to the injury.  She has found it to be a huge issue at her fitness facility.

Very cool.

Very excited that I could help out and looking forward to hearing how it goes for her. I have had a lot of people ask about the SI Joint presentation.  SI Joint will be this month’s injury of the month so I will have details on the program very soon.

For today, I want to answer a question that I got during the Muscle Imbalance Training session.

“What do you do with someone that gets knee pain with kneeling stretches?”

I also go through a common modification that many fitness professional do that I do NOT recommend.

Enjoy the video.

In the video, I mention Knee Injury Solution.

This is what I use for many of my knee clients.

The exercises are for a fit or athletic person but I modify them for a rehabilitation and health person by decreasing the range of motion and slowing down the movement.

If you would like more info on the program, click the image below:

Rick Kaselj, MS

I have been thinking a lot about injuries of late.

I am starting to expand my thinking on what it takes to recover from an injury.

I got another great article for you today and it focuses on knee pain from the stationary bike.

It is from a friend, way in Australia.

I know, those crazy Ozzies.

Take it away Kristian.

Knee pain and riding a stationary or even a road bike are pretty synonymous.

Back in my personal training days, I had one client in particular- an ex rugby player who had numerous surgeries on both knees and pretty much all of his remaining cartilage scraped away. He couldn’t run for obvious reasons but he loved to cycle and didn’t want to give this up too.

The problem was, after 10 or so minutes on the stationary bike or any time under load- the pain would nearly be too much to bear. Not that he would say anything but I could see it written all over his face. So we spent a lot of time playing around with the limited positioning of the typical upright gym bikes and found some rules to adhere to when setting up either an upright gym bike or spin bike. Once we got his set up dialled in, and did something else of high importance which I’ll discuss below- my client’s knee pain all but disappeared.

Taking a step back- lots of fitness professionals use stationary bicycles in their clients’ programs.

There are many benefits to this such as:

• increasing or re-establishing knee joint range of motion
• improving knee joint stability
• increasing strength of muscles around the knee

The features of the stationary bike, such as:

• non weight bearing
• low impact
• controlled movement
• variable resistance
• range of motion similar to needed daily activities

Now as a triathlete and a high level triathlon coach, I understand the importance of correct bike set up for both on road bikes and your standard upright gym bike and spin bike (many of my athletes travel for work and have to use gym bikes).

Getting the set up dialed in to reduce knee pain or stop the likelihood of knee injuries occurring. The set up guide below is specifically for upright and spin bikes commonly found in gyms.

1. Get the Saddle Height Correct

The seat height has a direct influence on the amount of knee bend that occurs and thus provides opportunities for pain or injury to occur. When the saddle is too high, you’ll find your hips rock from side to side which can create problems around the hips and the over-reaching (toes pointed) coupled with the repetitive cycling motion can irritate the illiotibial band (ITB).

When the saddle is too low, you end up putting enormous stress through the patellofemoral joint. If you’re suffering from patellofemoral pain and considering cycling, ensure that your saddle is not too low.

To adjust the seat height correctly:

1. Sit on a bike with your shoes on and make sure one pedal is in the 6 o’clock position (one crank arm point directly down and the other directly up).
2. Place your heels on the pedal and slowly pedal backwards, your knee should fully extend without your hips rocking. If your hips rock, the saddle is too high.
3. Now move the balls of your feet over the pedal and you should have a slight 5-10 degree bend in your knee. This will allow you to pedal comfortably without pointing your toes to reach full extension.

NOTE: If you’re coming off surgery and have limited range of motion (ROM) you’ll need to ‘slightly’ raise the seat to allow one full pedal revolution- as your ROM returns ensure you lower your seat height as advised above.

2. The Fore and Aft position

The correct position here is when your patellar tendon (knee in the forward position) is directly over the pedal axle.

3. Use the Pedal Straps

Nearly every stationary bike I have ever seen has pedal straps. These hold your feet in place and allow you to evenly push down and pull up on the pedals as they go through their circular motion helping you create a smooth and efficient pedal stroke.

Starting off with your muscle tissue in a better state

Above I mentioned another thing I did that was of high importance to rid my client of knee pain. This was using a foam roller for self myofascial release as pre-gen exercise tool.

A quick 10 minute session rolling through the calves, quadriceps and gluteals helps increase blood flow, and oxygen to the muscles, open up neurological pathways and break down any adhesions within the muscle tissue.

This prepped the muscles for exercise and started the warm up process but also reduced a lot of tension off the knees and created a better ROM from the get go.

I personally do not do any sessions now without some specific self myofascial release first and I highly recommend that all my athletes perform a pre session rolling ritual. The time investment is minimal but the eradication of pain and the performance gains are priceless.

Kristian Manietta of TriSpecific.com

It is Rick again.

Huge thanks to Kristian.

Excellent information.

If you have a question, make sure to leave it in the comment area.

If you have an opinion on the article, let me know.

Until next time.

Rick Kaselj, MS

Stop laughing. Yes, I am going to talk about high heel pain today.

I was a little bored so I got thinking about high heeled shoes.

I know it is summer and I should be thinking about sandals and flip flops but we will get to that another time.

Back to high heeled shoes.

I had a fitness professional ask me what I thought about high heeled shoes.

Are they a good thing or a bad thing when it comes to the body and injuries?

Hmmmm, interesting question.

Once again, I have my opinion, thoughts and knowledge but it is always nice to dig into the research and see what we can find.

It was amazing what I found in the research when it came to high heels.

#1 – High Heeled Shoes Create Twice the Force onto the Big Toe

In this article they looked at the joint reaction force of first metatarsophalangeal (MTP – The first joint from the foot in the big toe) during toe-off phase of gait while walking in bare feet and in high heeled shoes.

What they found was high heeled shoe walking forces in the big toe were twice as high as in bare foot walking.

Bare foot versus High Heeled Walking:

• 0.8 versus 1.58 joint reaction force in the MTP joint
• 0.44 versus 1.03 times body weight in the metatarsal-sesamoid joint

Conclusion – If you have foot pain or injury in your toes, wearing high heels will make it worse or slow down recovery.

Where to get more information – McBride ID, Wyss UP, Cooke TD, Murphy L, Phillips J, Olney SJ. (1991). First metatarsophalangeal joint reaction forces during high-heel gait. Foot Ankle. 1991 Apr;11(5):282-8.

#2 – Good Chance that High Heeled Shoes will Lead to Knee Pain

Osteoarthritis of the knee is twice as common in women as it is in men.

The researchers wanted to see if high heeled shoe wearing could be the cause.

They got women to walk in high heeled shoes and in bare feet and looked at the forces in the knee.

What they found was:

• a 23% increase force across the patellofemoral joint
• a 23% increase on the medial compartment of the knee

Conclusion – High heeled shoes increase the stress on the knee that can lead to patellofemoral pain or osteoarthritis.

Where to get more information – Kerrigan DC, Todd MK, Riley PO. (1998). Knee osteoarthritis and high-heeled shoes. Lancet. 1998 May 9;351(9113):1399-401.

#3 – Wide Heeled Shoes are No Better then Narrow Heeled Shoes

The researchers looked to see if wearing wide heeled shoes had similar knee tourque as narrow heeled shoes.

What they found:

• Wide heeled shoes had a 30% greater effect on peak external knee flexor torque compared to walking bare foot.
• Wide heeled and narrow heeled shoes increased peak knee varus torque by 26% and 22%.

They concluded that wide heeled shoes cause abnormal forces across the patellofemoral and medial compartment of the knee which are typical sides of degenerative changes to the knee, for example knee osteoarthritis (OA).

Conclusion – Both wide and narrow heeled shoes increase the stress on the knee and could lead to a knee injury.

Where to get more information – Kerrigan DC, Lelas JL, Karvosky ME. (2001). Women’s shoes and knee osteoarthritis. Lancet. 2001 Apr 7;357(9262):1097-8.

#4 – Even Little Heels Affect the Knee in a Bad Way

The researchers wanted to look to see if wearing moderate heeled shoes (1.5 inches or 3.8 cm) in height increased knee joint torque in women.

The cool thing in this study is they got a group of 20 year old women and 75 year old women to participate in the study.

Read the rest of this entry »

This morning I was working on this Osgood-Schlatters Disease article for you.

The idea came from an interview that I had heard a few weeks back.

The interview was with Ryan Kesler who is an ice hockey player for the Vancouver Canucks.

Since my ice hockey team is the Vancouver Canucks, I have seen him in the last few years become a very good ice hockey player.

He almost did not make to the National Hockey League (NHL) because he had an injury when he was a kid that could have ended it all.

He had Osgood-Schlatters Disease and if it was not for his father and his internal push to overcome his injury, his career in the NHL may never have happened.

The things that helped him overcome his Osgood-Schlatters Disease was his mindset which was determination, hard work and a never give up attitude that he could overcome his injury, plus a good exercise rehabilitation program.

Lets chat about Osgood-Schlatters Disease and an Exercise Program for it.

What Is Osgood-Schlatters Disease?

Osgood-Schlatters Disease (OSD) is a condition found in active adolescents that are going through a growth spurt where they have pain and tenderness at the patella tendon where it connects with the lower leg.  There ends up being traction (stress) of the muscle-tendon unit at tibial tuberosity which leads to pain.

Symptoms of the condition come and go and can take months to years to resolve fully.

About 90% of people overcome the injury with rest, ice, activity modification and exercise rehabilitation. Often times it resolves after the closure of the tibial growth plate.

Other Names for Osgood-Schlatters Disease:

• Tibial Aponphysitis.
• Morbus Osgood-Schlatter
• Rugby knee

It is classified as a knee extensor mechanism problem (knee straightening out).

Often times medical professionals will classify Osgood-Schlatters as anterior knee pain.

Other injuries that fall into the anterior knee pain classification are:

• Patellar subluxation or dislocation
• Patellofemoral pain syndrome (chondromalacia patellae)
• Jumper’s knee (patellar tendonitis)

The physical signs of Osgood-Schlatters are tenderness, warmth or swelling at the tibial tuberosity.

Key Structures Involved in Osgood-Schlatters Disease

Structures involved in Osgood-Schlatters Disease:

1. Quadriceps Femoris
2. Patellar (Quadriceps) tendon
3. Patella
4. Muscle-Tendon unit
5. Tibial Tuberosity
6. Tibia

Who Gets Osgood-Schlatters Disease?

It is most often seen in teenage boys and young men. The age range in boys is 12 to 15 and if it is seen in girls, their age range tends to be 8 or 12 years. Most times it is seen after the boy or girl has had a growth spurt and the symptoms gradually come on.

New research has come out showing that athletes with limited dorsiflexion could be at great risk for OSD. It is thought that a decrease in dorsiflexion in the ankle leads to compensation in the leg with increased knee flexion, tibial inversion and foot pronation during the stance phase of running. These three compensations may lead to greater stress placed on the patellar tendon which could lead to OSD.

What Can Cause Osgood-Schlatters Disease?

• Rapid growth and physical activity
• Athletes with poor ankle dorsiflexion

What Makes Osgood-Schlatters Disease Worse?

• squatting
• running
• walking up or down stairs
• cycling
• forceful contractions of the quadriceps muscle
• jumping (basketball, volleyball)
• kneeling
• hurdling
• repetitive hard landings place
• anything that puts excessive stress on the insertion of the patellar tendon

How is Osgood-Schlatters Disease Diagnosed?

• Physical exam by a qualified health care professional
• Radiographic imaging (x-ray)
• Ultrasonography or Magnetic Resonance Imaging (MRI) will show changes in the distal part of the patellar tendon at the tibial tuberosity

What can You Do to Overcome Osgood-Schlatters Disease?

• Modify activities
• Ice
• Decrease inflammation with over the counter or prescribed medication
• Infrapatellar strap
• Stretching
• Strengthening
• Often resolves after growth spurt is done
• 10% to 12% of patients may need surgery

In one study (Kujala 1985), athletes had on average 3.2 months of training and 7.3 months of some activity modifications.

Osgood-Schlatters Exercise Rehabilitation Program

Read the rest of this entry »

Well today, let’s chat about what to do about knee pain with lunges.

I was at a conference and I ran into Sara Dean. She heard I was into injuries and exercise and asked to do an interview with me.

Sara is like many personal trainers. She does one-on-one personal training and bootcamps. One issue her clients have is knee pain when performing lunges.

Here is the interview I did with Sara, helping her clients out on what to do about knee pain during lunging.

What to Do About Knee Pain with Lunges?

==>  Knee Pain with Lunges <==  What You Can Do About It

Let me go through what I talk about in the interview.

#1 – Try a Back Lunge

If you feel pain with a front lunge, you can try to do a back lunge.

This puts more of the force on the back leg and is likely to decrease the pain.

#2 – Look at Technique

Start off and make sure the lunge technique is perfect.

Ensuring that the knee does not pass the toes of the front leg and that the weight in the front foot is mainly on the heel.

#3 – Stride Length

Increase your stride length.

A lot of people will take a short step forward.  Increase the size of step that you take.  This will decrease the likelihood of the knee passing the toe.

#4 – Focus on Down

A lot of times people will focus on moving their body and knee forward during the lunge movement which leads to the knee passing the toes of the front leg.

The focus should be moving down with the body and this will decrease the likelihood of the knee passing the toes.

#5 – Look at Flexibility

Take some time to look at the flexibility in the quads and hip flexors.  These are often tight and put greater stress on the patella (knee cap) which leads to greater stress on the knee.

A huge thank you to Sara Dean, who is a Seattle Personal Trainer and helps new moms lose baby weight.

In the video we talked about Knee Injury Solution which is a program that I put together to help recover from knee pain and injuries.

Rick Kaselj, MS

Just as I was finishing up writing this, I was thinking about knee pain on the outside of the knee.  I think it would make a good blog post.  I will work on it and get it up soon.

If you are looking for more articles related to knee pain, here are some that may help:

• Squats and knee pain
• To Leg Press or Squat if You have and ACL Injury?
• The Best Exercise For Patellofemoral Pain Syndrome

Here are a few other knee pain videos that may interest you as well:

Read the rest of this entry »

I was talking with my friend, Shawna Kaminski, about squats and knee pain.

Shawna runs bootcamps and helps train women over 40. One thing she hears a lot is:

“I can’t squat or lunge because I get knee pain.”

I did an interview with Shawna on what you can do about your knee pain during squatting:

==>  Squats and Knee Pain

In the interview with Shawna, I talk about:

• The importance of squatting and lungeing
• How you can modify the squat
• How flexibility can help you with your knee pain during squatting
• A different kind of lunge that decreases knee pain
• Vicious cycle of knee pain
• Importance of using a mirror for feedback on your technique
• Master your lunge and squat exercises with no weight and added weight

As I discussed in the interview, one of the things you need to address when it comes to knee pain during squatting are muscle imbalances.  I go into detail about this in Muscle Imbalances Revealed.

I am having a tough time keeping up with all the kind words about Muscle Imbalances Revealed.  Here are a few more that I just got:

“Addressing muscular imbalances is of paramount importance when training athletes. Muscle Imbalances Revealed provides the background, assessments, training strategies, and specific exercises to restore balance across the lower extremities, lumbopelvic area, and shoulders, and therefore equips you with the knowledge you need to help prevent the most common sports-related injuries. Even better, you can benefit from all the content from the comfort of your home.”

Kevin Neeld
Hockey Strength and Conditioning Coach
KevinNeeld.com

“I am glad I had the opportunity to review Muscle Imbalances Revealed by Rick Kaselj. These are DVDs that you should NEVER let out of your education library. We all know how good DVDs just “disappear” all of a sudden. I am not only writing this review from the eyes of a fitness & sports performance coach but also a person that has suffered from knee and lower back injuries from my days in the US ARMY.

Muscle Imbalances Revealed is an indispensable resource for coaches and fitness trainers with an “all-star cast” of some of the best rehab and post rehab exercise specialists in this business. It’s not a perfect world and eventually your athletes or fat loss clients will get an injury you need to work with and around. This program has enlightened me and added a new toolbox to help my clients in a more effective way, and improve my own performance and past injuries I sustained while in the ARMY. Muscle Imbalances Revealed is a comprehensive and easy to follow program that I wish was around years ago. Not getting this program is leaving you unprepared for inevitable injuries that you or your clients may receive.”

Nii Wilson
New York City
USAW-Sports Performance Coach/ Underground Strength Coach Certified
NiiWilson.com

“One of the keys to my success as a personal trainer has been my ability to work with and around the nagging aches and injuries of people from 35-55, the very demographic that has the time, money, and demonstrated needs for our services.

The information you’ll gain in MIR is exactly what you need most to differentiate yourself from generic “just-make-em-tired-and-sweaty” trainers. Rick and the crew have done an outstanding job, and Bill Hartman continues to defend his title as “the Smartest Man in Fitness.”

If you want to elevate your skills and, therefore, your income, you need these DVDS. You owe it to your clients and to yourself to be the best you can be.”

Stephen Holt
“One of America’s Greatest Trainers” – Men’s Fitness
2003 ACE Personal Trainer of the Year
BabyBoomerFitnessAuthority.com

Okay, before going.

I remembered that I did an interview with Shawna a few months back where she talked about knee pain.

You can get her tips in this video:

In the interview with Shawna, she goes through:

• The importance of technique
• Where your knees should be positioned
• How you should place your hips

I think that is it.

Have a great day and thank you for reading.

Rick Kaselj, MS

I was training a client and she was getting knee pain when she was squatting.

I wanted to share with  you what I did it in order to get rid of her knee pain when she squatted.

I know it will help you and your clients.

Your Core Maybe Causing Your Knee Pain

The squat is important but at times it can bring on knee pain.  If you do get knee pain when you squat, look at your core strength.

This is not the only thing to look at, but one of the things to look at.

Let me explain what I mean.

When we are standing, we don’t use much of our core.  When our trunk or upper body starts to move forward, we need our core to support and stabilize our spine.

The trunk moves forward when we do a squat.

If our trunk moves more than 45 degrees forward, the extra weight of our bodies moves over the balls of our feet and leads to greater activation and stress on the knees by pressing the knee cap (patella) and the knee joint together.

This shift in weight is a compensation pattern for a weak core.

If you move your upper body so your trunk is less than 45 degrees, you put greater stress on your core. The deep and superficial muscles of the core have to work harder to keep you in the position but this also shifts your weight so it is over the middle of your feet and heels.  This shift in the weight on your feet will decrease the stress on the knee.

Now lets go through some exercises you can do to improve your core when squatting.

How to Strengthen Your Core For Less Knee Pain

Standing to ¼ Squat

You can begin by moving from standing into the squat position with the trunk less than 45 degrees forward.

I teach this with one hand on the stomach and one hand on the lower back.  I get my clients to activate the core and then move from standing into a squat position.

I will get them to hold the squat position for 10 seconds and then move back into standing for 10 repetitions.

We are working on the activation, endurance and strength of the core, and good motor patterns for the squat.

¼ Squat Exercises Exercises

After they have mastered the “standing to 1/4 Squat” exercise, I will get them to hold a 1/4 squat position and perform a variety of exercises.  It can be narrow grip rows or pec fly exercises.  They activate their core and hold the quarter squat position during the full set of the exercise.

I hope this gives you some more ideas on what to do if you or your client has knee pain when squatting.

Before I go, here are some kind words that I just received.

Here are some kind words that I received about Knee Injury Solution from a Personal Trainer and Pilates Instructor:

Rick’s Knee Injury Solution program is without a doubt a huge asset to anyone! I was excited to find out that many of the exercises are easily incorporated into a regular training routine without even noticing.  Many of the things we already do, such as planks, but Rick lays out how to put them together in proper progressions to gain success!  What is also great, is that you don’t need to have background knowledge to understand the program.  More and more people are complaining about knee, hip and foot pain, why not address these issues now?  Anyone can do the Knee Injury Solution program with Rick’s simple, progressive explanations of not only how to perform each exercise, but how to perform the exercises correctly (or correct for instabilities).

Knee Injury Solution is a tool I needed to get my clients permanent results. Thank you Rick for your insight!

Stacey Prejza

Kind Feedback from a Personal Trainer that Has Been Helped by Muscle Imbalances Revealed:

That is it.

Thanks for reading and we will talk to you soon.

Rick Kaselj, MS

I am always talking with people and last week when I was at Fitness Business Summit I got talking with Dr. Peter Osborne.

He had some amazing information on knee pain, diet and cartilage.

Can What You’re Eating Damage Your Cartilage and Lead to Knee Pain?

==> Knee Pain, Diet and Cartilage

Thank you so much Dr. Peter Osborne.

Just to sum up what he went through in the interview:

• Most don’t think of diet as an important component of the healing process
• We need these nutrients in our diet to help collagen to heal damaged cartilage
• With poor diet we may heal but we heal in a weaker state
• Inflammation of the body is a key to slowing down recovery
• How a component in wheat can be slowing down your cartilage recovery
• What glucosamine and chondroitin does to inflammation
• Other foods to consider when it comes to inflammation
• What supplements are as effective as medication

Thanks for reading and listening.

We will talk to you soon.

Rick Kaselj, MS

This little blog keeps ticking away.

I just got this email about Knee Injury Solution.

I thought it would be helpful if I sent it to you.

I am missing the ACL in my right knee (tore it in a horse accident & never repaired).

I have full range of motion, but when I run or do too many deep knee bends (i.e. to clean or to pick up something) I get pain in that knee and have to rest it until the pain goes away (could be weeks).

Will your product help me strengthen my knee so I can avoid this?

I am female, 57 and would like to be able to run more and do more hiking on rough terrain, as well as normal chores.

Thank you.

- D

Yes, Knee Injury Solution will help you.

The components of the program that will help you are:

Component #4 – Exercises to Improve Your Walking and Decrease Pain During Walking

These exercises will help strengthen your knees and  prevent future knee injuries with quick, easy and simple exercises that you can do at home.

This will be great for helping you with hiking and as you progress, you can perform the exercise onto an unstable surface like a balance board to help you with hiking on rough terrain.

Component #1 – 9 Exercises a Day Keeps Knee Pain Away

These exercises help improve the stability in your knee in all directions and loosen up your hip so it puts less stress on your knee.

This will work great to get you back to running.  It will slowly strengthen your knee and build stability around your knee for running.

Component #1 – 10 Minutes to Strong Knees

With these group of exercises, you focus on strengthening your knees.  The exercises can be done with a little equipment or even no equipment.  I have videos of the exercises and a handout you can print out and follow the exercises.

These exercises will help strengthen the knee so bending down will be easier.

D, I hope this helps.

Have a spectacular day!

Rick Kaselj, MS

If you are looking for resources to help you with knee pain or injuries:

• Knee Injury Solution
• Exercises for Prevention, Rehabilitation & Overcoming Knee Injuries

Other articles related to knee injuries and knee pain:

• Knee Injury Stuff – exercise good for knee health, gluteus maximus and the lunge, cartilage and osteoarthritis
• Do Men and Women Squat Differently?
• Ending Your Knee Injury Ends Today
• Fun Stuff about Solutions for Knee Injuries

Courses related to knee injuries and knee pain:

• Exercise Rehabilitation of the Knee

Balance Training for the Rehab Client

That’s all!

I have taken the afternoon to work on a presentation that I am doing for a group of group fitness instructors.

It is called Exercises to Strengthen and Prevent Knee Injuries.

It is a custom presentation that I am creating for the group.

I am getting more and more requests to do private fitness education for various types of fitness facilities.  On Friday it is a wellness facility and next week it is a personal training studio.

Private Fitness Education for Fitness Facilities

While putting my presentation together, I wanted to share with you a few of the cool things I found while taking a look at the research while preparing for the presentation.

Is Physical Activity Bad for Knee Joint Health?

There is the eternal debate if physical activity is good or bad for the knees.  The researchers looked at things from the point of view of: physical activity is encouraged in school, but is this increase in physical activity leading to osteoarthritis?

What They Looked At:

They went back and looked at a lot of the research that was created on physical activity and knee health.

What They Found:

• Strong evidence that physical activity lead to tibiofemoral osteophytes (bony outgrowth covered by fibrocartilage).
• Strong evidence that there was no decrease in knee cartilage based on radiological joint space narrowing.

So What?

This research challenges the belief that if we get our kids to exercise in school, we are increasing their risk of getting osteoarthritis.

We need to get kids moving because the benefits of doing so are much greater than just improved knee joint health.

Where to get more information:  Urquhart DM, Tobing JF, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM. (2011). What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011 Mar;43(3):432-42.

How to Target the Gluteus Maximus Better During the Lunge

What They Looked At:

They looked to see if trunk position (upper body) had an effect on the muscles in the lower body during lunging.  They got a group of 10 to perform an upright, trunk forward (hip flexion) and trunk back (hip extension) lunge.

What They Found:

• Something About Gluteus Maximus – Performing the lunge with the trunk forward (hip flexion) lead to greater gluteus maximus activation.

So What?

We talked about the lunge earlier this week in this blog post, where the researchers showed that females have greater gluteus maximus activity when performing a lunge compared to men.  If you need to get more muscle activation for gluteus maximus in your clients, then look at getting them to move the trunk forward.

Where to get more information:  Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM. (2008). Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J Orthop Sports Phys Ther. 2008 Jul;38(7):403-9. Epub 2008 Apr 15.

How to Prevent Cartilage Damage and Osteoarthritis in the Knee

This was more of an opinion on preventing cartilage damage and osteoarthritis in the knee.

It does show how one injury can lead to another injury which is an important thing to remember.

They had some interesting observations:

• Articular cartilage has a difficult time healing and often times progresses to osteoarthritis.
• Athletes are at greater risk of getting osteoarthritis compared to the non-athlete.
• Those with osteoarthritis often times report joint pain, decrease range of motion and joint stiffness.
• The diagnosis of osteoarthritis is confirmed by the symptoms and the radiological findings (narrowing joint space, osteophyte formation and subchondral sclerosis).
• There is no strong link between symptoms and what is found in radiographic findings.  This is a common theme with most injuries.
• Risk factors for osteoarthritis are excessive musculoskeletal loading (at work or in sports), obesity (based on high body mass index), previous knee injury, female gender and muscle weakness around the knee (quadriceps, hamstring).
• Cartilage injuries are often seen in young to middle-aged active athletes.
• Cartilage injuries often predisposes someone to osteoarthritis.

Where to get more information:  Takeda H, Nakagawa T, Nakamura K, Engebretsen L. (2011). Prevention and management of knee osteoarthritis and knee cartilage injury in sports. Br J Sports Med. 2011 Feb 25. [Epub ahead of print]

Well that is it.  Thanks for reading and let me know what you think by leaving a comment.

Rick Kaselj, MS

If you are looking for resources to help you with knee pain or injuries:

• Knee Injury Solution
• Exercises for Prevention, Rehabilitation & Overcoming Knee Injuries

Other articles related to knee injuries and knee pain:

• Do Men and Women Squat Differently?
• Ending Your Knee Injury Ends Today
• Fun Stuff about Solutions for Knee Injuries

Courses related to knee injuries and knee pain:

• Exercise Rehabilitation of the Knee
• Balance Training for the Rehab Client

.

I am so happy that I got a chance to sit down and look at what is new in the research world.

February was one of those months.  It was full of assessments and clients plus teaching of courses.

We will see how March goes.

Now lets get into the research.

You Squat Funny!

I am getting ready for two in-services over the next two weeks.  One is with a group of fitness professionals in a corporate fitness setting and the next is in a personal training studio.

What They Looked At:

Cool Stuff in the Paper:

What They Found:

So What?

If you try to replicate their findings, it makes sense.

Lets say you got into a single-leg squat and you try to decrease your knee flexion and increase your hip extension. You can feel your weight shift more over the middle of your foot and heel.  Plus you can feel the greater activation of gluteus maximus.

Just keep an eye out for this when you get your clients to single-leg squat, lunge and step-up-and-over.

Where to get more information: Dwyer MK, Boudreau SN, Mattacola CG, Uhl TL, Lattermann C. (2010). Comparison of lower extremity kinematics and hip muscle activation during rehabilitation tasks between sexes. J Athl Train. 2010 Mar-Apr;45(2):181-90.

While I was doing research for the above research paper, I came across this:

Fellin RE, Manal K, Davis IS. (2010). Comparison of lower extremity kinematic curves during overground and treadmill running. J Appl Biomech. 2010 Nov;26(4):407-14.

Is Treadmill Running the Same as Running on the Ground?

What they found was they were similar.

This did kind of surprise me.

They looked at things when it came to kinematics of the lower body.  They found that the differences were less then 1.5 degrees between the two except for rear foot dorsiflexion at footstrike on the treadmill which had a decrease of 4.5 degrees.

Interesting to note and something you can pass onto your client if they ask if there is a difference between running on a treadmill or on the ground.

That is it for now.

Still got some more journals to look at.

Take care.

Rick Kaselj, MS

I had a tough time getting started today.

It’s one of those days when I was not sure of what to write about.

But, I think I got it.

Here we go.

Private Knee Injury Course

I have been asked to do more private fitness education classes for fitness professionals in the Vancouver area.  Companies and fitness professionals have been asking me to come to their facility and teach a group of 5 or 10 people about an injury topic they are interested in.

It has been fun getting these personal requests and setting up private fitness education courses for them.

In March, I have another one for a group of fitness professionals who want me to talk about knee injuries and exercises.

They have some specific questions about what to do with collateral ligament and meniscus injuries.

I know what I would do, but I always like to head to the research to see what’s new.

I am reading this article right now:

Edson CJ. (2006). Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. 2006 Jun;14(2):105-10.

The article is okay -  there’s a strong focus on diagnosis and what to do right after the injury.

Not much about what you should do when it has been multiple months (or years) since your medial collateral ligament other than wear a brace.

I will have to keep searching.

The main thing that I do is look at the hip and the core stability of the hip.

When it comes to the medical and lateral collateral ligaments, they provide stability in the frontal plane (side to side) and so does the core stability of the hip.

When the core stability of the hip is poor, it puts greater stress on the collateral ligaments.

One thing I make sure to do is assess and look at the hip, to make sure it has good stability so that there is less stress put on the collateral ligaments.

Special Population Cheat Sheets

I have been looking at the last few Strength and Conditioning Journals.

In the last few issues, they have included a cheat sheet covering what to do for specific special populations when it comes to designing an exercise program.

The one I am reading now is multiple sclerosis.

I have been saving them on my computer and putting them into my “Special Populations” folder.

I am going to refer back to this one, and to others I find.

If you get the journal or have access to the journal, I would recommend doing the same.

A Few More Kind Words

“Plantar Fasciitis Exercise Solution is a very comprehensive program that not only describes the causes and consequences, but also tells you how to go about healing the problem and giving relief where possible.  Provides alternative ideas to suit all clients/patients.  The best thing of Plantar Fasciitis Exercise Solution was the whole thing really.  Specific advice for exercises and stretches, what to avoid and what to do.  Great!”

Joanne Butler

Bendigo, Australia

Fitness and Athletic Development Coach

Well that’s it, have a great day.

Rick Kaselj, MS

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I would like to talk about some fun stuff about Knee Injury Solution.

I am very proud of Knee Injury Solution.

After 11 webinars, 3 manuals, and numerous books, I am getting closer to what fitness professionals are looking as it pertains to exercises and injuries.

I have made some mistakes, and I have received great feedback from thousands of health and fitness professional on how I can improve my programs.  With Knee Injury Solution, I feel that I am there.

Fun Stuff #1 – Video of the Exercises

The number one feedback from trainers, coaches, and therapist was that they wanted videos of the exercises.

In the past, I would write things out and talk about them in my video presentation. People also want to see the exercises being done.

I have started to do this.  Sometimes I don’t do the exercises right or they are too advanced for me, but I hope people see that I am not perfect and have lots of room to improve on as well. I know having me or someone else go through the exercise will help people out.

Fun Stuff #2 – Hottest Day of the Year

I decided not do the videos myself for the 9 Exercises a Day Keeps Knee Pain Away and 10 Minutes to Stronger Knees workouts.

I got a local female soccer player to help me out.

We filmed her doing the exercises during the summer.  Of course, we picked the hottest day of the year.

She was a trooper, but she went through 4 liters of  water before we knew it.

We had to head into the shade to finish the rest of the exercises.

It was great to take the exercises outside and show people that the exercises can be done anywhere.

It was also great to have a female go through the exercise, so that you can see how she does them and how her body reacts to fatigue.

Fun Stuff #3 – A Guide to Refer To

Other feedback I received was that people like something they can print out and quickly refer to.

I created a little guide with photos, descriptions, and a few details that people can refer to quickly in order to remind them of the exercises and what to do.  If they want more detail, they can watch the video.

I think that’s it.

Make sure you email me and let me know what you think of anything I do.

With Knee Injury Solution, I know that I am closer to getting it perfect.

Take care, and I will talk to you soon.

Rick Kaselj, MS

.

Thank you for participating - well over 40 people entered the Knee Injury Solution Program draw.

There were so many great entries, and a lot of nice things were said about myself and my various products.  Thank you so much.

Just after the video below, I headed into the Fitness Centre in the recreation center to train a rotator cuff injury client that came from Victoria to see me.  While I was there, I saw 4 other fitness professionals that recognized me and who had very kind things to say about the blog.  Thank you.

Now, here is what people have been waiting for:

The Winner of the Knee Injury Solution program is……

This is what the Winner of the Knee Injury Solution Program gets…..

Can the Knee Injury Solution Program Help You or Your Clients?

If you would like to see if the Knee Injury Solution could help you with your knee injury or your clients with knee injuries,  CLICK HERE to find out.

Thank you so much for reading the blog and for leaving comments.

Please keep commenting even if there is not a prize to be won!

Have a great day, and I will talk with you on the blog soon.

Rick Kaselj, MS

Win a Copy of my Knee Injury Solution Program:

This is coming out next week.

You can win a copy of the program, right now.

This is what is included in the Knee Injury Solution Program:

• 9 exercises that you can do to prevent knee pain
• A quick 10 minute workout that you can do anywhere to make your knees stronger
• The exercises to do after knee surgery to increase range of motion and decrease pain
• Exercises to do in order to make walking easier and pain-free
• A guide for those that have knee pain due to an ACL injury to read and have a better understanding of their injury

This is what you have to do in order to be eligible to win a copy of the Knee Injury Solution Program:

1. Go to the comment area and answer this question: “How will having a go-to exercise program for knee injuries help yourself or your knee injury clients?”

It’s that simple.

I will be reading all the comments over the next few day and will pick the winner Monday evening.

Now scroll down and leave a comment.

Rick Kaselj

I forgot to post this:

Moving on to part 6 of the ACL Injury series.

ACL Exercises (Part 6)

An injury involving the anterior cruciate ligament is a serious matter. The ACL is not adequately supplied by blood, which contains oxygen and the nutrients needed for tissue repair and healing. For this, an injury involving the ACL may take some time to heal, if at all. Over time, this can severely limit your physical activities, mobility, and independence. For severe tears, it may take 6 to 12 months (or longer) to restore knee function. Re-injury is also frequent once your ACL has been torn,  resulting in degeneration of the knee joint.

In complete ACL tears, a surgical procedure is the most likely recommendation to avoid further injury and re-injuries and to restore stability. Although the results of an ACL reconstruction are promising, the cost is financially damaging. In the United States, a reconstruction costs between $20,000 and $50,000.  An additional $3,000 is required for rehabilitation and follow up rehabilitation visits.

A neuromuscular training program is the best and most inexpensive way to prevent the occurrence and recurrence of ACL injuries. This training program consists of specialized balancing, stretching and strengthening exercises of the knee’s dynamic stabilizers, agility drills and plyometrics. These activities aim to improve knee stability on jumping, landing and pivoting. This program retrains you to use and move your body correctly, specifically the muscles and tendons surrounding the knee.

Neuromusclar training exercises are usually completed within 15 minutes. It is recommended that these exercises be included in your regular exercise regimen 2 to 3 times per week.

Warm Up Exercises

Read the rest of this entry »

There is a lot more awareness when it comes to muscle imbalances.

The incredible success of Muscle Imbalances Revealed 2.0 has really taken the industry by storm.

Trainers, coaches, and therapists from around the world have been using it to help their clients overcome injuries, bust through fitness plateaus, and prevent injuries.

It has been amazing to see how this little product has helped thousands of fitness & health professionals, which in return has helped hundreds of thousands of people.

Sad to say, the battle continues.

We need to do more to better understand, assess, and prescribe exercises to eliminate muscle imbalances.

In 2011, there will be more and more emphasis on muscle imbalances.

Muscle Imbalance is my #8 Exercise Rehabilitation Prediction for 2011

 
In fact, I just got approached by an Australian outdoor magazine to write an article on muscle imbalances and how it can affect the outdoor athlete.  Very cool.  I will let you know how it goes.

With the media starting to focus on it, so has the research.

Muscle Imbalances in the Research

Read the rest of this entry »