I get a lot of questions when it relates to knee injuries and I have been very interested in knee injuries since I flared up my knee a few weeks ago.

While surfing around the internet, I came across the Knee Pain Guru.  I contacted him and he was kind enough to share his insight when it comes to knee pain and injuries.

The interview is with Bill Parravano.

Enjoy the interview!

CLICK HERE to listen to the interview with Bill Parravano on 4 Techniques to Speed Up Knee Injury Recovery.

CLICK HERE to listen to the interview with Bill Parravano on 4 Techniques to Speed Up Knee Injury Recovery.

What Bill Parravano Shares in the Interview  on the 4 Techniques to Speed Up Knee Injury Recovery:

• Who is Bill Paravano and what is his vision when it comes to knee pain?
• How his own personal experience with knee injury lead him to become a knee pain guru?
• What are the exercises that benefit the knee and around the knee areas?
• Important keys to remember in bringing back balance to the knees.
• Understanding knee pain and knowing the right exercise program for it.
• Understanding the differences between symptoms and cause of knee pain.
• Understanding the huge role of proper water hydration and good nutrition in treating knee pain.
• Discuss the other factors that can worsen the knee pain.
• The techniques he created to speed up knee injury recovery.

If you would like to learn more about Bill, CLICK HERE.

A few things you need to know about listening to the interview:

• To listen to the interview, scroll down to the bottom of this page and click the play button symbol. If you do not have time to listen to it right now, just click the “download” button and download it to your computer. Then you can listen to it on your computer when you like.
• Also the interview is up on iTunes. You can listen to it here or subscribe to the itunes podcast and get all the interviews when they are ready. Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview. I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

If you have a neat specialization or business information that would be of benefit for fitness professionals to know about, please do contact me and I would love to share it with the EFI world.

If you know of a fitness professional that may benefit from this, please forward it onto them.

Take care.

Rick Kaselj, MS

P.S. – If you liked this kind of interview, here are some other articles that may interest you:

• Why Fitness Professionals Must Focus on Fascia
• How Life Coaching Can Help Your Personal Training Clients
• Why Fitness Professionals Should Be Giving Nutritional Advice

4 Techniques to Speed Up Knee Injury Recovery with Bill Parravano [ 37:42 ] Play Now | Play in Popup | Download

I am off to Windsor.

If you have no idea where that is, it is beside Detroit, but in Canada.

I am heading there to present to a group of fitness professionals on, you guessed it, injuries.

I am doing a one day intensive course called Optimal Injury Recovery.

This will be a nice start to a very busy few weeks of travel and teaching.  I am also teaching in Vancouver, San Diego and Edmonton.

Before I left, I needed to clean up my email box and answer a few questions.

Let me share a few of the questions that I got.

Well, before I get to the first question, make sure to watch Jedd Johnson’s video on some of the tactics he used for his elbow and forearm pain:

Should I Get Your Program?

Hello. I don’t know if you remember me but a while ago I messaged you about piriformis syndrome. I wasn’t diagnosed with that yet but I should get an MRI approval tomorrow. After a long walk I lay down and my leg starts twitching where my glutes are at. I have sciatica but no back pain. Should I wait for my approval for the MRI to purchase the piriformis program?

- AR

AR, I remember you.

Yes, I feel the Piriformis Syndrome Solved program will help you.

More important then getting my program, is you need to start doing something to help with your injury.

AR, I am not picking on you.  I have just seen it so many times, someone waiting for an MRI for a rotator cuff injury before they do anything.  They get the MRI, the doctors says it is not surgical and all that time has passed when the person could have been working on making their injury better, but they waited for the MRI.

It is important to get an accurate diagnosis by a physical assessment and diagnositic tests, but an important question to ask you doctor is, “Will a positive result change if what I do is not surgical?”

In many situations, the answer is  ”No.”

Getting a diagnosis provides a foundation for what exercises to do and not to do.  Plus it will rule out anything more serious.  Getting input from other health and fitness professionals can help with the solution, but the biggest thing is to do something for your injury now.

If you look at disability management research, it shows that the longer one waits to get treatment, the longer their injury will be around.  In my opinion, treatment is not going to appointments but doing stuff you can at home and the gym.

All I can say is, get a diagnosis, find out what you should do and start taking action.  We all want someone to fix us but the person that is the best at fixing your injury is yourself.

Sorry, I Don’t Speak Physio

I am a rugby trainer. Where I come from we are not that advanced in sports medicine.  My rugby team, who is about to start their season in a week, has a couple of players with knee injuries (suspected ACL tears and partial tears).

Most of these players will never play rugby after this year so the physio has advised good strengthening, and getting them to play with strapping.

Would you be able to help out with developing programs for these players, or would any of your resources on knee injuries be useful? If so could you advise which one?

I am a conditioning coach and not a physio so will not understand too many medical terms. Would you have any easy to use program that I can do for my players with ACL injuries?

Eagerly look forward to your reply.

Thanks,
B

B, great to hear from you.

I honestly think Knee Injury Solution will give you a good start.

The program is focused on athletes and active individuals, plus many of the exercises focus on ACL prevention and recovery.  I have it set up as an ebook and easy to watch videos.  I have kept things easy to understand and not technical.

I would suggest giving the program a go.

If you need any other help when it comes to setting up a program for your players, I am more than happy to help.

Have a great season, B.

How to Get More Referrals?

Good Afternoon Rick,

I’ve been networking with different health professionals starting this year. However, I’ve had trouble establishing relationships with Physiotherapy Clinics effectively. Do you have any quick words of wisdom you can pass on to me? And as well, I had someone ask me, “Why would people refer clients to Kinesiologists instead of a Physiotherapist?” I partially answered the person’s question but I didn’t fully answer it because I am still quite new in this field. Besides the obvious, would you able to shed more light on this?
Thanks,
–
MS

Thanks for the email.

Building relationships with physical therapy clinics is no different than any relationship.  It involves giving, helping and time.

I would strongly suggest listening to this:

Click here to go to the interview.

The other interview I would recommend is:

Click Here to go to the interview

MS, I want to reply to the “Why should I refer to a physical therapist compared to a Kinesiologist?”

I would focus on the skills and talents that you have that are unique.

For me, I don’t say that I do personal training, exercise rehabilitation, ergonomics, disability management, functional capacity evaluation, etc.

I focus on the fact that “I help people with injuries with exercises.  I can meet you at my gym, your gym or your home, whichever is convenient for you.”

How do you differ from a physical therapist: “I work with people that are finished with physical therapy and are working themselves back into the gym or back into sport.  I work with the physical therapist and build on what she has done when it relates to your injury.  Plus I help people in the gym focus on exercises that will help their injuries and not make it worse.”

I hope this makes sense, MS.

Listen to the two interviews, they will help a lot.  Plus focus on the things you are really good at.

Fixing Elbow Pain

Here is Jedd chatting about the Fixing Elbow Pain program that we put together.

This is what Jedd was talking about:

Just note that today is the last day of release discount for Fixing Elbow Pain.  If you want to check it out, you can here.

Rick Kaselj, MS
.

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If Something Improves Performance is it Better?

Better is a relative term, especially when talking about artificial means of performance enhancement. The mistake people make is assuming that because something improves performance it must be better and therefore you want to use it all of the time. The fact is that equipment can either enhance good technique and fitness, or cover up technique and fitness gaps, and there is a huge difference between the two. The first will let you tap into your own abilities even more and the second will lead to plateaus and overuse injuries.

Mountain Biking and Clipless Pedals

In mountain biking this is seen in the rampant use of clipless pedals, but ours is not the only sport that has this problem and we can learn something by looking at the parallels between our situations. In fact, the best analogy to explain this concept is the use of a weight belt when squatting or deadlifting.

How Clipless Pedals are Like a Weight Belt

Using a weight belt will help you lift more weight, which technically makes it “better” from a performance point of view. However, anyone who knows anything about strength training knows that you don’t use a weight belt all of the time. You save it for when you need it, but on average, 80-90% of your lifts should be without it.

Why is this?

If a weight belt is “better” then why do the strongest guys in the world not use it all of the time?

The answer is because they know that you must build your technique without it so that you keep yourself honest and do not start to use the belt to cover up technique flaws. Watch someone who really knows how to squat and his technique will look the same with or without the belt and his best raw squat (using no belt) won’t be too far behind his squat while using a belt.

Compare this with the average gym rat who uses a weight belt for everything. It doesn’t take a highly trained strength coach to see that they their technique sucks and if you took the belt away and exposed their pathetic core strength they wouldn’t be able to squat nearly as much. Most of us would agree that in this case you are better off building your technique and fitness “raw” and using the equipment to enhance that base.

Specialized Equipment is for Competition

In fact, most sports have specialized equipment that is “better” than normal training equipment but they only use it to get used to it and for competitions. Track has racing shoes, swimming has special suits, and I believe that clipless pedals belong in the same category – equipment that does enhance your performance but not something you should be using all of the time since they can be used to cover up technique flaws.

What Does the Research Say?

The truth is that you should be able to ride a bike relatively well with some good flat pedals and shoes. In one study (Mornieux et al. Int J Sports Med 2008; 29:817-822) it was found that the pedal stroke of elite cyclists looked the same on flats and clipless pedals. Another study (Korff et al. Med Sci Sports Exerc 2007; 39:991-995) showed that pedaling in circles or pulling through the top of the pedal stroke resulted in a less powerful and efficient pedal stroke –  in other words, there is no “magical” pedal stroke that is only available by attaching your foot to the pedals.

If you can’t pedal half as well without being attached to your pedals then that is a sure sign that you would benefit greatly from some time spent riding “raw”, so to speak, and building your technique and fitness base without the aid of being attached to your bike. Once you can ride almost as well on flats as you did on clipess, go back and try clipless pedals again and I’ll bet you see a big difference in how effectively you can use them.

Variety is the Key

It is always a good idea to go back from time to time and spend some time on flats, just to keep you honest. During the off season make sure you do your indoor intervals with them since you can’t really practice clipping in and out anyways. During the riding season at least spend a couple rides each month on flats as a way to check your technique and make sure that you aren’t developing any bad habits along the way.

The dirty little secret is that the best riders are already in this category – take away their clipless pedals and they would still be the best in the world. They are using clipless pedals to enhance their already great technique, not make up for the fact that if their feet weren’t attached to the pedals they would fly off on every climb or rock garden. Training “raw” is a lesson that every sport has learned and we would benefit from not trying be at “100%” all the time and developing our technique and fitness base without the help of artificial enhancements. Clipless pedals are “better” in some regards but with that knowledge needs to come the perspective on how to best use them.

————————————————————-

MTB Strength Training Systems is the world leader in integrated performance training programs for the unique demands of mountain biking. As the strength and conditioning coach for World Cup Teams and 3 National Championships, his programs have been proven at the highest levels. James has helped thousands of riders just like you improve their speed, endurance and skills on the trail. Visit www.bikejames.com to sign up for the free Trail Rider Fundamentals Video Mini-Course.

I am back with another exercise and injury interview for you and today it focuses on a knee injury.

The specific knee injury we are going to talk about is osteochondritis.

I am going to talk with Zach Moore who is a strength coach and he is going to talk about how he overcame numerous knee surgeries and osteochondritis.  In the interview he talks about how it was a bit of a journey to find a place that got him doing the right exercises for osteochondritis.

Enjoy!

CLICK HERE to listen to the interview with Zach Moore on Exercise and Osteochondritis.

CLICK HERE to listen to the interview with Zach Moore on Exercise and Osteochondritis.

What Zach Moore Goes through in the Interview on Exercise and Osteochondritis

• Zach talks about his injury, osteochondritis
• What osteochondritis is and how Zach got it
• The variety of surgeries he had to have for osteochondritis
• He did all kinds of rehab after his surgery and for his osteocondritis, but was not happy with the results
• How getting an assessment from Bill Hartman was the key to helping him to finally get on the right rehab track
• The importance of focusing on the hip when it comes to knee injuries
• Exercises to focus in on for osteochondritis
• Key exercises to avoid if you have osteochondritis
• Important exercise techniques for lower body exercises
• The mindset you need to have in order to overcome your injury
• The right kind of research to do for your injuries
• How being a client at IFAST and meeting Mike Robertson and Bill Hartman was the start of his strength coach career
• Tips for those recovering from knee injury and pain
• Who is Zach Moore

A few things you need to know about listening to the interview:

•  To listen to the interview, scroll down to the bottom of this page and click the play button symbol.  If you do not have time to listen to it right now, just click the “download” button and download it to your computer.  Then you can listen to it on your computer when you like.  Plus you can subscribe to the itunes podcast and get all the interviews when they are ready.  Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview.  I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

If you are looking for the knee injury exercises that I use with clients, you can check out Knee Injury Solution by clicking here:

If you liked this interview and are looking for other exercise and injury advice, check out these other articles, videos and interviews:

• Exercise after C-Section with Carmen Bott
• Rapid Recovery from Neck Fusion Surgery with Josh Henkin
• Hip Flexor Injury Exercise Considerations with Dr. Casey Kerrigan

If you have an injury recovery story, I would like to hear it.  Please do contact me – I would love to interview you.

Rick Kaselj, MS

Exercise and Osteochondritis with Zach Moore [ 21:34 ] Play Now | Play in Popup | Download

Over the last few months, a common question has been appearing in my email box:

What if Exercise is Not Enough for Your Knee Injury?

I have been sitting on my hands, thinking of a reply and it finally hit me:

You Break the Knee Injury Rules

All of this came in a subtle way:

• clients asking what else they can do for their knee injury
• customers that ordered Knee Injury Solution
• registrants from past Exercise Rehabilitation of the Knee courses
• a family member asking for some help

I have purchased your knee injury solution product and many more.

They are great.

I have several clients though (I’m a Personal Trainer) that have knee injuries that are not going to go away.

For instance, the lady who has no meniscus left and damaged cartlidge and tendons throughout her knee but is told she’s too young for a knee replacement.

She wants to continue training, and she does, but she has no or very little stability in both knees and cannot perform any degree of squat or lunge without pain.

We therefore avoid these exercises, but there’s only so many hip bridges and rom deadlifts we can do.

We also do a bit of band work, but must be very careful about which plane we move in. She must sit for most things, even upper body work as some days just a bit of upper body movement is too much for her unstable knees.

Any ideas how I can further approach this?

On good days we can do boxing, battling ropes etc for cardio, cycling is no good-too much pain and definitely no running or even walking is out some days.

I have 3 clients in this same situation all due to being obese for years-all have reduced to healthy weight now and have endured knee operations that haven’t helped.

JB

This is the Knee Injury Solution program that JB was talking about:

Let me go through a few things that she can do.

I can easily just ramble off stuff that I know would help but I wanted to dig in the research and see what it had to say on what she and you can do about knee injuries.

#1 – Losing Some Weight can Eliminate the Need for a Knee Replacement

Let’s start here.

This is a huge statement.

We oftentimes do not want to start here with our clients but it is probably the biggest factor and if this is not dealt with, everything else won’t matter much.

A lot of the research refers to osteoarthritis (OA) of the knee and hip and what can be done to help each with management and recovery of knee injuries.

Let’s look at some research that came out last month from Anandacoomarasamy (WoW, that is a last name.).

It is well documented in the research that weight loss can reduce symptoms in the knee due to OA.

This should be enough to motivate people to lose some weight.

In the pager, researchers wanted to see the effect weight loss had on knee cartilage structure.  They had 111 obese adults in the study,  at a mean age of 51.7 and 32% had clinical knee OA.  They found that a 7% weight loss had a positive effect on the medial femoral compartment, not the lateral compartment.

In the paper, they made this powerful statement :

“Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage.”

They ended with the statement that weight loss could be enough to “reduce need for total joint replacements.”  A very very very powerful statement.

To sum it up, your client might have to search out the best way for them to lose some  weight.  This might mean changing their exercise routine, having you clean out their kitchen, making a lifestyle change or medical weight loss.

This probably should be the first and most important step for one’s knee injury.

Where to get more information - Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, Sambrook PN, March L. (2012). Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012 Jan;71(1):26-32.

#2 – Stop Doing Upright Lunges

I have a feeling this statement is going to make the fitness technique police go crazy and a good chance a number of fitness educators will complain to the association that I am telling people to break the rules when it comes to the lunge.

The biomechanics of it is simple and the research backs it up.

Move from an upright lunge position to a trunk forward lunge position.  

This will decrease the stress on the knee and activate gluteus maximus which will make the exercise easier to do but help work gluteus maximus which most people with knee injuries need to work on.

Not sure what else to say other than try it.

Do a lunge that has been approved by the fitness gods.

Then do a lunge with your trunk forward.

• How does it feel on your knee?
• How do the muscles in your knee feel?
• How does your seat feel when you do it?

Okay, moving on.

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.

#3 – Take Some Good Pills

I am not a big pill popping fan.

After being sick this week and feeling how quickly I started feeling better after taking the right pills, my view has started to change.

The evidence is good when it comes to glucosamine sulfate and chondroitin sulfate in order to interfere with the progression of OA in the knee and the hip.

Dose, frequency, brand, form, etc are things to consider.  I might dig in the research another time to see what it says about this.

If you’ve got a knee injury, look into GS and CS.

Before, I move on, pain may not be a good thing to look at when it relates to this stuff working.

Let me explain:

“This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.”

Glucosamine sulfate and chondroitin sulfate have small to moderate effect on symptoms (pain being one of them) but may interfere with the progression of osteoarthrits (OA).

Where to get more information - Bruyere O, Reginster JY. (2007). Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007;24(7):573-80.

#4 – What You Are Eating is Making Your Knee Injury Worse

If we look at weight loss being important for a knee injury and most often times the cause of weight gain is diet.  Plus, if there are specific things we can eat that can help our knee injury, then there has to be specific things that we are eating now that can be making our knee injury worse.

The first person to highlight this to me was Dr. Peter Osbourne.

Above was an interview I did with him at a conference that we were at.  When he told me that, it got me thinking a lot about how what we eat can be slowing down our knee injury recovery.

I will be seeing him again next month so I will work on getting another interview for  you.

Plus Dr. Peter Osbourne has a great article on “Foods that Contain Gluten” which is eye opening.

The Last Word

I hope you enjoyed this article and got as much out of it as I did putting it together.

I think I have focused so much on exercise helping injuries and have not spent enough time looking at other things that will help with injury recovery.  I am always challenging what I am doing, learning new things, testing things out and sharing what has worked.

If you do have any feedback or insight, please do let me know.

Rick Kaselj, MS

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Nothing is as scary or as debilitating as a knee injury. Yet everyone—athletes and fitness enthusiasts alike—constantly ignore chronic knee pain. And I was one of them. There came a point when walking up steps was a death sentence. But there was no way I was going to miss my squatting session, even if the pain reached a new high. I just thought it was the nature of the beast—that there was nothing I could do to fix it. So I saw it as a badge of honor. It was more like a badge of stupidity.

Sometime in 2009 I posted a rather gruesome video to YouTube. No, no heads were chopped off. And no, blood wasn’t spewing into the next county. It was just a close up of my knee being flexed and extended while all sorts of nasty clicks, pops, and cracks radiated from my patellar tendon. Although I knew it wasn’t exactly “healthy,” I knew that my knee—for all intents and purposes—was structurally sound. There were no torn ligaments. No mangled menisci. But my patellar tendon was on the fritz, and I had no idea why.

Instead of idly accepting a life of chronic knee pain, I made dramatic lifestyle changes. I didn’t want to struggle getting in and out of cars at the age 21. So, I experimented. About six months into my quest, I knew I had something. And one year later I collected and organized what I found into a grand theory and accompanying routine so that I could test it on others.

KNEE = ELBOW

One thing that sparked my interest—and paved my road of rehabilitation—was understanding that the lower limb shares a lot of similarities with the upper limb. The ankle and wrist are mobile yet fragile. The knee and elbow are facilitators—strong links in a connected chain. And the hip and shoulder are the complex, powerful, and responsible joints that connect the limbs to the body.

After being around the strength and health world for a while, you notice things. At that point I had done a boatload of interning and personal studies, so I was pretty in-tune with industry.

The elbow was (and still is) a hot spot for lifters. Golfer’s elbow became a frequent topic of discussion among general fitness trainees. 99% of the remedies for golfer’s elbow involved ditching the straight bar and moving something that allowed a hammer or neutral grip. This advice holds true to this day.

It took me a while to be able to step back far enough to conceptualize this, but this advice basically says that elbow health is determined by the position of the wrist. There were no super-secret rehab exercises. Just simply avoiding straight bars in an effort to stop putting the elbow in a compromised position.

I paralleled this with my knee rehab, which consisted of bunches of TKE’s, Petersen step ups, leg extensions, hamstring curls, hamstring stretches, and quad stretches—all things that focus directly on the knee.

But if the elbow didn’t need direct rehab, why would the knee? This made sense to me at the time because my knee was getting worse. And now that I’ve helped many people, I notice that TKE’s and like movements don’t work with more severe cases of tendonitis.

THE EQUATION OF LEGEND

In cases of chronic knee pain, from the crudest look, the patellar tendon hates life. It’s your job to find out why, and how to fix it. Most times, the answer isn’t to pound it with more dysfunctional movement. If your knee hurts when you squat, and you keep squatting through the pain, you’re never going to be healthy.

The knee can rotate somewhat and is a rather special joint, but when compared to the hip and shoulder it’s boring. (It’s funny how so much dysfunction can manifest itself in such a simple structure.) So I made a bold prediction, and one I still believe in: most chronic knee pain has nothing to do with the knee itself.

Overall movement of the knee depends on both the hip and ankle. Don’t believe me? Rotate your ankle and stand on the side of your foot (invert your ankle). Try to collapse your knee inward. It’s not going to happen. There are more examples, but the idea is that the knee—and the elbow—are facilitators when used in larger compound movements. They connect the powerhouse of the chain (hips and shoulders) to the distributors and manipulators of the chain (hands and feet).

So I created this mega fancy calculus like complicated equation to explain this Einstein like phenomenon, and it goes something like this:

FOOT + HIP = KNEE

While I’m sure this holds truth in most knee injuries—even the severe ones—this recipe is primarily targeted to chronic issues such as tendonitis, tendonosis (jumper’s knee), and even patellar tracking problems. They are all born from similar dysfunctions.

AN ATHLETE’S GUIDE TO CHRONIC KNEE PAIN

Suffering from tendonitis as a college basketball tryout, my 19 year old self wished there was a guide written specifically for athletes and debilitating chronic knee pain. Fast forward to now, I confidently hold the systematic and structured system I once wished I had.

There’s an abundance of knee information out there, but not much narrowing in on the chronic troubles that athletes face—the stuff that’s not serious enough for surgery, yet still bothersome in life and on the field. And let’s face it: recovery from a torn meniscus is going to be different than recovery from tendonitis. I wanted to focus on those nagging chronic knee issues that athletes face because I was once in their shoes.

Athlete’s Guide to Chronic Knee Pain: Theories and Solutions for Patellar Tendonitis, Jumper’s Knee, and Patellar Tracking begins with a small memoir so that readers can immediately tell whether or not they can benefit from the information. Followed are the theories and solutions for beating chronic knee pain, ending with an eight week rehabilitation program to follow.

It’s only a matter of time before this theory is widely accepted as the research is slowly emerging to support it. There are a lot of studies out there, but here’s a handful:

Chester, R, Smith, TO, Sweeting, J, Dixon, D, Wood, S, & Song, F. (2008). The relative timing of vmo and vl in the aetiology of anterior knee pain: a systematic review and meta-analysis. BMC Musculoskelet Disord., 1(9), 64.

Dolak, KL, Silkman, C, McKeon, J, Hosey, RG, Lattermann, C, & Uhl, TL. (2011). Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther, 41(8), 560-70.

Karst, GM, & Willet, GM. (1995). Onset timing of electromyographic activity in the vastus medialis oblique and vastus lateralis muscles in subjects with and without patellofemoral pain syndrome. Phys Ther, 75(9), 813-23.

M¿lgaard, C, Rathleff, MS, & Simonsen, O. (2011). Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc, 101(3), 215-22.

Smith, TO, Bowyer, D, Dixon, J, Stephenson, R, Chester, R, & Donell, ST. (2009). Can vastus medialis oblique be preferentially activated? a systematic review of electromyographic studies. Physiother Theory Pract, 25(2), 69-98.

Sheehy, P, Burdett, RG, Irrgang, JJ, & VanSwearingen, J. (1998). An electromyographic study of vastus medialis oblique and vastus lateralis activity while ascending and descending steps. J Orthop Sports Phys Ther, 27(6), 423-9.

Willson, JD, Kernozek, TW, Arndt, RL, Reznichek, DA, & Straker, J. (2011). Gluteal muscle activation during running in females with and without patellofemoral pain syndrome.Clin Biomech (Bristol, Avon), 26(7), 735-40.

So if either you or one of your athletes is suffering from chronic knee pain, check out An Athlete’s Guide to Chronic Knee Pain. Or you can live with the regret of failing to reach your athletic peak, hating life every day, and slouching your way through pain. Just saying.

By Anthony Mychal

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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:

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

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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

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