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Knee Pain

Common Faulty Movement Patterns Involving the Knee

Everyone at some point in their life has had knee pain. Most commonly this pain is at the front of the knee and may hurt walking up and down stairs. Knee pain comes and goes but it is a huge sign that biomechanically something isn't right. The knee is considered a stable joint because its plane of motion is mostly in one direction. Muscles that surround “stable” joints have a unique ability to produce tremendous torque. Torque at a joint is simply movement in one direction in a period of time. The knee, for example, is able to extend very quickly and forcefully due to its “stable” joint position. Another way of saying this is that there is less variance of joint position so the muscles can fire maximally with one purpose. The only problem with this joint stability is that our muscles surrounding our knee are not very good at stabilizing joint position. This is usually because we are not often in “unstable” joint positions at the knee where the muscles are forced to stabilize.

The opposite is true at the hip and ankle. These joints have many planes of motion which force the muscles surrounding to stabilize at each joint position. The muscles surrounding these mobile joints are not as capable in providing torque, but rather are great at providing stiffness. This is because the muscles at these joints are forced to act as stabilizers more often on a daily basis. Stiffness is achieved when muscles from either the side of the joint (the antagonists) contract in synergy to provide less movement at the joint. Now don’t get confused, the muscles around the hip and ankle are not there to limit movement but rather stabilize the joint through a large range of motion. With this being said, there are many instances where different levels of torque and stiffness at each joint are needed simultaneously and independently. A problem occurs when range of motion or muscle control is lost. Let's say we have someone with anterior knee pain. Yes, most likely rectus femoris or your quad is tight. At this point you must ask, “Why is my quad tight?” This could be because of a lack of hip extension, a lack of dorsiflexion in the big toe (not kidding), or multiple other reasons. After this you must ask yourself, is this a joint problem or a motor control problem. Do you have the joint range of motion but not able to use the range of motion through a functional movement? Are you not able to get into glute extension because of a lack of a stable core and subsequent lumbar extension and anterior pelvic tilt? The point is that something simple such as knee pain cannot be simply looked at as overuse. Getting a massage, dry needling, stretching, or simple single joint exercises are not going to fix the cause of your problem. A biomechanical problem needs to be addressed by analyzing biomechanics, not chasing pain. The key to getting out of pain and staying out of pain is realizing the difference between the cause and source of pain. No one has to live with knee pain. Make sure you are getting the care you deserve and get back to doing the things you love to do.

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.

Taking Squat Tips From A Baby

This is my little girl Callan Kay who is obviously the cutest thing in the world (I’m not at all biased). What is not so obvious is how perfect her squat is or how the heck she got there. Why do babies squat with such ease but when us adults are asked to squat, we act like we’ve been asked to play darts with spaghetti?! I mean, I thought we got smarter as we aged! Let’s discuss some of the reasons squatting is so difficult and why babies are really just out to piss us off with their amazing squat form.

First things first. How did a baby get this perfect form? Put yourself in a baby onesie and let’s think. When a baby learns to move, he/she has limited muscle strength and coordination to perform a task. When a baby rolls over for the first time, all of the muscles that made this happen worked PERFECTLY. There was no other way for the baby to roll over except for this one way. Thus, a movement pattern is born. There are windows in babies lives that are ideal for these movement patterns to be built. Otherwise, the baby will get stronger, miss the window, and forever compensate around this ideal movement. Missing this window may lead to malformation of joint surfaces, less coordination during movement, or even early arthritis. Don’t freak yourself out about missing these windows. Simply follow one rule and these windows won’t be missed: Never put your baby in a position that they cannot themselves get in. For example, putting a baby in a walker before they can walk themselves will only cause problems (this is why they are banned in Canada)!

Now on to the adults… The reasons not every squat will be the same include: a bunch of science and terms that confuse people. The bottom line is that every body type is different and this has a profound effect on how you move. For example, someone with a longer torso and shorter legs will squat much differently than someone with a short torso and longer legs. Don’t get me wrong, everyone has a unique ideal squat that should be strived for. The hard part is picking out what needs to be changed from what needs to be compensated around.

One thing that I hate to hear is someone in the gym describing what they think is ideal squat form. Telling someone to get their “butt back” is not always the best cue! There is a reason why not every pitcher in the major leagues throws the same way. In fact, it is near impossible to find the same exact form! Of course, squatting is much less complex than pitching form, but the point is that not everyone’s squat will be the same, nor does it need to be.

With this being said, there are certain key points that must be addressed to maintain good squat form.

1. Intra-abdominal pressure, created by your core musculature, is the foundation of any dynamic movement including a squat. Great intra-abdominal pressure keeps you upright in your squat, limits spinal flexion, and actually decreases the pressure in your discs! Training intra-abdominal pressure will not be accomplished by doing sit ups and crunches. A good place to start training this motor pattern is to think of filling up your stomach like a balloon having equal pressure 360 degrees around your core.

2. Equal loading of the “tripod” of the foot allows for ideal stability and function of the knee. The tripod of the foot consists of the heel, the ball of the foot, and the knuckle of the pinkie toe. Finding the tripod of the foot and being able to actively load the arches before squatting will save your knees! Make sure you do this before every squat under load.

3. Hip hinging at the correct angle with the correct rotation of your thigh allows you to use your glutes and hamstrings. This is a common problem seen in squat form which is why you always hear “Get your butt back!” The problem is that this angle is not the same for every person. Make sure you know what angle is correct for you in order to limit future low back pain and knee pain.

4. Ankle mobility is a necessary component that must be addressed to have good squat form. It is very difficult to get full range of motion in your squat if you have poor ankle mobility. Decreased ankle mobility can be because of many reasons but the most common reason is because of tight or shortened calves. And no, simply stretching your calves will not fix the problem. To see if you have an ankle mobility problem, try placing weights underneath your heels during a squat, 1 or 2 inches in height. If you are able to get lower into your squat with better form, then “Ding! Ding! Ding! We have a winner!”

Don’t let the vagueness stress you out, everyone is different and they need to be analyzed as such. Let an expert examine you to find YOUR perfect squat.

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.

Dry Needling? No Way, I Hate Needles!

What is Dry Needling?

To put it simply, dry needling is another way to manage pain (remember managing pain does not fix the problem). It focuses on addressing trigger points. Trigger points are those “knots” you feel that cause pain. Sometimes the pain is localized to the area of the “knot” while other times the pain can be referred to other areas, ie. headaches.

What is a trigger point?

Think of it as a good thing in a poor functioning system. It is a neurological way of protecting a certain part of the body. If certain muscles around a joint are not moving and coordinating correctly, trigger points can be seen in muscles surrounding that joint.

Why are we getting rid of trigger points if they are a protective mechanism?

For one, getting rid of trigger points gets rid of pain, and people don’t like pain. If a trigger point is dissipated by dry needling but the function around the joint is not fixed, the trigger point will return most likely the same day. This is the problem with band-aid care. An adjustment and soft tissue work is great but if the function is not fixed the problem will not resolve (this is a soapbox for another time). The treatment should be creating ideal function around the joint which in turn gets rid of trigger points and pain. Dry needling and other manual therapies should be used as an adjunct to creating proper function. Using manual therapies alone may feel good but is a waste of time for the patient in the long run as their problems will not be fixed.

Why dry needling?

Dry needling is the easiest way to address stubborn trigger points. Dry needling combined with adjustments is the best way to get these muscles to immediately relax. To get the most out of a treatment sometimes it is wise to get rid of the trigger points before changing motor patterns, or the way you move. This all depends on patient presentation including pain presentation and ability. Once again, needling of any kind does not fix the problem but should be used as an adjunct to fixing biomechanical fault.

How does dry needling work?

Dry needling works by disrupting the constant neurological signaling causing the trigger point. This disruption of signaling is because of multiple factors including increasing mechanoreception, damaging the motor end plate, manipulating fascia, increasing blood flow, increasing cortical awareness of the structure, or a combination of these.

Is dry needling for you?

If you have muscular pain (which a lot of times is because of trigger points), then yes!- but only in the correct context! At The Rehab Docs we use dry needling to facilitate the treatment process. It is a great tool if you use it correctly!

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.