Fast Fitness - Fixing Arches, Knock Knee, and Knee Pain Without Orthotics
Friday, January 23, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - Stop one major source of inward-turning knees (knock-knees). Click the movie arrow to run:
Look at your bare legs in a mirror with feet facing straight forward.
See if the knees turn inward to face more toward each other than forward.
Feel how the muscles can pull outward to gently move (not force) knee position. These muscles like to be used correctly, not left unused.
Often, knees turned inward are a simple case of letting body weight sag downward onto the inside of the leg and arch of the foot, not a case of unchanging anatomy. Pain often comes from letting the knees and ankles twist, rotate, and sag. Restoring neutral position can stop this source of pain.
Orthotics are hard inserts that hold your foot in a certain position. Orthotics are different from cushion inserts that make a softer landing for each step. You can control leg and foot position without orthotics. That doesn't mean orthotics don't work, just that you can do it without them. It's cheaper and you get a free leg muscle stability workout at the same time.
Remember, don't force. If it hurts, it's wrong. Creating new strain instead of restoring function is not health or good thinking. All you are doing is restoring muscle length and using that to learn how to stand neutral, not tilted so much that you compress your joints.
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Questions come in by the hundreds. I make posts from selected ones. See if your answers are already here by clicking links and archives. Read success stories of these methods and send your own. Have The Fitness Fixer e-mailed to you, free. Click "updates via e-mail" - Health Expert Updates (trumpet icon) upper right column. Find fun topics on the Fitness Fixer Index.
Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain
Thursday, January 22, 2009
Jolie Bookspan, M.Ed, PhD, FAWM
David from Belgium has been a success story and valuable contributor. He frequently makes us photos and movies showing how to fix pain and unhealthful fitness using Fitness Fixer techniques. He first left a comment on a post in 2007:
"I'm training to be a yoga teacher and I'd love to teach the right things to my pupils such as good posture. Your insights are very inspirational. After struggling with minor but persistent knee pain for some years, I was diagnosed with seriously fallen arches recently. I'm not really flat-footed, but ankles that drop inwards too much. (I could clearly see that on the video my podiatrist made of me walking on bare feet). In a week I'll be getting new orthotics. Though, after reading a patient's testimony on your site I decided to try and use my feet differently. So now on my walks to and from my day job I'm trying to walk 'right'. Rolling on the entire foot, heel to toes, leaning more on the sides and using all five toes. It feels awkward though and I notice that I often forget it. I wonder if this will 'fix' my feet eventually? Anyway, thanks for sharing your knowledge!"
I replied that it "fixes" arch positioning as soon as you do it. It is natural to control how you stand and move - the whole intent of functioning in a healthy way in life, and the intent of yoga (supposedly). It seems at odds to say that yoga teaches body awareness, strength, or positioning, then let ankles slump without control, and purchase devices to do it for you. Once you understand the purpose, it will not be awkward. It is the same as any other good posture.
Since then, David has consistently made good use of these materials, and shared many success stories. He has fixed various pain producing habits for himself and his students, fixed his mother's herniated lumbar disc by showing her healthy bending around the house - Bending Right is Fitness as a Lifestyle, and developed a new yoga system of healthier movement - Getting the Right Yoga Medicine.
Orthotics are rigid shaped devices, fitted by prescription, that specifically move and hold your foot in a certain position.
Orthotics are different from over-the-counter shoe pads that can help by cushioning impact.
Orthotics do not do anything you cannot do yourself using your own muscles and sense of positioning (kinesthetics).
It is a myth that only a device can move your foot and leg leg. Click the label "myth" under this post for all Fitness Fixer posts on fitness myths.
Try these in relaxed way:
Stand and see that you can raise your own arches back to normal, taught in the post Arch Support Is Not From Shoes. It takes only seconds.
Make sure you are also not pronating from higher up - Healthy Knees.
Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints.
The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
During walking and running, a brief and small inward drop (slight pronation) occurs right after foot contact that creates part of the "spring" and propulsion. The idea is not to prevent all foot motion, but to not let the knee twist inward. You can do that with your own brain and muscles.
See if your answers are already here by clicking links, labels under posts, archives, and the Fitness Fixer Index. Read success stories of these methods and send your own. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer - Click "updates via e-mail" - (trumpet icon) upper right. Find fun topics on See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
Friday, April 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - feel how your own muscles work to hold arch support, so that you can have healthy arches without artificial shoe arch supports or orthotics, which weaken the supporting muscles from disuse:
Stand with feet parallel and look in a mirror where you can see your feet, or just look down.
Pull outward (straighten) until your arches rise and restore to neutral position, and your ankles are straight.
Learn to feel neutral position. Don't hold rigidly or roll outward. You gain built-in muscle strength and arch stability with each step you take.
Click the > arrow to see the short movie made for us by reader David from Belgium:
First he allows his weight to shirt inward, pushing his arch flatter toward the floor. At seconds 3 to 4 in the movie, he uses the outer muscles to pull to straight neutral ankle position. At seconds 8 to 9 he allows the arch to sag again, then restores and holds healthy arch from second 13 onward. The "exercise" is not to roll back and forth. It is just to learn to feel what allowing sagging too much feels like, and how to restore neutral position.
During walking and running, there is a small natural inward drop (slight pronation) that is part of the spring and propulsion. Allowing exaggerated sagging is like rounding your shoulders too much. Legs and feet have posture that you can control yourself. Use your own muscles and get free built-in exercise and arch support all day, and stop painful poor positioning.
Some people with existing abnormality or growths in the ball of the foot will roll inward (or outward) to get the pressure off the deformed area because standing straight hurts. See your doctor first. Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy. ---
Fast Fitness - Strength, Abs, Balance, and Ankle and Leg Stabilization
Friday, November 09, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - quickly increase functional stabilization of the knee, leg, and ankle while increasing overall strength and balance.
Anyone can lift weights, but can you do it balancing on a basketball? Get started by standing on one foot:
Do your regular lifts, curls, presses while standing on one foot (and then the other). Breathe.
Notice the leg you stand on. Don't let the arch of your foot flatten toward the floor, or knee roll inward toward the other leg. Hold knee, ankle, arch inline, using your muscles. See Arch Support Is Not From Shoes.
It reduces exercise to sit, even on a fitness ball. It is more exercise, more functional, and better balance training to stand on one foot than to sit. You sit all day already.
Be safe, be excited about having fun doing functional movement, be happy.
"The public has an insatiable curiosity to know everything, except which is worth knowing." - Oscar Wild
April 1 seems to be a day to notice, more than usual, if things in the news are not facts but April Fool. On other days, urban legends and other stories are still popular, sometimes more popular than what is really going on.
The observation that the Earth is flat seemed obviously true at one time until we had more information. It used to be a taught as a medical fact that the cause of epilepsy was masturbation. When I was in school, one of my medical books stated that you don't need to eat calcium since you can "get all you need from your bones." It is true that you pull calcium from your bones when you don't eat enough, although with unhealthy results.
The post Forensic Science told of two crime-science myths, often still taught in forensic books and popularized in television shows, which were never true. Following are more posts hoping to replace myth with information, so that you can get stronger and do more, without the injuries or restrictions in activity that are part of many fitness or injury rehab practices.
We're just back from teaching the medical school elective in wilderness medicine. Each year I teach there, working over my birthday. Same food as last year. But the creek was thinly iced - good for ice swimming.
Before lecturing, I worried that my information on health - stand up straight, eat right, exercise, "and all that," would be so known and obvious to the bright young medical students that it would bore them. Instead, it was called, "Out of the box." When did health become out of the box?
I spent years of my career in a lab as a serious, intensely number-checking research scientist. I worked to ensure that we knew what truly worked, and what was hype, unrelated, or just wrong. I made certain that what I discovered and developed for patients was squarely right, practical, and in the best interest of the patient (and fun too, which is health). All I pursued was The Truth. Matt Cartmill once said, "As a youth I craved factual certainty, and I thirsted for a meaningful vision of human life. So I became a scientist. This is like becoming an archbishop so you can meet women."
Why is bypass surgery, angioplasty, stents, obesity, diabetes, and medications with uncomfortable, unhealthful side effects considered normal, while eating a vegetarian diet is labeled wacky and extreme when it is medically documented to stop and prevent heart disease, diabetes, high blood pressure, and other prevalent conditions that rob people of joy in life?
In my diving medicine lectures, I wanted students to see how the information worked and how it relates to many things in and out of diving, not just dictate lists of conditions to memorize. I showed slides, asking them to identify why an accident would happen on the way down versus up and why. I told them that if they understood, they would not have to memorize. I just wanted them to think. As my father once enlightened me, "Jolie, you're asking a lot!"
In the orthopedic lectures, I taught the same principles I tell in this Fitness Fixer blog of gaining great physical improvements without making pain and injury in the first place. After one of my lectures, students scattered for personal time, while a few stayed in the lecture hall, bent over laptops. They sat hunched, rubbing sore shoulders. Eventually one nudged the other, "Get the doc, she's right here." After some indecision, one student asked me to give him stretches to fix the pain of working at the computer. I told him you can sit and work without getting pain in the first place, and why didn't I show him that, instead of a stretch as an "antidote." He protested that the computer made his neck hurt. I agreed that the way he was sitting would do that, and repeated that you can easily sit and work in a way that doesn't cause the pain in the first place. More protests came, that as students they had to work on the computer long hours.
Medicine is not supposed to consist of allowing bad things to happen so that you can do a cool procedure to try to reverse it. Readers, do you want to try what I showed him and get a free house-call right now?
I moved his chair in close to the table where he was working. Move yours in close now.
Standing behind him with my hands on his shoulders, I gently pulled his upper body up and back to rest against the chair back. At home you can feel me guide your shoulders and upper body back.
Next, keep the chin gently in, not jutting forward.
We moved his computer back from the front edge of the table to make room to rest his forearms while using the keyboard. If you use a "below-desk" keyboard tray, it is often better to move the keyboard back to the desk. Don't crane your wrists, making a new problem. Relax and breathe.
I told them that at my own desks, I raise computer on a shelf, block, or book about 10 inches higher than desk level, and use a cheap external keyboard. Even without these helpful changes, you don't have to round forward over a laptop.
The seat back of the lecture chairs were concave - shaped to curve like the letter "C" so that you sat rounded forward. This is a common problem in many chairs, even some called ergonomic chairs. Another of the students mentioned he had a commercial lumbar roll at home. It was expensive and he didn't use it much because it was uncomfortable. I showed them how to use a small soft roll, which can be your gloves or light sweater, nothing fancy or expensive. Nestle it in the small inward curve of the lower back, then press your upper back, not lower back, against the chair back so that you can sit straight and lean back, instead of rounding forward. Pressing the lower back against the lumbar roll is a common way to make it useless and uncomfortable.
It turned out that most of the young, active, outdoorsy, academically talented medical students had muscle and joint pain. So did many of the top ranked physician faculty. Several told me they thought their pain was normal from their activities, from studying, their fallen arches, or body structure. They regularly took anti-inflammatory medicines and thought they needed special shoes.
You probably heard not to slouch since you were a child. That easy medicine hasn't changed. You heard to eat vegetables for health and an apple a day to keep the doctor away. I think only a few of the medical students I was teaching caught on, and will help others with what they learned. It can be so easy. As for the rest? Who is the one who is out of the box?
Are you doing unhealthy sitting without realizing it, during work, play, and exercise?:
All-in-one resources for healthier pain free life:
Fix Your Own Pain Without Drugs or Surgery. Chapters on fixing each kind of pain plus patient stories in every chapter tell how things work, why, and why not.
Health & Fitness THIRD ed - How to Be Healthy Happy and Fit For The Rest of Your Life. Exercise, food, health, fixing pain, functional built-in healthy life, family, mental, it's all here.
Healthy Martial Arts. Top level book for any athlete or those who would like to be.
--- Questions come in by hundreds. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy. ---
The previous post showed how the best ankle support comes from your own ankle, leg, and foot muscles. Pronation (flat, sagging arches) is rarely just the way your feet are made, or something you can't prevent. You may allow ankles to bend inward or outward, or you can prevent sagging and easily hold your ankles in healthy position, no differently than not letting your posture sag anywhere else.
It is commonly taught in gyms, medical schools, aerobics certification programs, and footwear stores all over the US, that shoes or orthotics are necessary to hold your arches in position. That is a fallacy. The needed support should come from your own foot muscles. How do you do this?
Stand up with both feet parallel, pointing straight ahead.
See if your arch slumps downward, pressing your arches against the floor (left photo). In most cases, there is nothing wrong with your arches, but simply because you allowed it to slouch.
If you use the muscles on the outsides of your ankles and legs, you can gently shift your weight more evenly to get your body weight off your arch (right photo) and stand straight. Don't tilt completely to the side or stand on the sides of your feet, just shift enough to lift your arches from the floor.
Having arch support is the same as having neck support by using your upper body muscles to stop slouching. Pull your chin inward gently right now to remind yourself of this.
Remember, don't force. If it hurts, it's wrong.
All you are doing is learning how to stand neutral, not tilted too much in or too much out. Both can compress your joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.
Support your feet by holding position using your own muscles, not a shoe 'straight jacket' that lets ankles atrophy and doesn't let toes move, stretch, and straighten.
My web site page Inspiring Patient Stories for a first-hand account of a patient who fixed a lifetime of pain and pronation by stopping the cause - letting ankles and feet sag. By holding healthy positions during your normal day, you can get free, built- in exercise for your feet and ankles, and better health.
It shouldn't hurt, or take commercial products or machinery to just stand up straight.
--- Read success stories of these methods and send your own. See if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
Which Shoes Help Exercise, Fall Prevention, and Ankles?
Tuesday, February 20, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
We are in the cold, damp Tennessee mountains for the rest of the week, teaching at a medical school program of wilderness medicine. It should be warmer than home in the Northeast US where it's snowing, and the Schuylkill River, and water bottle on my bicycle are frozen. I won't have Internet or phone access at the wilderness camp. Unflagging Healthline staffer Carrie Locke is posting the blogs for me all week. Thank you Carrie, once again.
For wilderness treks and hikes, and everyday walking, you need to walk on uneven surfaces without stumbling or spraining your ankles. Expensive shoes, inserts, arch supports, braces, ankle supports, and orthotics are sold on the belief that they are needed to hold your foot and ankle in position. However, this is an expensive fallacy.
You are the one who can hold your ankles in straight position or let them sag into foot pronation. You don't need, or even want, shoes that hold your ankles straight for you. Without use, your ankle muscles weaken. With shoe support, your ankle doesn't have to work to hold itself. It gets weaker. It forgets how. It is the opposite of what is needed.
It is not high top shoes or ace bandages or taping or orthotics that prevent falls and ankle sprains, or prevent ankles from sagging inward or "pronation." The most important thing you can do for healthy ankles and preventing sprains is to use your own leg muscles, and simply hold your ankles without sagging, the same as any other posture. Think of a beginning skater. At first, they let their ankles bend and sag inward. They do not know how to hold their legs using their own muscles. Eventually, they learn to hold straight, healthful positioning.
Letting your ankles sag inward can press the joints of your arches, ankles, knees, even hips. In most instances, supportive shoes and inserts are no more needed than putting your mouth in a sling to keep it from falling open when you walk around. Thinking that you need supportive shoes to brace uninjured ankles for hiking and walking is a common myth that perpetuates weak, unstable ankles. Many people who use arch supports never learn how to use their own muscles, and are told to never go barefoot. This is an unfortunate and unnecessary restriction to their health.
The post Healthy Knees shows what inward-sagging knee positioning looks like and how to fix it. It is easy to do and makes an immediate and important improvement to your joint health.
Often in wilderness settings, I see hikers in expensive boots. The native mountain guides and pack-bearers are wearing flip-flops. This is not just a salary inequality. It is not that the guides don't know ankle health. They know something crucial - the health of your ankles comes from your own muscles. You will save much money on footwear and products that prevent your foot and ankle muscles from working, and you will get free, built-in leg and foot exercise with every step.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Don't forget to stretch your toes. You need mobile toes for balance, healthy walking mechanics, and foot health.
Every day, take your feet in your hands and stretch your toes apart side to side, easily and comfortably. Make sure all your toes can move apart from each other, and that each one moves up and down. It is not healthy for your toes to remain stuck together and not moving.
Sitting in various ways can be a built-in stretch for the toes. If you sit on your heels, as in the photo at left, or kneel on your hands and knees with toes curled under you, or when you are sitting in your chair right now, see if you can bend your foot behind you and still touch all your toes to the floor - even your little toes. Don't force toes to bend, just gently see if they all reach the floor. After stretching your toes back (toward the top of your foot) bend them all down toward the bottom of your foot. Many people, particularly people who wear heeled shoes wind up with toes that are bent upward all the time. The tendons on the top of the foot can shorten from keeping the toes bent up, and the toes can get stuck in a pulled-up position. Future posts will cover more on stretching your feet for mobility, pain control, and health.
When you sit, as in the photo above, see if you can rise to a stand without pushing off the floor with your hands or bracing your hands against your leg or knee. Just use your leg muscles and get a strength and balance exercise while you get a nice stretch on the bottom of your feet.
The photo was taken when I studied a medicine course in Cambodia. Before and after classes you practice respect, concentration, and self-discipline. While you do this, you get a lot of physical exercise - it is commonplace for people of any age to kneel without using hands for anything except to hold the candles, flowers, and incense, and to rise the same way. The photo was taken in the middle of bowing, so I am not fully straightened yet. The nun is laughing. My Cambodian is so bad that I made her laugh. I think that is good exercise and good medicine too.
My Tuesday night martial arts students worked hard last night on sweeps, falls, tumbling, and quick recovery to their feet. Each week they also learn a new jump rope technique. They have been getting good at fast skipping, crossing the rope in multiple spins to the front, sides, and overhead, and varied footwork during jumps.
When landing from jumps, it is important not to let your knees knock inward under your body weight (photo at left). It is important for knee health not only when jumping, but descending the stairs, bending for all daily needs, and even getting in and out of your chair.
Letting your weight fall to the inside of your knee joint, instead of holding your weight evenly on your knees using your own leg muscles, adds load and wear to the cartilage on the inner surface of the knee bones, stresses the anterior cruciate ligament (ACL) in the middle, overstretches the ligament on the inner side of the knee, and can damage a meniscus. A menscus is one of two small cushions in each knee between the knee bones. Letting knees sway inward more commonly damages the medial meniscus (the inner one) although either or both can be stretched or twisted by bad knee positioning. Letting your knees sway inward is not a "condition," and not unavoidable or something you are born to have. It is a posture you can control using your own muscles to hold your legs from swaying inward.
A while back I took a box-aerobics class because I had a coupon for a free week at a local club. The woman in front of me was stomping up and down as she swatted the air. Her knees bumped together every time her feet landed. Her feet were at least ten inches apart yet her knees bashed together, over and over, bending inward at the knee joint. It was alarming.
Don't let your knees (or ankles) sway inward under your weight. Use your muscles to hold knees in position, over your feet:
When landing, land lightly - softly. Don't pound. The only noise should be the whirring of the jump rope, not your feet slamming the ground, transmitting shock to your knees and hips, and up your spine.
Bend your knees lightly when you land. Don't land straight-legged.
When you bend your knees for landing, don't let them sway inward.
Keep kneecaps facing the same direction as toes, not twisting inward.
Land softly, on the ball of the foot first. Quickly bring heels down while bending knees to absorb impact.
Remember healthy knee positioning during all activities. Look at your own knees and other people's knees when they take the stairs, and when bending to reach or retrieve things for healthy bending at home and work. Notice knees when you get out of your chair and sit back down. Don't let knees sway inward. Hold them in line using your thigh muscles, not letting them angle sharply inward.
It is easy to control leg positioning for healthy knee joints while you stand, bend, take stairs, exercise, and jump so that your daily life and exercise is healthy.
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