Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better

Captain Scott, pilot, athlete, all around good reader, asked about knee pain when the kneecap (patella) "slides to the outside due to tightness in the tendons and muscles on the outside of the knee." His physician recommended surgery to cut the tight area. Is this needed?

Tracking problems have several names: Lateral Facet Syndrome, Chondromalacia, Anterior Patello-Femoral Pain Syndrome, Lateral Pressure Syndrome, Malalignment Syndrome, Maltracking Syndrome, Patello-femoral Degenerative Arthritis, and other scary names. It is not a disease or a syndrome or that you are doomed to arthritis, but usually a simple injury process that can be stopped.

Instead of surgery, you can stretch the tight side area and retrain the weak area, so the kneecap slides normally instead of grinding sideways in its channel. Stopping causes stops need for surgery, bracing and pain pills. The knees heal and you go back to all you want to do, using the new healthy mechanics.

What can you do when pain continues after physical retraining? Captain Scott wrote that he had been to physical therapy for his knees "for a few months without much success." He had previously endured ongoing treatments for back pain, then discovered Fitness Fixer methods and resolved the pain. He came back to see if he could do the same for his knees.

Kneecap tracking should begin normalizing within days of stopping causes - far sooner than "a few months." If not, one obvious thing to check is if you have the right re-tracking stretches, exercises, and functional retraining. After that, here are four common reasons when PT does not "work."

1. Tracking Exercises That Don't Fix Tracking. A common PT scenario is doing 10 (or however many) repetitions of straightening the knee against resistance of a stretchy band, called "terminal extensions," "setting" exercises such as squeezing things between the knees, stretching the lateral (side structures), and small leg lifts with ankle weights to strengthen inner thigh muscles (VMO)s. Without retraining gait and knee use during real life movement, the person often gets up from the PT session and walks away and goes back to their activities with the same poor tracking. PT needs to look at and fix specific use during real life activity - do you turn your knee inward or your feet outward, do you let your foot flatten, do you let your upper leg bone rotate. Also, weight or resistance used is often far less than what the knee encounters when the person stands up and uses their knees to walk away from their exercise session. Tracking angles should monitored during rehab. Not just during standing or during leg lifts, but during the patient's customary activities. If they are not changing, and they are the confirmed cause, then you may not be changing tracking.


2. Are You Sure It's a Tracking Problem. Knees can hurt for other reasons. You can go for the best re-tracking programs, but if your knee does not have an actual tracking problem, it is no mystery when tracking exercises do not help. You have not spent time fixing the cause. Make sure that tracking is the reason before treating for tracking. Tracking can be identified with specific patellar x-rays or other scans that can clearly include position during several points of motion. Tracking also can be visualized - look at kneecap path during quadriceps use during several kinds of movement. The kneecap slides up and down obviously under the skin at the knee during use. There is a variable degree of normal angle at the knee. Human legs are not straight from upper to lower leg. That angle at the knee allows us to walk upright on two legs in a smooth gait. The angled knee is one of many markers that tell forensic scientists and anatomists if the leg bones they are looking at are human. Sometimes a normally tilted kneecap slide is misidentified as a tracking problem when it is a normal angle in line with the joint.


3. Multiple Causes. Sometimes tracking mal-alignment is confirmed and rehab done. The patella tracks normally and stops wearing the area, but pain continues from other causes. No mystery. Check for other poor knee mechanics that cause injury. Check if your shoes are too hard. Many people paying for "good supportive shoes" get knee pain from the hard shoe. Often the pain from bad shoes is sharply outlined around the kneecap with deeper aching. Check your bending. If you have pain with knee bending (squatting), fix that. Fitness Fixer articles summarize and my books detail more.


4. Medicines that Cause Pain. Whether you have tracking problems or not, common prescription medicines cause pain that does not respond to PT. Look into stopping reasons you need the medicines in the first place, and save yourself time, money and pain.

My idea of health care is a quick, straightforward assessment of causes and intelligently addressing them. That beats having someone stick a knife in your knee and charging you for it.


Related Knee Fitness Fixer:

• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
• Fast Fitness - Great Hip, Side, Leg, and I.T. Stretch
• Instantly Better Hip and Quadriceps Stretch
  
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• What Works Better Than Knee Surgery?
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
• Daughter's Love Saves Parent's Knees
• Prevent Knee Pain When Rowing
  

Related Drug Pain Fitness Fixer:

• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others

Random Unrelated Fitness Fixer:

• Rocky Movie Computer Fight Simulation

Books To Fix Knee Pain:

• Fix Your Pain Without Drugs or Surgery
• Health&Fitness in Plain English THIRD edition - How to Be Healthy, Happy, and Fit for the Rest of Your Life. Both available from www.DrBookspan.com/books.

Labels: fix pain, forensic, knee, surgery

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Fast Fitness - Third Group Functional Training Exercise: Ankles and Knees in Jumps and Landings

Here is Fast Friday Fitness - third in the series of Functional Fitness Training (FFT) to teach your teams, squads, classes, students, kids, groups, battalions, etc.

Assemble your group in neat rows. Stand in front in view of all. Tell them this is a basic, functional physical skill to reduce musculoskeletal injuries, that puts together the first and second skills, previously learned:

1. Tell everyone to crouch using good bending (knees do not sway inward or slide forward, taught in the first skill), then rise to toes with stable neutral ankle (not bowing outward at the side, taught in the second skill).
2. Next, have everyone bend and rise increasingly rapidly and smoothly, in a jumping motion, first without rising from the ground, then barely jumping. With each bend and rise, they maintain good knee bending and neutral ankle. Repeat 10-100 times, depending on time and needs.
3. Next, tell everyone to jump, landing softly using thigh and hip muscles for shock absorption, and good knee bending and neutral ankle. Start jumping moderately, then work for increasing height with each repetition. Repeat 10-100 times, depending on time and needs.

Use conscious control to prevent inversion sprains and turns by not allowing the ankle to invert (turn sideways) when rising to toe during push-off in running and jumping, and coming down during landings. Watch for healthy ankle and knee stability and placement throughout the team season.

Each new Functional Training exercise shows how to teach your groups (or self) how to prevent common musculoskeletal problems during the team season or operational theater. Learn this one to be ready for an upcoming FFT, needed for cutting, changing direction, lateral movement, more.

Trainers, Drill Instructors, readers, send in your stories of how you use these in your program.

Functional Group Trainings:

• Info on this new Functional Training program - Back to School With Fitness Fixer
• Fast Fitness - The First Group Functional Training Exercise, Good Bending for Back and Knees
• Fast Fitness - Second Group Functional Training Exercise: Ankle Stability and Ability
• Fast Fitness - Third Group Functional Training Exercise: Ankles and Knees in Jumps and Landings
  

Related Fitness Fixer:

• Fast Fitness - Develop Ankle Stability Sense While Stretching
• Bending Right is Fitness as a Lifestyle
• How To Treat Ankle Sprains and Prevent Them
• No More Ankle Sprains Part II
• Which Shoes Help Exercise, Fall Prevention, and Ankles?

Random Unrelated Fitness Fixer:

• What Does It Look Like to Not Use Abdominal Muscles?

Labels: ankle, fast fitness, International Academy of Functional Sports Medicine, jumping, knee, leg strength, military fitness, sprain

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Fast Fitness - Count How Many Times You Help Or Hurt Your Body Daily

Here is Fast Friday Fitness - a simple tool to help you notice how many times during your ordinary day you can either get functional built-in exercise for leg, back, and hip muscles plus a Achilles tendon stretch, or produce a common factor in back and knee pain.

1. Every time you bend down to reach or retrieve something, count it
2. See how many bends you do for ordinary chores and by the end of the day
   
3. Choose if you want to hurt or help your fitness each time.

David from Belgium has written numerous Fitness Fixer success stories and created many photos and videos for better learning. He writes:

"I just spent half an hour vacuuming our house downstairs.

"When I do chores like these, I try to practice some focus instead of letting my mind wander all over the place.Usually this means I try to remain aware of my breathing (breathing normally, not grunting, straining, or holding breath to reach or lift things).

"But today I thought of one of your articles that said how many times on average a person bends over during the day. So I decided to count this for myself, just for fun and something to focus on.

"In the roughly 30 minutes of vacuuming, I counted 67 squats. Now that's a good workout! =)

Photos by David of squat and lunge for household bending

Bending over "wrong" is a common factor in back pain, and not only for out of shape people. It is common in many weight lifters. Bending "wrong is often done as an exercise. It doesn't strength back muscles as much as other ways, and puts large load on the discs, So it's not a helpful trade-off.

Previous Fitness Fixer posts explained that doing a few good rehab exercises and stretches for back pain won't undo a day of bad bending, and that you bend hundreds of times each day. "Fitness as a lifestyle" does not mean doing crunches during TV commercials or doing squats while on the phone. It means how you live. Get real exercise, built in, during real daily movement.

You get to choose whether you add an obvious check mark in the pile of things that don't benefit your fitness or whether you get functional exercise.


Fitness Fixer post on good bending for knees and back at the same time:

• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending

Related Fitness Fixer:

• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• Readers Count - Second Missed Cause of Back Pain With Golf
• Household Fitness in the New Year
• Fast Fitness - Better Back and Leg Exercise When Vacuuming
  
  

Labels: achilles stretch, fast fitness, knee, lower back, readers inspiring story, squat, tests of fitness/health

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Weak Hips on Purpose? Running Injury and Hip Strengthening

Who works their hips? Fitness Fixer success story Robert Davis wrote me several

notes that the weightlifters he knew didn't want to exercise their hip because they thought it would take away from the "V shape" they worked for.

Mr. Davis said that using my daily good bending and other functional exercise worked his hip greatly. He was pleased with reduction of stiffness and pain and increase in strength and mobility. No decrease in "V-shape."

The May/June 2009 issue of Sports Health: A Multidisciplinary Approach, published a study based on a literature review, concluding that running injuries to the lower leg may have more to do with weak hip muscles than how many miles run. Lead author Reed Ferber, Assistant Professor and Director of the Running Injury Clinic from the University of Calgary stated ”Hip muscle weakness especially appears to lead to atypical lower extremity mechanics and increases forces on knees and feet while running.” He also stated, "Based on a literature review, it appears that foot pronation (turning the arch and ankle flatter to the ground, and/or the knee inward) and inadequate hip muscle stabilization are the top categories for injury.”

From my own work in this area, I found that strengthening alone won't make you run with good mechanics, prevent pronating, or other injurious habits, you need to retrain them too. Not hard. Stopping your life to do rehab exercises then returning to bad daily movement also isn't so helpful. My work builds-in both strengthening and mechanics to daily life - functional exercise. Robert Davis has been sending in his successes fixing back and other injury using functional fitness.

Robert Davis writes:

"I had made a slight error in my story! I just wanted to let you know.. I had not ordered fix your own pain till only about 4 weeks ago cause I was looking at my expenses and the Amazon one came up!

"So to see how rapidly things change when you take up these habits is even more encouraging.

"Some things I noticed along the way (I did have some slight questions on this!). My hip muscles for one, started to get "sore". I believe this is because of over tightness and overall lack of use. My guess is like every other gym rat they avoid things to make obliques and lower back "too" big because it takes away from the V shape they are after. Everyone seems to fall for this but it is an un-healthy trap I now realize.

"Anyhow I had started to get really sore over the last few weeks in hip muscle areas and even upper buttocks from stretching these areas and working them (using your stuff). When I practiced going into full squats, this really seemed to stretch out areas that began to show signs of weakness/tightness. So it was like working out muscles and getting that "soreness" when your muscles start to adapt. I kinda figure it is as it is just as normal to workout a bicep and for it to "be sore" the next few days.

"The soreness goes away and with each passing week, it becomes more mild - kinda like the body getting used to biceps being sore and you don't get sore anymore.. They do not get sore like they did when I first started your stuff. I was just curious if you had seen this. I am sure it is normal, especially for a group of muscles not used to being used or stretched out.!

"Jeez I do not think most people realize just how tight and weak they can be in areas, mostly because they are never used or people are used to being tight there. People do not believe in the squat (I showed a few people to prove them wrong lol) because they are too tight. I realize how much I am glad I found this out early in life. I get stronger every day in the areas that were weak. I know I will have a much better core, lower back, complete back, and body then before I hurt myself :)

"I put together my "planche/pull up" setup for pictures and to start working on a full planche! That is difficult to do like you do it! Any suggestions? Just keeping trying? Heheh

"Thank you again! Thank you for posting my story."

Mr. Davis, thank you. You are well ahead of the fancy researchers :-)


Strengthen and stretch your hip functionally:

Bending Right is Fitness as a Lifestyle
How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
Cardiovascular Cleanup
Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches
Household Fitness in the New Year

Labels: fix pain, hip strength, hip stretch, knee, military fitness, practice of medicine, pronation, readers inspiring story, running

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Knee Surgery - Arthroscopy Results No Better than Pretend Surgery

A study of arthroscopic knee surgery found that the surgery was no more successful than pretending to do the surgery.

Arthroscopic surgery for knee arthritis is performed in substantial numbers. Why? The patient's doctors said they needed it. Where did the doctors get that opinion? It is taught in medical school and repeated at medical conferences. Repeating things is not evidence-based medicine (which is key) but vehemence-based medicine. When highly paid people repeat things without even knowing if it is true, that is eminence-based medicine.

Studies are now following up the same patients who had the surgery. Numbers show that often the surgeries are not needed, and people can do as well without surgery, and with intelligent non-surgical rehab.

This is not new. In the 1930's, patients being prepared for the rigors of surgery through exercise, often found that by surgery time, they didn't need it. Other patients without receiving exercise went straight to surgery. They may have had continuing pain and damage after surgery or later in life, but patient tracking was not done. Doctors just reported that the surgery was done, the patient lived, and that was all, and on to the next paying job.

Then studies compared surgery to physical rehab without surgery. Improvement rates were found to be about the same.

Then came an even more interesting study in 2002 of 180 patients that compared knee arthroscopic surgery to cutting the patient but not doing the knee surgery. Sixty patients in the placebo group received skin incisions and underwent a simulated surgery without insertion of the arthroscope. Two other groups had one of two typical knee procedures: Sixty-one patients had arthroscopic lavage group, and 59 to had arthroscopic débridement.

Results showed, "At no point did either of the intervention groups report less pain or better function than the placebo group." Conclusions were, "In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure."



This does not mean that surgery does not "work" but that you do not have to have it or be rushed into it, if it is not right for you. There are other ways, often as quick, and less expensive and painful and without the limitations following. Take your time. Don't let anyone push you into something not right for you. Medical claims that you will get worse if you do not have immediate surgery have not turned out to be factual.


Related:

Surgery for Knee Arthritis, Meniscus, Unnecessary
What Works Better Than Knee Surgery?
Anterior Cruciate Ligament (ACL) Surgery Unnecessary
Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

Labels: arthritis, fix pain, injury, knee, practice of medicine, surgery

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Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

A common myth is that injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles.

Early studies showed poor ratios of quad to hamstring strength. It was concluded that because of this, when the athlete would kick, for example, the overly strong quadriceps would overstraighten the knee, and the overpowered hamstring behind the thigh would not be able to stop the powerful straightening. The knee would overstraighten and hyperextend the joint, injuring it.

Athletes were put on hamstring strengthening training. Then they went back to kicking with the same bad habit of overstraightening as before.

The problem was simply that they athlete would hyperextend the knee. They were allowing it through bad training habits, not being made to do it by a strong quadriceps. Your muscles do not make you move. You learn though training and practice how to move in healthy ways.


What to do?
When you kick, don't fling your leg out and hyperextend (overstraighten) the knee. Control the end point position.
When you land from jumps or descending stairs, don't step down on a locked, straight knee. Control the end point position.

Muscle use is not automatic from muscle strength:

• Fixing Posture - No Exercise Needed
• Gluteal Muscles Myth - Shaking The Dog's Paw
• Good Life Works Better Than Bad Ab Exercise

Labels: anterior cruciate ligament/ACL, hamstring, injury, knee, leg strength, meniscus, myths, practice of medicine

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Fast Fitness - Fixing Arches, Knock Knee, and Knee Pain Without Orthotics

Here is Fast Friday Fitness - Stop one major source of inward-turning knees (knock-knees). Click the movie arrow to run:

1. Look at your bare legs in a mirror with feet facing straight forward.
2. See if the knees turn inward to face more toward each other than forward.
3. 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.

Labels: ankle, arches, fast fitness, fix pain, knee, orthotics, pronation, video/movie

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Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain

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.
• Understand more with Which Shoes Help Exercise, Fall Prevention, and Ankles?
• 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.

Check back tomorrow, Friday January 23 2009, for: Fast Fitness - Fixing Arches, Knock Knee, and Knee Pain Without Orthotics - with a short movie by David of restoring arches and knee position.

Labels: ankle, arches, feet, fix pain, knee, myths, orthotics, pronation, readers inspiring story, shoes, yoga

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Surgery for Knee Arthritis, Meniscus, Not Needed To Stop Pain, Restore Function

Good news. If you don't like or want knee surgery for most arthritis or meniscus injury, you don't have to have it. Lack of need for surgery has been demonstrated over many years in rehabilitation populations, and in a mostly ignored older clinical study. Recent studies confirm you can stop most pain and restore function just as well without surgery through good physical rehab.

Millions of Americans undergo arthroscopic surgery for knee pain every year. Over the last 30 years, arthroscopic surgery has been routinely accepted and prescribed for knee pain without undergoing rigorous evaluation.

Even when a 2002 study published in the New England Journal of Medicine (NEJM) found that results of arthroscopic surgery for knee osteoarthritis were no higher than medicine and physical therapy alone, the surgical community "remained unswayed."

Dr. Brian Feagan, co-author of a study in the Sept. 11 2008 issue of the NEJM stated, "It really didn't change practice that much. That's why this second [study] was really important."

Feagan's randomized, controlled trial involved 178 patients, average age 60. All had moderate-to-severe osteoarthritis of the knee. Half underwent arthroscopic surgery plus medical and physical therapy. The other half used medical and physical therapy alone. After two years, both groups' scores on a measure of arthritis severity were about the same.

A second study also published in the same journal issue, found that meniscal tears are common in the general population and, "may not, in fact, be responsible for painful symptoms." That means that if you have knee pain, and have scans and imaging which show a meniscus tear, it may not even be the tear that is causing the pain.

"There's going to be a swing in practice," said Dr. Feagan.

Study authors stated that meniscal tears detected on MRI may confuse matters and lead to unnecessary therapy. This is a similar finding to back pain where patients with pain are shown to have a herniated disc, stenosis, or other finding, but the pain is not from the anatomical finding, but the same bad movement habits, slouching, and lack of good movement that make anyone hurt. Discs also often appear herniated, and spines compressed by stenosis on scans of people with no back pain. Don't base your treatment and future on a picture. Scans are not tea leaves.

Poor knee stability increases risk of developing arthritis, and increases wear on the meniscus. Studies tracking results for years following surgery are finding that surgery "adds no benefit over rehabilitative training alone." That means you don't need the surgery to fix or prevent possible future arthritis.


You don't have to have surgery to stop knee pain:

• What Works Better Than Knee Surgery?
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary

How to fix and prevent knee pain from arthritis and most meniscus injury:

• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
• Most Helpful Olympic Advice So Far

Next:

• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, martial arts, meniscus, practice of medicine, repetitive strain, surgery

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Anterior Cruciate Ligament (ACL) Surgery Unnecessary

After injury to the anterior cruciate ligament of the knee (ACL) it is common to be told that surgery is the only way to restore function. Is it?

Ninety percent of ACL injuries in the U.S. are treated with surgical reconstruction. A study reported in the Dec. 15 issue of Arthritis & Rheumatism found that, "Two to five years after treatment, patients had similar muscle strength and function whether they had training alone or with surgery." The study concludes, "Reconstructive surgery is not a prerequisite for restoring muscle function." That means you can have good results with good rehab and without surgery.

A second question is development of ostoarthritis following ACL injury. Poor knee stability increases risk of developing arthritis. Studies tracking results for years following the surgery are finding that surgery "adds no benefit over rehabilitative training alone" and that surgery is done, "despite an absence of evidence to suggest that reconstruction of the ACL prevents or reduces the rate of early-onset osteoarthritis." That means you don't need the surgery to prevent possible future arthritis.

Another common myth is that knee injury comes from "muscle imbalance" in the thigh from too much strength in the quadriceps muscles over the hamstring muscles. The strength of a muscle does not make you move it. That means you control whether you overstraighten a knee or not. It is a use issue, not a strength ratio. Future posts will cover the issue of quadriceps to hamstring ratios and injury to the ACL and other knee structures.

You don't have to have ACL surgery to rehab a knee injury.

Fitness Fixer Posts on Fixing Knee Pain Without Surgery:

• What Works Better Than Knee Surgery?
• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
• Most Helpful Olympic Advice So Far

Meniscus. Coming Next:

• Surgery for meniscus repair found to be not needed to restore function or prevent later injury - Surgery for Knee Arthritis, Meniscus, Unnecessary.

Hamstring to Quadriceps Ratio:

• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury

Helpful Books, available from my BOOKS page - www.DrBookspan.com/books:

• Fix Your Own Pain Without Drugs or Surgery
• Health&Fitness - How To Be Healthy Happy and Fit For The Rest of Your Life. THIRD edition.

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, leg strength, practice of medicine, surgery

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What Works Better Than Knee Surgery?

New studies have been making big health news. These studies conclude that knee surgery is not needed to rehabilitate after several kinds of knee injuries, and that "question the benefits of the surgery." This information is not new. How do I know this? Because of years of previous studies concluding that surgery "worked." Here is what those previous studies often meant:

About 10 years ago, I attended a sports medicine conference. A new line of knee surgeries had come out, and the surgeons and manufacturers of the products used were anxious to have their surgery accepted and endorsed. One of the clinical presentations of the conference was the results of a study that compared patient outcome after knee surgery to the outcome of physical rehabilitation without surgery.

The patient group receiving physical therapy had improvement of function and reduced pain over time. The sample undergoing surgery went through the risks of anesthesia and surgery, lost work and wages, pain controlling narcotics during surgery and recovery, reduced activity for a minimum of 2 months following surgery, and pain from the surgical area. They then underwent months of physical therapy to regain function lost from the surgery. Many had permanent reduction of knee range of motion, considered "standard and acceptable" for that surgery. The loss of range can reduce function of the area, and reduce ability to stretch the hip, which can cascade years later into further restrictions. The physical therapy group had improvements that started soon after beginning treatment. The surgical group initially had decreases in all measures of strength and function, then months of painful recovery, and further months of reduced physical condition while they worked to "get back in shape."

Patient outcomes of muscle strength and pain levels were compared after two years and found roughly equal. The conclusions of the study were that surgery was effective, since two years afterwards, patents in the surgical group had made gains equal to the therapy group. I raised the question to the presenters about the initial painful recovery, then months of recovery, which the therapy group never had to experience. They were angry that I could not see that the outcome measures were equal, so "all's well that ends well." They pointed out that their surgical patients often thank them because they, "wake up and the pain is gone." They omitted that post-surgical patients are on pain relieving drugs, often narcotics.

I do not judge my own patients to be fine, or a method to be worthwhile, if they have to endure loss of mobility and physical levels at all, let alone over two years.

What works better than knee surgery?

1. Physical retraining of how you use your knees in daily life when walking, running, and other activities.
2. It is common to do exercises to strengthen the legs, then walk away from those same exercises allowing the knees to sag inward, slide, or twist in directions different from the line of the joint. The chronic unequal loading grinds, stretches, and wears at various bands of cartilage that connect upper and lower leg bone (ACL and PCL), meniscus cartilage, can grind the inside of the kneecap causing pattelo-femoral pain, and can even wear away at the shiny smooth cartilage covering bone ends (the articular surfaces), predisposing to arthritis.
3. This is why much supposed knee rehab isn't " working" - it is being undone the rest of the day by continuing the causes of the problem. Physical retraining is for all real life, not just a bunch of "sets and reps."
   

You don't have to have surgery to stop pain. Here are Fitness Fixer posts on fixing knee pain without surgery:

• Healthy Knees
• Daughter's Love Saves Parent's Knees
• Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life
• You Can Fix Your Own Knees
• Prevent Knee Pain When Rowing
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why So Many Aerobics Injuries?
• Walking Softly Benefits Olympic Wrestler
• Save Knees When Squatting
• Arch Support Is Not From Shoes
• Strengthen Legs Without Knee Pain - Standing Lunge
• Down the Stairs
• Better Exercise on the Stairs
  
  

Coming next Monday - Surgery for anterior cruciate ligament (ACL) repair found to be not needed to restore function or prevent later injury - Anterior Cruciate Ligament (ACL) Surgery Unnecessary.

Labels: anterior cruciate ligament/ACL, fix pain, injury, knee, meniscus, practice of medicine, surgery

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Most Helpful Olympic Advice So Far

The commentators for US gymnast Justin Spring's great Olympic floor exercise routine last week told how Spring underwent months of rehabilitation for knee, ankle and other injuries. The commentators continued about his rehab, exercises, physical therapy teams, and surgeon. Spring landed the end of his difficult routine with straight-legged jolt. One of the commentators mentioned again about the surgeon who fixed the injury. The other commentator replied, "The surgeon should have told him to bend his knees."

The commentator is right. The best health care is not to collect money to cut and treat someone, but prevent the need for cutting them. Landing with a straight knee transmits impact to your spine, neck, ankles, hip, and knee joints. Landing with properly bent knees absorbs impact more through the muscles. Landing hard with a straight knee can push the upper and lower leg bones hard against the two tough pads in each knee called menisci (singular is meniscus) that help cushion each step.

Over repeated hard landings, holes and tears can bore through the meniscus. With repeated landings at an unhealthy joint angle, cartilage can overstretch or tear. The tough strap that crosses the middle of the knee joint, called the anterior cruciate ligament (ACL), can overstretch or tear with repeatedly landing on a twisted knee. More on this to come. It is mostly an avoidable training error, not a gender issue as previously thought. Ankle wear and injuries can result from the same. Injury forces increase when the landing is on knee or ankles allowed to sway inward instead of maintaining motion at the midline. These injuries can heal without surgery. More on this in posts to come.

Sometimes injury results from a single high-force landing, such as a bad parachute landing, jumping from extreme heights, or a car crash where a passenger sitting with straight legs is propelled forward (or the engine backward) hard against their feet forcing compression past strength. An example is an ankle injury called a pylon injury, where the far end of the lower leg bone crushes.

Know the mechanism of injury so that you can get out and have fun, and do extreme sports while you move in ways that reduce unhealthful forces. Preventing repeated bad movement habits can also give your joints a larger margin for occasional unexpected dings.

1. Check what you do with your knees when you step or jump down. From small landings, bend knees a small amount.
2. Larger heights and circumstances (carrying a heavy backpack) can benefit from more shock absorption using the thigh and hip muscles with deeper bending. It should not be the knees that take up the shock of the bending. It should be the muscles of the hip and leg.
3. Keep effort on the muscles through how you position your knees. Letting them slide forward shifts weight to the joint. Keeping knees back by only sticking out the backside in back can shift weight to the lower spine. Keep knees back with neutral spine and you will feel the effort in the muscles.

Here is how - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
Here is why - Why So Many Aerobics Injuries?
Here is an example to get started - Down the Stairs.
Knee position when jumping - Healthy Knees.
Posts on avoiding surgery.
Check comments and replies already present in posts for more.
Click the labels below each post for more Fitness Fixer posts about each topic.
Try fun books.

Labels: ankle, impact, injury, knee, Olympics, practice of medicine, repetitive strain, stairs, surgery

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Down the Stairs

Readers Carol, Don, Teresa, AJ, and others asked about strength, and knee pain and placement when descending stairs.

Physical trainer Teresa wrote:

"Hello Dr. Bookspan,
"The post on "Better Exercise on the Stairs" from July 2007 contains the following statement: 'When descending stairs or hills, bend your knees when landing for soft shock absorption. Don't step down on a straight, locked, knee.'

"Some clients I work with have the habit of descending stairs on one leg because they can land straight-legged on the "weak" leg. Pain or fear of pain keep them from having the confidence to bend that "weak" leg sufficiently to support themselves for a soft landing on the other leg, but the "strong" leg will let them land softly on the "weak" one. When I get them to practice it, they find the proper motor pattern that is pain-free, but end up falling back on the old motor pattern that creates pain.

"Do you have any ideas on this one since descending usually requires more use of the toes than climbing the stairs does?

"I keep recommending your site to loads of people because you are sooo right. It's about motor patterns of moving our bodies, not just "exercise." Thank you for your time and assistance!"
Teresa Merrick, M.A.
ACSM HFI, NSCA-CPT/CSCS, NASM CPT
Master Trainer

Climbing stairs is a functional (real life) skill. Not having the strength to support your own body weight is serious weakness:

1. It is not healthy to land straight-legged with a locked knee on either a weak or strong leg. The functional life skill needed to descend the stairs is similar to what is needed for simple daily healthy bending (right drawing). Bending knees to retrieve and reach is something everyone needs to do many times a day. How many times a day do you think you bend for ordinary actions? Click How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending


2. Use the simple built-in life activity of healthy bending using the half squat (right drawing) to train your legs for the strength and mobility needed to descend stairs in a healthful way.


3. When you bend in the half squat, keep both heels down and your weight shifted back over the whole foot (right drawing), not just the toes (left-hand drawing). Pull back more to the heels if you slide forward.
   


4. No need to increase the inward curve, called hyperlordosis, or overarch (left). Hyperlordosis pinches the spine and can cause impingement and mystery back pain (Prevent Back Surgery). Overarching is sometimes taught to weightlifters because it shifts some of the effort onto the lower spine joints called facets, making the lift easier. It is healthier to keep the weight on the muscles and not overarch. Keep neutral spine (right drawing).
   


5. Keep heels down for bending using the half-squat, instead of lifting the heel. Keeping heels down shifts weight to the thigh and hip muscles and off the knee joint. Enjoy the free, built-in Achilles stretch with each bend. Specifics on this in the post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.
   


6. Descending the stairs should not be a toe-intensive maneuver. Your body weight belongs on the strong muscles of the thigh and hip.

Once you have the idea of the healthy bending you need for daily life bending, transfer that healthy movement to the stairs:

• Keep more weight on the leg on the upper stair, instead of flopping and stomping all weight down on the foot that is stepping down.
• Keep your weight back more toward the heel on the upper leg.
• Keep heel down longer on the upper leg, instead of lifting the heel right away. Get the free, built-in, functional Achilles stretch.
• Bend knee slightly upon stepping down instead of landing straight-kneed. Remember this is the same strength and skill that you need and have been developing (or should have) for ordinary daily bending, which totals many dozens every day.
• Use good shock absorption from the thigh muscles of the leg stepping down.

Instead of dong artificial leg exercises like leg raises, use legs for real life to get automatic built in exercise in the way you need to move. The movement gives built-in strengthening and stretch and movement patterns. The built-in strengthening and stretch and movement patterns directly improve daily function.

More will come in future posts. Have a real life of activity and fun, and enjoy.

Related:

Better Exercise on the Stairs
Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs
Click the label "stairs" under this post for all Fitness Fixer articles on stairs.

Labels: achilles stretch, fix pain, impact, knee, leg strength, leg stretch, lower back, squat, stairs

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Runner Fixes More Pain With Straighter Push-Off

Last year, reader Ted fixed back pain by learning to use neutral spine during running and daily life. This week he checked in to say the back is still fine, and that he went on to fix other painful sites.

Fixing pain and injuries by doing some exercises may temporarily ease symptoms. Instead, you can stop the source of injury by making movement habits healthy while exercising and moving through daily life, so that you can get exercise at the same time that the area can heal, and the pain not return.

Ted writes:

"Dr Bookspan, last summer, you helped me return to running, and did an article on me and how the neutral spine fixed my back problem with running.

"The back is a NON ISSUE. Thank you so much.

"Currently, I am working on hip/hammy/knee issues (probably due to over-training). Just thought I would share a thought on the ''Duck Foot'' issue you had talked about (I read the Fitness Fixer religiously). While running on the padded infield of the Stadium Football Field, I was still noticing pains in my hip (caught my foot on the ''upswing'' during a run, hip has hurt off and on since October).

"I focused on my feet, specifically, how I pushed off after the foot-strike (very soft, I often scare other runners because they can't hear me coming up on them). A straight push off after the foot-strike made the pain go away (probably because it aligned my foot/knee/hip during the movement). Also, when the knee pain flared, tensing my quads made it go away.

"I have enjoyed reading your ''Running Articles' please keep 'em coming.
AND
Thank you for fixing my Back.
Much Appreciated,
Ted H"

"Ps. I got your new book (Health & Fitness THIRD edition). VERY good info, I'm trying to use it everyday."

To fix the source of pain, it works best to understand healthful movement retraining and not just "do" a series of rules. One important example is keeping feet parallel or facing forward. The idea is to understand that a straight push-off comes from keeping all the joints in the kinetic chain from feet to hip and spine from twisting in unhealthful ways, not just straighten one segment by twisting another. Yanking or forcing the feet straight is not the point of good positioning.

Ted has more helpful stories to come in future posts. Click these posts for more:

• Back Pain From Running - Ted's story
• Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?
• Walk Lightly - Shock Absorption for Happier Joints
• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Plantar Fasciitis Part I
• Health & Fitness Third Edition at Last

Labels: feet, fix pain, impact, knee, readers inspiring story, running

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Fast Fitness - Leap for Balance on Leap Year

Here is Friday Fast Fitness for the intercalary year (Leap Year) - Leap to develop ankle and knee stability, leg power, and balance.

1. Leap forward, landing on the other foot with soft shock absorption. Don't land hard, which jars joints.
2. "Stick" your landing, without wobbling or setting the first foot down.
3. Leap backward to the original foot and place. Hold your landing steady. Try several leaps forward and backward, then change the leading leg and repeat.

When landing, keep ankle stable by preventing your foot from rolling to the outside. Info in the post No More Ankle Sprains Part II.
Train knee and hip stability by preventing your knee from swaying inward upon landing - Healthy Knees.

Labels: ankle, balance, fast fitness, feet, hip, holiday, impact, knee, leg strength, sprain

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Walk Lightly - Shock Absorption for Happier Joints

"Your tread must be light and sure
as though your path were upon rice paper

"This rice paper is the test
Fragile as the wings of the dragonfly

"Clinging as the cocoon of the silkworm
When you can walk its length and leave no trace
You will have learned"
- Master Khan to Grasshopper in the 70's TV series Kung Fu

Walk, run, jump, and move lightly.

Banging down with each step is not good for your body. It increases risk of joint pain and plantar fasciitis.

I tell my students to stop banging and stomping when they walk and move and jump. One day, a student asked me "How?" Here are some things to try:

1. I asked the student to stomp his foot.
Then I asked him to place his foot down lightly. That is how.

2. Use an analog bathroom scale. Step on heavily and see the numbers go up high. Then step on again lightly and see that the last number reached is a lower number. In sports medicine, we use force plates to measure ground forces when an athlete jumps or runs by.

3. While walking, try not to make noise. It doesn't mean to tip-toe, but to walk with regular heel to toe gait, but lightly.

4. Try walking with a full-to-the-brim cup of hot coffee or any liquid. Don't tip-toe, just walk softly without spilling any.

5. Practice jumping in the air and landing softly. Bend your knees when landing. Increase the height of the jump, maintain soft landing. Work up to jumping down from increasing heights without making a sound, or much sound.

Labels: arthritis, feet, impact, knee, leg strength, martial arts, plantar fasciitis, running, walking

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Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II

In Part I of this post on Monday, photographer Bernie tells of fixing years of pain that doctors told him only surgery would fix, even after three surgeries. Here is a look "behind the scenes."

10 March 2005, Bernie e-mailed me:

"I've had this persistent paresthesias for 4+ years. I just learned about you yesterday. Where are your back & spine classes held. Tomorrow, I'm having lumbar myelogram & CT at (top name deleted here) Hospital. Before I consider anything else, I want to learn about your methods."

I wrote back with class information. I had two classes coming up. One was the next month. The second would be in early May and only a few blocks from where he lived. I told how we work to see change in pain right in class. I asked him to let me know the test results and that I hoped to see him in class.

20 March 2005 he wrote back:

"Thanks for asking, I never expected you to keep in touch. The myelogram and CT showed moderate central spinal stenosis at L4-L5. Severe facet joint arthropy & hypertrophy of ligamentum flaxa causing compression of the lateral recesses stenosis of L5 on both sides, kinking of L5 nerve root sleeves on both sides. I have a copy of the xray, showing the "hourglass" at L4-L5

"(name deleted) is the attending, 3-B Orthopaedics. He said the next step is surgery, by ( ), at ( ) Hosp. I asked if strengthening of my upper body would help support my spine. He said "try it" so I'll be at physical therapy next week to start.

"I have a commitment for the weekend of April 2-3 so can't attend that class, much as I'd like to. Since I live at (close to) your class at Temple CC is my best chance of attending. Cordially, Bernie Cleff"

I checked back in to make sure he was signed up for the May class and to ask what he was doing in Physical therapy. He wrote:

29March 2005
"The phys therapy that I'm getting concentrates on my core muscles. Thanks for getting in touch...very kind of you."

I wrote back saying that conventional core exercises were not the best thing. Usually they are forward bending actions that will further compress the discs, the nerves, and also do not retrain the abdominal muscles in the way they work when you go about daily life. Strengthening does not automatically support the spine. I wanted to make sure that he had my Ab Revolution book, which was then out in a training manual version. He said he had it with him for PT. (I found out two years later that they had the book, but they were not using it, and were doing traditional forward bending abdominal exercises.)

10 May 2005, the day after the Fix Your Own Back Pain workshop was held, Bernie wrote me,

"Hello, I did sign-up for your class at TUCC on Monday 5/9, but I was too tired to attend. On top of that, I am scheduled for spine surgery at ( ) on Wed 5/11/05, with ( ). After having 2 epidurals and physical therapy I decided to go for the surgery. My nerve that is pinched is in the shape of an hourglass (at L4- L5) and (the doctors told him) that no body position or exercise changes are going to help at this time. Both legs are numb and I am walking like a drunk. It is kind of you to keep in touch. I hope to meet you at your fall class."

Days later, Bernie had the surgery. He tells about it, and his next two years, in Part I of this story. The doctors all considered his surgery a "complete success." They said the surgery went completely according to plan, with no complications. His recovery was in line with expected results. The fact that his pain returned, was worse, and complicated by limited movement from his plates and screws and other surgical hardware not a factor to them. They felt the limited movement was beneficial and a goal of the surgery. The commonly held idea is to stop motion in the area to stop the pain.

In late October of 2007 arrived to teach the Fix Your Own Back and Neck Pain Workshop. I had 16 people waiting for me. One was Mr. Bernie Cleff, a funny white-haired muscular man of 80, who was in much pain.

We had a fun, energetic class. One of the students was a young man from India. He sat unsmiling as I mentioned various yoga poses that can injure discs in the neck. I explained that I am not against all yoga, and studied years to become a teacher myself. He sat unsmiling. We did three specific techniques to stop the neck pain process and a beautiful smile radiated from the young man from India. He had three herniated discs in his neck from his yoga practice of the specific moves I had mentioned, together with sitting badly at a computer for his work. He already knew those yoga moves hurt his neck. He had just been worried the pain would never stop. When the pain stopped right there in class, he smiled.

Another of the students was a golf pro. Who I consulted with afterward to test out my work on lower back pain and golf. More on this to come.

Mr. Cleff did great in the first class. This class was done over two weeks. I gave the students things to try during the week before the second (last) class.

Oct 25 2007 he wrote me:

"Today (Thursday) is my class day at The Clay Studio, working over the wheel for 5 hours. I felt good with very little noticeable pain. Usually after walking the 5 blocks from my home to the studio both my legs would tingle badly and I would stop to rest halfway. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to check-up. You are one hellova person and I'm thankful that I've met you.

"I've had my spine problems with the pinched nerves for a long time - roughly 4-5 years - and I'm slowly getting better since you came into my life. There is no other way to say it. Thanks Jolie."

He was improved in one class, and he felt that he was "slowly" getting better. I like an empowered student who does not want to dawdle to get better. The day after the second of the two sessions, Bernie wrote:

28 Oct 2007

"Last night, I walked about 7 blocks to restaurant AQUA (great value, low cost & delicious) and back home another 7 blocks.

"Upper back extension causes no pain, lower back does. I can do plank on elbows, holding for 60 seconds now, no pain.

"If you want to make photos of a geriatric doing your things, it's OK with me. as you've seen, I'm not bashful or delicate. I will work at getting better, my daughter is getting married January 5 and I want to be able to dance with her and my wife."

Bernie went back to his doctors to ask about a small amount of remaining pain. They told him he should have more surgery and gave him prescriptions. He wrote to ask me:

"On Nov. 2 I have a follow up with the spine surgeon (same guy) and on Nov 14 a consult with a Neurologist ( ). Do you have any suggestions about a pain med FENTANYL, which was suggested by a doc at the V.A."

I wrote back that Fentanyl is a surgical grade narcotic. It is used "off-label" for back pain and there have been deaths. I asked him to tell me more about what hurt, and when, so we could stop it without any harmful medicine, and also what the neurologist said.

14 Nov 2007, he wrote:

"I had an office visit with the neurologist at ( ), he said my twisted nerve at L5 will never get better and I will always have pain."

They told him to have another spine surgery and take the Fentanyl. (Then why did they put him though all that surgery??)

He wrote:

"Hello, I still have some tingling in both knees...but much better than 2 weeks ago! There has always been pain in my left flank between spine & hip, never told you because the knees were my greatest problem… The lower back pain persists, but only left side. When I do the trap stretch leaning to left--puts much pressure on that pain. Leaning to the right feels like a good stretch. Any additional suggestions?"

I found that that he was still doing "their" exercises. Conventional exercises of bending forward to stretch the hamstrings are often prescribed for back pain. The assumption is that tight hamstrings have something to do with back pain. However, bending forward is one major contributor of this kind of back pain. I changed how he stretched his hamstrings to one of the ways we did in class.

He was also continuing to overarch his lower back when walking, which was a large source of the tingling pain. When he used the Trapezius stretch, he was also overarching, which makes pain when bending to that side. This kind of pain is often confused for spinal stenosis. One classic sign of stenosis is pain when bending toward one side. However, the narrowing is not true stenosis, but just overarching which narrows and pinches the area. For someone who has stenosis, not pinching the area further with overarching is frequently enough to stop pain.

What was complicating everything was his surgeries. They were considered "completely successful." The two knee replacements were "completely rehabbed" meaning he could bend his knees enough to sit in a chair. He could no longer stretch the front of his hip enough to prevent the kind of tightness that encourages standing and moving in overarched position. The back surgery put a plate in his back to prevent much movement. That meant that even small overarching movements were enough to pressure the newly immovable area. The back hurt, and the tight back and hip were compressing nerves going down both legs.

After we fixed these issues he wrote two mails:

"Jolie You hit on the spot. I will keep at it gently."

and

"Jolie, a quick note to tell you today I walked 12 blocks, stopping to stretch hamstrings.. often on steps or fireplug....as you suggested...also lunge stretch. I will dance at my daughter's wedding. Much thanks.

"There will not ever be more surgery on my body."

For the flank pain, he had been for many tests, and was even scheduled for a kidney evaluation. The muscles in the area were so tight, that I biked over to his home to do a sports medicine technique to stretch it out for him, and checked his other stretches. I went over how to stretch the front of the hip without overarching his lower back. His sweet funny wife made me lunch. We got some fun photos of things as gifts for you, of fun stretches and activities.

He wrote:

"I've had x-rays, MRI, bloodwork, surgery, injections, no Dr. had any solution.
YOU HAD THE ANSWER. No wonder so many people have thanked you."

He did the work and gave me the credit. That's a good man.



Next:

• Bernie dances at his daughter's wedding in Cauda Equina - Result Not Cause.

Related:

• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I
• Overhead Lifting, Reaching, and Throwing - More Part I
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
  
• Prevent Back Surgery
  

See Mr. Cleff Demonstrate:

• Fast Fitness - Quick Relaxing Hip Stretch
• Fast Fitness - Relaxing Hip, Leg, and Groin Stretch
• and Dynamic Partner Balance Challenge.
  
  

Labels: drugs, facet joints, fix pain, hamstring, impingement, injury, knee, lordosis, lower back, neck, practice of medicine, readers inspiring story, side, stenosis, stretch, surgery, yoga

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Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I

In this post, Bernie, an 80 year old retired photographer tells how he was signed up to take my "fix your back pain" workshop in 2005, but was convinced by his doctors that nothing but surgery would help. After "completely successful" surgery, his pain returned and worsened. He returned two years later to me. December 2007, Bernie wrote:

"I was a professional photographer for over 53 years-freelance-meaning go any place, any where- for many varied clients and I am now 80 years old and retired from photography.

"Much of the time I carried a 40-pound camera bag on my shoulder when climbing a 75 ft radio tower, walking on railroad construction sites or climbing The Great Wall in China.

"When I was at my vacation home, I climbed ladders to paint, replace cedar shingles and install new windows.

"Both my knee joints were replaced (5/93 & 6/01). Sometime in 2003 I was aware of tingling in both of my lower limbs from the knees downward. That started my medical testing with EMG’s, MRI, CT Scan and X-rays. The diagnosis was spinal stenosis caused by age-related changes in my spine. Physical therapy was started and I had an epidural, which helped for about a year. Then a second epidural lasted for only 3 months.

"I had been volunteering in an E.R. for 7 years helping patients and I had to stop as it was impossible to walk or stand on my feet because of the strong tingling in both limbs. Then I was told that spine surgery was the answer, but continue P.T. with some changes of the therapy. So, two years later, with some relief… but not enough to continue, I stopped the P.T., had an MRI scan which showed further degeneration of L4 & L5 with kinking of nerve roots. All along there was a pain in my left flank, but that was overshadowed by the strong tingling in the knees. There had been suspicion of kidney stones or liver function but x-rays & all blood work proved negative. I was hurting more in both knees.

"The spring passed at my vacation home near Barnegat Bay with much pain and with me looking at my kayak that had remained in storage. I called for surgery to be scheduled.

"The lumbar myelogram & CT was done at Pennsylvania Hospital and surgery date was set.

"On March 10,2005 I found the website of Jolie Bookspan and e-mailed her with my “story” of pain. Her class to fix back pain was going to be held soon a few blocks from where I lived. She asked me to try the class first, (it was being held a week before the schedule surgery) but I told her that both legs are numb and I am walking like a drunk, the doctors said no amount of exercise or body mechanics would fix such structural problems, and am going thru with the surgery on May 11, 2005.

"Post-op recovery was hell. The summer was hell with pain killers and sleeping pills. At the follow-up exams, I was told “the surgery went well, no infection, you’ll be better in 6 to 8 months”. The laminectomy used a metal plate & 4 screws and a bone graft from my hip for the fusion of L4 & L5. The pain in my left flank remained throughout 77 physical therapy treatments. The surgeon prescribed Elavil and when I took it, I felt like a zombie. After I told him, I was told to try a half tablet. That made me feel like a half-zombie.

"No doctor had a solution except “try Tylenol, Advil, Fentanyl, and more”…a consult with a neurologist said that my twisted nerve would never get better. (So why all the surgery?) The pain in my left flank remained.

"Then I took Jolie's class on October 20, 2007 and she had the answer. My left flank pain was not a medical condition (I was put through every test including kidney function), but a muscle in spasm. I was doing the wrong exercises that I had learned in PT and they were making it worse. She taught me to do the exercises the correct way as shown in her books and articles in her websites.

"Five days later I reported to Jolie that I had been working at The Clay Studio, throwing clay on a wheel making pottery for 4 hours and felt good. Usually after walking the 5 blocks from my home to the studio both legs would tingle badly and I had to stop halfway to rest. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to checkup. You are one hellova person and I’m thankful that I’ve met you.

"I’ve had my back problems with the muscle spasm and damaged nerve for a long time…roughly 4-5 years…and I’m getting better since you came into my life. There is no other way to say it. Thanks Dr. Jolie for your passion for helping others.

"On your questionnaire in the first class I wrote that I wanted to be able to dance with my daughter at her wedding in January 2008. You have made it happen for me.

"I will dance."

Next - Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II - a look behind the scenes.

Follow-up Note - the wedding on the 4th of January was great and Bernie danced and danced. Here is a photo.

Labels: fix pain, impingement, knee, lower back, practice of medicine, readers inspiring story, side, stenosis, surgery

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Fast Fitness - Strength, Abs, Balance, and Ankle and Leg Stabilization

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:

1. Do your regular lifts, curls, presses while standing on one foot (and then the other). Breathe.


2. 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.
   


3. Don't lean your upper body backward (increasing lower back arch) when lifting arms up - a hidden source of back pain. See Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.

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.

Labels: abdominal muscles, ankle, arches, arm, balance, exercise ball, fast fitness, hip strength, knee, leg strength, neutral spine, pronation, sitting, strength

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Daughter's Love Saves Parent's Knees

A special story came in. I had been answering inquiries from a reader who wrote me to ask how to stop her mother's knee pain, and after her mother was better, to help her father. I was charmed by this good daughter who wanted to help her parents. She faithfully taught her mother everything I wrote her, and she wrote back with results. I didn't know where she was from, and didn't ask. In the weeks of letters back and forth, she caringly scanned and e-mailed me copies of lab reports and pharmacy prescriptions. She asked good questions about the medicines and tests and how they could help her parents. The tests and prescriptions had notes in Arabic and distinctive generic names. I wondered if I might wind up on a watch list of people who correspond with people from certain countries. In one reply that I wrote, I headed the instructions on knee pain with, "To whoever else may read this, please use it to stop your knee pain too, for more peace and less pain in the world."

Here is the story of Katayon:

"I belong to Afghanistan and I am very grateful to Dr. Jolie Bookspan. My mother’s knees pain was my biggest concern for a long time. She went to more than six best doctors here in Pakistan. But all she got was medicine for relieving her pain which not always helped her. She was also told not to walk a lot and rather sit on the chair most of the time. My mom is young and still it’s very soon for her to spend her life just sitting. Doctors said the cartilage inside her kneecap has dried and can never be recovered and she will always have the pain. And that the only way is to always use those tablets. This really bothered me to think of her feeling pain all her life.

"After trying the doctors in the city, I selected the option of getting support through the internet. That is where I fortunately found Dr Jolie Bookspan who always keeps telling me that medicine is not the only option. But rather we have to adopt healthy movements. In the first stage, this knowing this thing encouraged and cheered me a lot. She also introduced me to the free articles- exercises related to knee pain and back pain, on her website. I have checked almost a lot of those useful links and currently I am following a lot of those helpful movements, exercises and directions mostly for knee pain. Currently I am also suffering from knee pain which is due to weakness of my muscles as the doctors here have told me. Dr Jolie has been a great help for me and my mother.

"And now I and my mother are feeling much better. I learned not to use knee-bands (bracing) because it further weakens the joints instead of strengthening them. I have shared all what I leaned with my whole family. So we are all blessed with an opportunity of adopting healthy joints movements. Besides a lot of other very useful guidance, I learned these important things: climbing the stairs putting full flat foot on the ground avoiding knees coming forward, so overall moving the knees in a healthy way which should not create pain while walking – I am practically doing this and I really see how useful and pain free it is; while picking something from the ground, trying to avoid knees coming forward and instead making it like sitting on a chair. So all in all, we are following all of the guidance and tips which really are pain free and help my knee joints get strengthened. I and my mother regularly every morning and anytime during the day we find time do the squat and lunge exercise which are very much helpful. Not only this, but I have also shared this exercise and all of the other healthy tips with my office colleagues who are suffering from knee pain.

"I never thought of a way out but only as the doctor said that the only option is to have medicine for whole life, whereas Dr. Jolie changed the whole thing for me encouraging me to have fun and keep walking pain free. I feel very fortunate to have found her. And I appreciate all of her time and efforts that she makes to help the world live without pain. I and my mother are deeply inspired by what she is doing to help the people. And we wish her best of luck and lots of energy to keep on her good job."
Katayon Q – Afghanistan

To learn the techniques Katayon used:

• Strengthen and Retrain Function With The Lunge
• Strengthen Legs Without Knee Pain - Standing Lunge
  
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Why this kind of bending gives better exercise and prevents pain and injury
• Reduce Knee Pain on the Stairs
• My free web site Sports Medicine page

Why is there a picture of a flower with this story? A personal photo was not the right thing. I asked Katayon what photo she thought would represent her story and country. She wrote:

"With this email I am sending a picture to go with my story. I was thinking of something to show relief and happiness as a result of being healthy. And I came up with the idea of selecting flower picture for my story. To me, a flower presents every positive thing."

Labels: fix pain, injury, knee, leg strength, lunge, practice of medicine, readers inspiring story, spirit, squat

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Inspirational Ivy II - Beating Foot Drop and Sciatica, and Getting Healthier

Ivy had serious sciatica with foot drop. She had knee and other injuries. She was in awful pain. In this kind of foot drop, the nerve cannot serve the muscles enough to lift the foot to walk normally. The toes drag. The foot hangs limply and slaps the ground with each step.

Commonly, someone with foot drop is put in a leg brace for life. One surgery done for foot-drop fuses the ankle so the foot is rigid and doesn't hang. Other problems come over years from changes in walking mechanics. For the terrible pain, patients are often directed to drugs and surgery. These are not healthy.

We changed that:

1. Monday's post Inspirational Ivy told the essentials of stopping the cause of the sciatic pain and nerve impingement, rather than treat the results with unhealthy means. Links to specific methods are there.
2. Sciatica, disc damage, facet pain, and impingement are results, not the cause of pain. They are not a diagnosis. When you have them, find what is causing them. Then you can reverse the cause: The Cause of Disc and Back Pain
3. The post How Often Should You Be Healthy? explains when and how to apply it.

Ivy followed my directions exactly and used her brain to understand how to get the intended results, not just "do a bunch of exercises." When she first began, she wrote,

"Over the past few days, I have been very conscious of my movements and, hey presto, I have not experienced any tingling or pain. I have to take total responsibility for every movement I make. I am constantly telling myself 'Think before you go to the fridge or need to pick up something off the floor - think lunges.'"

I gave her simple gait retraining. Ivy quickly discarded the cane she had used for nearly 7 months.

Ivy went on to teach several neighbors in her community how to fix their own pain. One story is posted in Each One Teach One.

In April 2006, Ivy wrote,

"It is nearly 5 months since I started your wonderful programme so I thought it was time that I gave you an update. I am fit and well, the sciatica has disappeared, if I get a little niggle in that area, I ask myself as to what have I done wrong, my left knee (IT Band) is no longer a problem, my balance has improved immensely and the "dropped" foot is great, in fact, when I go for my daily walk, I no longer hear the plop, plop of which I hated. I can also now wear "normal" shoes.

"Without your help and support and putting me on the right road so to speak, I would still be in constant pain plus making the chiropractor richer. Please note, I no longer go to him for treatment - I DON'T NEED HIM."

At age 70, Ivy is steadily improving strength and range of motion using healthy movement for daily life. She is eating healthful vegetarian food. January 2007 brought this note:

"The reason for this e-mail being that I feel somewhat excited re a remark made by the son of one of my fellow villagers. His very words being, "How did you become the woman that you are now. I have watched you over the past couple of years - when I first met you, you were obviously in a lot of pain, what is your secret?"

"I also sent the photos to my son and daughter-in-law who live in the US, they too, could see the improvement - they thought I looked great. Mind you, over that 2 year period, I gradually lost 20 lbs."

What about Ivy's e-mail that I mentioned in the last post about the new hip stretch? I'm out of room again. Watch for the next post - Good Life Works Better Than Bad Ab Exercise.

Labels: disc, facet joints, feet, fix pain, footdrop/dropfoot, gait, iliotibial band, injury, knee, lunge, nutrition, readers inspiring story, sciatica, shoes, spirit, squat

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Inspiring Update from Jill - Celiac, Knees, Fasciitis, and Restoring Happy Life

Reader Jill hasn't sent a photo yet, but her words are a beautiful picture. Her story can help many readers stop pain and improve strength and function for happier daily life.

In the post Lunges and Beans Jill commented on Celiac disorder, an immune reaction to foods with the gluten protein - principally wheat plus a few others. Symptoms can be baffling until identified as coming from gluten.

Jill writes: "I had bad and steadily worsening joint problems, especially in the knees, for ten years before I found out about my gluten sensitivity. By that time my legs were extremely weak from having been unable to put weight on a bent knee for so long.

"I let the knees heal without doing anything special for them until I hit a plateau, then started doing isometric exercise for the quads (the classic wall chair), then six months after that started running slowly on an elliptical trainer. Weightlifting exercises for quads, though, still left me hobbling.

"That's where I was when I found your blog, and since then I've been doing squats at every opportunity, which was very hard at first and got much easier. Along with the foot stretch you gave, the Achilles tendon stretch in the squats also caused tremendous improvement in my plantar fasciitis.

"After a few weeks of that you posted the stair climbing posts and now I'm having far less trouble on the large numbers of stairs I climb every day. I am shying away from lunges from long associating them with pain, but plan to get over that soon and try them (gently) according to your detailed suggestions.

"Your blog has given me an enormous number of ideas to help in rehabilitating my knees from the years of gluten, which has made an enormous improvement in my quality of life. Thank you for the care and skill you put into it."

Jill, thank you for your care and skill to write things that will help many, and to do empowered good work to shine again. I put the posts with their links. Everyone, add your favorites:

• Foot stretch - Healthy Toe Stretches
• Achilles stretch - Better Achilles Tendon Stretch
• Achilles stretch built into daily bending with half-squats - Bending Right is Fitness as a Lifestyle and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Happy knees during stair climbing - Better Exercise on the Stairs
• Plantar fasciitis - see the comments in Why So Many Aerobics Injuries?
  
• Lunges - Strengthen Legs Without Knee Pain - Standing Lunge and Strengthen and Retrain Function With The Lunge
• All posts helping knees

To stop pain and regain your life, you don't have to "do exercises" - use movement for healthy life. Have fun. Shine!

Labels: achilles stretch, celiac, feet, fix pain, knee, lunge, planter fasciitis, readers inspiring story, squat

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Strengthen Legs Without Knee Pain - Standing Lunge

Many people know they need to bend "right" but don't because it hurts their knees.

Bending right will not hurt knees. It will help fix one of the things that has been injuring them - bad bending habits which pressure and grind the joint.

Good bending will also give your knees the exercise they (and you) need.

Some knee patients are told to never "bend right" with a half-squat or lunge because it is bad for the knee. There are specific things about bending and straightening the knee that can increase certain kinds of pain, to be covered in future posts. Use your brain and try the following gently and safely. Done right, it should reduce knee pressure, not increase it.


How To Lunge:

1. Stand with one foot far in front of the other. Both feet face forward. (Left photo.)
2. Feet remain normal width from side-to-side, not directly in line front-to-back.
   
3. Lift your back heel. Don't turn the back toes outward. Look at your back foot and check.
4. Tuck your hip under (click "neutral spine" label for posts explaining how). You will feel a far better stretch and strengthener.
5. Bend both knees to lower straight downward. Don't touch back knee to the floor. Use leg muscles. Watch your front knee and keep it over your front heel, not sliding forward. (Right photo.)
6. Don't let your front knee sway inward.
   
7. Keep upper body upright and straight. (Right photo.)
8. Lower and rise several times, then switch legs. Keep feet still, not stepping forward and back.
   

Tips:

• To keep healthy knee positioning for the front knee, peek downward to see your front knee and foot.
• You should be able to see your front toes all the way through the bend.
• If your knee slides forward covering your toes, you are shifting weight to your knee joint and off your leg muscles. This is one of two common ways to increase knee pain while bending. Letting the front knee sway inward is another.
  
• Keep front knee steady over your front ankle, not sliding forward or inward. You will strengthen and stabilize your knees and legs instead of hurt them. You will feel more muscle use when you keep healthful positioning.

Lunge is a Lifestyle, not an Exercise to "do" 10 Times:

No need to go to a gym to do lunges. Use the lunge for daily bending around the house. It will add up to many lunges every day, built-in as fitness as a lifestyle. The posts How Often Should You Be Healthy? and Bending Right is Fitness as a Lifestyle give ideas of how to use healthy bending for normal daily life.

Benefits of the Standing Lunge:

• Strengthen leg muscles
• Strengthen the knee
• Stop harmful forces on the knees from bad bending
• Stretch the front of the hip of the rear leg
• Stretch the Achilles tendon and foot of the back leg
• Learn knee stabilization
• Practice balance
  
• Retrain healthful bending for daily life - transferring to function instead of just being an arbitrary exercise - free exercise all day
• Retrain straight upper body position for bending - more functional exercise
• Provide beneficial general exercise, warming which makes further movement easier, and healthful body movement.

Have fun practicing this now. You will need the standing lunge for tomorrow's Fast Fitness - Quick Warm Up. Enjoy.

Labels: achilles stretch, feet, hip stretch, knee, leg strength, leg stretch, lunge, neutral spine, squat, strength

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Better Exercise on the Stairs

Old woman: Come upstairs and we'll make love.

Old man: I can NOT do both.

If you would like to strengthen legs and reduce knee pain while going up stairs:

• Don't lean forward (photo 1 above)
• Stand upright (photo 2 below)
• Keep your heel down on the foot that steps up.
• Push off the whole foot, feeling the push-off through the heel. Do not push off the ball of the foot.
• When you raise one leg to step up, don't let the other leg pull and bend forward. Keep the standing leg straight (not locked straight).

Many patients who come to me, previously unable to step up a curb without pain, can climb flights without knee pain using this repositioning. Stairs become not only accessible, but a source of the exercise their legs need to strengthen and regain function.

Keep your weight back toward your heel to use leg muscles instead of putting your weight on the front of your knee. You will get knee pain relief and a built-in Achilles tendon stretch with each step. Done right, you will feel a more muscular and strong push off, making stairs easier to climb and better leg exercise. Even if you have big feet and your heel is off the step, keep your heel down instead of going up "tip-toe."

Notice if you bend forward. Instead, stand straight. The post Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs explains how hip tightness increases bent forward posture when raising one leg for kicks and activities like stairs, and shows how to hold straight body position instead, to stop tightness, and get a built-in hip and body stretch.

When descending stairs or hills, bend your knees when landing for soft shock absorption. Don't step down on a straight, locked, knee. Future posts will cover more about stairs. Have fun improving leg strength and knee function by taking the stairs during daily life in a healthy way. Send photos of your successes.

Next - Down the Stairs.

Labels: achilles stretch, fix pain, hip strength, knee, leg strength, stairs

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Strengthen and Retrain Function With The Lunge

The previous post Leg Exercise That Helps Your Back introduced the lunge. The lunge can be a quick effective fitness and health enhancer when you understand that you use it for real life bending, not just as an exercise to do for a set number of "reps."

The idea is to use the lunge in a healthy way instead of bending over "wrong" for all the hundreds of times you bend around the house and workplace. Then you stop one of the major sources of back (and knee) pain and degeneration while you get free built-in exercise, calorie burning, and leg and hip stretch and strengthening. The post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending shows just how many times every day you need to know this.

Reader Ivy from New Zealand sent in the photo above right showing a great way to bend for some of the many times you need to bend to reach and get things - the standing lunge:

• Upright torso
• Bending straight downward, not forward
• Front shin pretty much vertical
• Front knee over the foot
• Front knee does not sway inward. This is key in retraining knee stability during real life bending, stairs, and other movement.
  
• Back foot facing ahead, not turned out
• Front heel down. Better for knee and gives built-in Achilles stretch
• Feet nicely spaced
• Hands free, not on front leg
• The side-seam of the jeans from hip to waist-band is vertical, not tilting forward. It is somewhat hidden by Ivy's arm, I know. But the idea is important - do not tilt your hip forward to stick the backside out in back. Keeping the side seam vertical does several important things to strengthen and stretch, and keep neutral spine that I will cover in future posts on lunging.
• Looks comfortable and doable.

When using the lunge, do not bog down in "rules" over placement. The idea is to move in simple, healthy positioning, not hold yourself rigidly.

The post The Cause of Disc and Back Pain shows more on why healthy bending is key to fitness as a lifestyle, and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending introduces the half-squat as one of several fit and healthy normal ways to bend for every day activities.

Going to a gym three times a week is not fitness as a lifestyle. Instead of "doing" exercise, lift, and bend, and move in healthy ways all the time for real fitness as a lifestyle. Give it a try and send in your success stories.

Labels: achilles stretch, hip, knee, leg strength, lunge, stretch

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Leg Exercise That Helps Your Back - Why The Lunge?

I receive the question often, "What exercises should I do to stop my back pain?" I stress that that the exercises you need to do are to simply change away from all the injurious movements that are causing all the pain in the first place (left drawing) and use good movement instead (right drawing). Then your back can heal. The pain will stop.

I see patients all the time who come to me after going through back pain exercise programs. They went through their eight or ten week program, then their pain came back. Every day they did their exercises, then bent over wrong to put down their weights (left drawing), bend over wrong to pick up their gym bag (same left), sat badly on the way home, then hunched over their computer to record their exercise session. It is no mystery.

The post Disc Pain - Not a Mystery, Easy to Fix shows the mechanism of how bad bending and sitting damages the spine and discs. It is a simple injury, not a disease or condition. You can easily stop the process yourself.

A lot of dollars are spent on the common assumption that you need to strengthen or stabilize the back or exercise a particular muscle set, for example the multifidus. That does not fix the source of the damage. At the gym I see trainers, students, and yoga and Pilates teachers doing their exercise classes week after week, saying they come because they have to because of their back pain. Even the exercises they are doing were contributing to the problem. Many things that are bad for you feel good at the time. The post Common Exercises Teach Bad Bending gives examples so that you can avoid this pitfall. The post Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch shows how the most common stretches done, even in back pain programs are contributing to the problem, and what to do instead.

The answer is easy. The post Bending Right is Fitness as a Lifestyle showed one of the most important exercises you need to do to stop back pain. It introduced the squat, which is not an exercise to do for 10 repetitions, but to use instead of bad bending for the hundreds of times every day you bend for things. Instead of hurting your back hundreds of times every day, you prevent hurting your back hundreds of times a day. Instead of hurting your back hundreds of times every day, you strengthen your legs hundreds of times a day. It is not the exercise of squatting that fixes your pain by strengthening, but by preventing the damage in the first place.

This post introduces the lunge as a second wonderful "exercise" to stop back pain. It is not something you do as an exercise for a number of repetitions. Instead, you use it, along with the squat, for the many times a day you need to bend for all the daily things around the house and workplace - the laundry, the pets, the things on the floor, the kids, the dishwasher and refrigerator, and everything else, all day, every day:

1. Stand upright with one foot far in front of the other (right drawing).
2. Feet apart comfortably, both facing ahead, not turned outward (right drawing).
3. Bend both knees
4. Don't let your front knee come forward. Keep it over the front ankle (right drawing).
5. Lower straight down.
6. Your back heel comes up. Keep the front heel down for better knee health. It's a free, built-in Achilles stretch too.
7. Don't touch your back knee to the floor.
8. Don't hold your hands on your front knee. Although common, you get better balance and strength without it.

Done properly, the lunge should not hurt your knees. If you are too weak to lower enough to pick up the mail on the floor and get back up, that is serious weakness. You need functional strength to do ordinary daily life. This isn't walking miles over rocks to the river and returning with heavy water jugs over your back just to cook with. This is getting the mail.

Bending right with the lunge burns more calories than bending over wrong. Good bending helps a weight loss program.

Click the labels under this post to see more on these topics. The next post Strengthen and Retrain Function With The Lunge shows a reader making good use of the lunge. Posts to come will cover more about how wonderful the lunge is to transform your life from weakness and pain into easy function. This is fitness as a lifestyle.

Labels: disc, knee, leg strength, lower back, lunge, strength, weight loss

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Calories Burned in Prayer

Last week at the sports medicine conference, I talked to a researcher from Kuwait University. Dr. Jasem Ramadan presented a lovely little study called Bioenergetics of Islamic Prayers, measuring the amount of oxygen and calories the physical movements of the prayers burned.

Five standard prayers (Salat) are mandatory every day for every adult male and female Muslim. Each prayer has a continuous sequence of body movements (Rakkas) consisting of standing, bowing, kneeling and sitting. Each Rakka lasts between 3 and 6 minutes. Dr. Ramadan looked at the energy cost of two and four Rakka prayers in thirty-two male and female adults. He found that Salats have a positive effect on metabolic function. For an 80 kg person, energy cost of daily prayers was about 80 calories a day, and could be considered a form of physical activity that enhances fitness.

Dr. Ramadan told me, "The prayers have been done for thousands of years and no one thinks about it as physical exercise." I told him I think that often. I told him that Russian Orthodox prayer was pretty physical. A liturgy lasts hours, done standing and continuously crossing yourself from the floor in a squat to high overhead. Everyone including the oldest people do this, up and down, and up and down, and up and down, stretching and squatting, reaching and bending. I always thought it was group community health activity, probably found long ago to be protective against many ailments (and attributed divinely). The original yogas were the same, reaching upward to exalt the heavens, bowing, kneeling, prostrating, rising, over and over.

I told Dr. Ramadan that many Westerners aren't comfortably able to do the kneeling Rakka shown in Healthy Toe Stretches or rise to a stand without using their hands, as in the post Quick and Easy Strength and Balance Exercise, not only the elderly, but the rest of the population too.

He seemed surprised and interested. I told him I believed that this lack of basic human movement for real daily life was a major contributor to the epidemic numbers of people who are too weak and unstable to get up unassisted, to walk without canes and walkers, have trouble taking stairs, have poor balance, and for much knee and hip pain and degeneration. Dr. Ramadan said that elders in his country do not suffer knee and hip arthritis in high numbers, and can easily rise from the floor into their old age. I told him that many Westerners are familiar with a device that is worn, with a button to press for help if they cannot get up from the floor or chair. At this point, he was sure I was kidding.

If you cannot get up from the floor or low chair easily without using your hands, you likely have dangerously decreased leg strength and balance. Use good bending to strengthen your legs and knees many times a day and improve your fitness, explained in the post How Often Should You Be Healthy? Use healthy movement every day to sit, rise, bend right, clean, garden, give thanks, stretch, take stairs, and play to get healthy functional exercise, and prevent common joint pain. That is fitness as a lifestyle.

Labels: aging, arthritis, balance, fix pain, hip, hip stretch, knee, leg strength, leg stretch, strength, stretch, weight loss, yoga

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Fixing More Fitness Myths

On April 1st, I covered some fun fitness myths and how to change myth into healthier exercise. Today continues with more fun ways to get more exercise and reduce injury at the same time:


Heart Health

Myth - Anger has no health effects. Instead, turn contempt and anger for others to healthy dialog with:
Healthier Heart.

Understanding How "Sticking Out in Back" Isn't Neutral Spine:

Start with this one to see what overarching the lower back means, and how correcting it lets you do more in healthier ways:
Fixing the Commonest Source of Mystery Lower Back Pain

Then try Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine to visualize how you simply tuck enough to make the belt line level when standing, not tilted. A small inward curve in the lower back remains when you shift to neutral spine, but not large enough to cause degenerative pinching on the facet joints, the joints of the lower spine.

Then feel the difference of tucking until neutral: Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

and Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain

Here is how to try it during squats: Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending

Here are some abdominal exercises using these principles: Change Common Exercises to Get Better Ab Exercise and Stop Back Pain

Here is what it looks like not to use abs:
What Abdominal Muscles Don't Do - The Missing Link
What Does It Look Like to Not Use Abdominal Muscles?
and Healthier Carrying - Get Free Ab Exercise and Stop Pain.

Abs and Tightening:

Myth - Pressing navel inwards to tighten abs is the way to strengthen your abs or fix your posture. Fact - tightening will not move your spine out of unhealthy position and it impedes normal fluid motion:
Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine.

Exercise Injuries

Myth - Exercise injuries are usually overuse and aging.
Fact - Simple misuse is easily fixed: Why So Many Aerobics Injuries? and What is "Fitness as a Lifestyle?"
A recent injury survey by US military revealed that 62% of American injuries in Iraq are occurring in the gym. Welcome to the Fitness Fixer tells more.
Some top docs say the military press should be avoided. I think it is a functional exercise and can be done in ways without upper body injury: Safer Overhead Military Press.

Dispelling Myths about Circulation and Massage:

Keeping Thai Massage Healthy Part III - Should You Do "The Blood Stop?"
Making Thai Massage Healthier Part II - Avoid Snapping Elbows or Knees Backward
Changing Thai Massage to Be Healthier Part I - Avoid Pressuring Lower Back Discs.

Sitting and Rising:

Myth - The way to sit and rise from a chair is to lean forward and stick out in back. Here is a way that uses muscles more:
Get Better Exercise From Your Chair
and
Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats?

Dispelling the Myth That The Best Ab Exercise Means Crunches, Leg Lifts, and Bending Forward:

Abdominal Muscle Exercise - Better, Different, Not What You Think
Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique
Change Common Exercises to Get Better Ab Exercise and Stop Back Pain.

Knee Pain:

Myth - to avoid knee pain you must avoid impact activities or exercises that bend the knees. Here are ways to do all you enjoy and get stronger healthier knees:
Understanding positioning and impact: Healthy Knees.
For full squatting to the heels: Save Knees When Squatting
For half squatting for bending and exercise: Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.

Backpacks and Back Pain:

Myth - Carrying the weight of backpacks makes your back hurt. Fact - You can change the source of the back pain by how you carry the same pack:
Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain
and
Carrying Schoolbooks Is Not the Cause of Back Pain.

Back Surgery:

Myth - surgery is necessary to avoid later problems. Fact - Studies have now found that is it not true that you necessarily risk future consequences if you do not have surgery. Surgery itself can be a source of later trouble:
Fix Disc Pain Without Surgery
and
Studies Say Back Surgery Not Needed.

Squats:

There are medical people who say that squats are bad for the back and knees. I believe that healthy squats make daily life and exercise healthier and smarter, and can prevent much back and knee pain:
Bending Right is Fitness as a Lifestyle
How Often Should You Be Healthy?
Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending.

Cause of Disc Degeneration and Herniation:

Myth - Vertebral discs just go bad without warning, from small provocations like a sneeze or reaching or from aging, so it doesn't matter what you do. The good news is that discs are not soft "jelly donuts" as often described. They are tough like truck tires. It takes years of the same, specific, problem to break them down and move them out of place. See the mechanism:
Disc Pain - Not a Mystery, Easy to Fix

Then see examples during daily life:
The Cause of Disc and Back Pain
Are You Making Your Exercise Unhealthy?
and How Often Should You Be Healthy?

Brain Damage:

Myth - knocks to the head are funny and harmless. In reality, long-term damage may be common and serious. This has far reaching implication for law enforcement, domestic violence, full contact sports, and extreme entertainment:
Rocky IV and Head Injury.

Sitting and Back Pain:

It made headlines when researchers seemed to say that sitting up straight was wrong. Here is what they really meant:
Don't Fall for "Don't Sit Up Straight."

When you exercise for health, are you sitting in unhealthy ways? Are You Making Your Exercise Unhealthy?

and here are two for more comfortable sitting:
When Did Health Become Thinking Out Of The Box?
and Exercise and Stretch for Long Travel Sitting.

Upper Back and Neck Pain

Breasts Causing Upper Back Pain is a Myth

Myth - All neck stretches fix neck pain. Fact - there are some stretches that increase neck pain:
Upper Back Exercise and Neck Pain Prevention Too
and The Stretch You Need The Least.
Here are stretches that work better:
Fixing Upper Back and Neck Pain
Thumbs Can Show Tightness That Leads to Upper Back Pain
Nice Neck Stretch
and Quick, Feel-Good Upper Back and Chest Stretch.

Dispelling the Myth That Any Exercise or Stretch is Good For You:

The Stretch You Need The Least
Is Bad Martial Arts Good Exercise?
Common Exercises Teach Bad Bending
Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs
Healthier Hamstring Stretching
and Better Achilles Tendon Stretch.

Is More Calcium is the Answer for Bone Density?:

Exercise is More Important Than Calcium Supplements for Bones
and
Collapsing Astronaut Gives Healthy Reminder.

Making Peace

I have taken many classes where the teacher claims their exercise system gives focus and calm, then they lose all their concentration if a student arrives late, if a phone rings, or if the class next door is too loud. These posts give things to try instead:
Which Ancient Exercise Gives Focus and Concentration?
Exercise Common Sense Discipline
The Story of the Black Belt.

More myths - Fixing Fitness Myths

Labels: abdominal muscles, circulation, facet joints, holiday, knee, lordosis, massage, myths, nutrition, squat

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Why So Many Aerobics Injuries?

A recent New York Times article quotes aerobics teachers and devotees saying they now have painful, chronic injuries from years of aerobics classes. Why did this happen?

I receive frequent e-mails from aerobics instructors, many only in their 20s and 30s, saying they are too old to continue teaching because of pain and injuries from teaching. I am older than their parents. At the schools and clubs where I teach classes, teachers and trainers are often absent, or replaced, because of herniated discs.

The Times article quotes major aerobics spokespeople, attributing the injuries to jumping on "concrete floors in bad tennis shoes," and related how former well-known-names in the aerobics industry now teach low impact classes. The article continued, "A lot of people doing aerobics back then can no longer do any jumping whatsoever. They have problems with their backs, feet and hips."

Conventional "impact activities" are not the problem.

• In the years I spent in the lab studying injuries, seeing patients, and teaching students, I have found that the problem is not that impact must be avoided. I see patients who are instructors of Pilates, stretch, yoga, rowing, martial arts, and Alexander technique for degenerating joints. It is simple misuse.
• It is not that people are doing the exercises "wrong" but the movements themselves.
• If you saw someone bend over at the waist or hips to hoist a suitcase or child, you know it is bad bending and it hurts the back. The same people will bend over the same way to lift weights in a gym or do yoga stretches. It is the same disc-injuring bending in all cases.
• The post Common Exercises Teach Bad Bending gives interesting examples from a class that is "low-impact." Wear occurs on the lower back and neck discs regardless of how expensive and engineered the aerobics shoes.
• The post Are You Making Your Exercise Unhealthy? shows you how to put the knowledge of bad positioning together in your mind with how people are exercising, to realize it is not rocket science when people have pain, even though they "do their exercises."

You can run, jump, walk without jarring impact

• Many people walk with higher impact than a good martial artist will kickbox.
• Many people are unnecessarily restricted from favorite sports and told to walk instead, based on the fallacy that running or tennis is necessarily higher impact, instead of looking at how heavily they clomp around letting spine, hips, knees, and ankles sag and grind.
• One story with helpful links is told in You Can Fix Your Own Knees.
• Another is Walking Softly Benefits Olympic Wrestler
  

What about body weight?

• Many of my obese patients with knee pain stand and walk with their knees in sagging positions. This is not a consequence of their body weight.
• When I show them to simply hold their knee from knocking inward (or outward) by using their own muscles to hold straight, the pain quickly goes away. They say that they can then, for the first time, *do* any real exercise to lose weight.
• Lightweight people can have the same knee and other pain. They may move heavily without good shock absorption or hold joints in angled painful ways.

The post When Did Health Become Thinking Out of The Box? explains more of why you don't have to have pain from exercising or even long sitting while studying (or watching TV). I don't take people away from their favorite activities when injured. I even use their sport as rehab, showing them how to do it in healthier ways so that they can do more, lift more, and run more than before, not less. Health care should not be "Limit to the patient to limit the pain."

Read Inspiring Patient Stories on my web site - how patients fixed their own pain and could do more than before.

Labels: ankle, disc, fix pain, hip, injury, knee, martial arts, planter fasciitis, shoes, yoga

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You Can Fix Your Own Knees

E-mails have been coming in how readers quickly fixed their own pain and got better strengthening using the simple principle here on Fitness Fixer and my website.

Last week's post Each One Teach One showed how reader Ivy from New Zealand fixed a neighbors back pain.

This week is an e-mail from KMLash who quickly stopped 15 years of knee pain:

"Your paper on how to fix your knee pain is by far the most important thing that I've done for my knee since I injured it 15 years ago. I've tried every supplement that has good statistical results behind it (e.g. ASU), custom orthotics, physical therapy, message, leg strengthening, weight loss and any other cure that I read about and still I've been suffering with knee pain for years - especially when standing in 1 spot. It's put a damper on countless vacations, social engagements, etc.

"I read How to Fix Your Own Knee Pain and within a few days of implementing the techniques for both walking and standing I got results in my knee and surrounding muscles that I have not been able to get in 15 years. The first day I began using the techniques in your paper I began to experience relief and the second day it was obvious to me that I had come upon something that would do for me what nothing else did in 15 years of trying. I have never come across the concept of proper leg posture and its potential to relieve knee pain until I came across your paper. But the minute I read it and took a walk to try the techniques it became obvious to me that my leg posture was terrible and that all my weight was being placed on my knees with minimal support from my leg muscles. The concept of using my heels has been especially helpful. Additionally, keeping my body weight slightly backward from where it use to be during walking and standing has allowed me to place my weight on my heal and maintain proper posture. With that I immediately felt my leg muscles begin to spring into action and my body weight taken off my knees. The relief to my knee and surrounding muscles that has ached for years was very noticeable.

"Thanks for sharing this paper on the internet. It's a major find for me that's relieved knee pain that's hampered my life for 15 years. I really appreciate it."
KMLash

"One other point worth mentioning - In becoming aware of my leg posture, I became conscious of the position of my feet when standing. The foot on my "bad knee leg" pointed outward a good 15-20 degrees. The foot on my "good knee leg" pointed outward less than 5 degrees. I have consciously been pointing the foot on my bad knee leg straighter and it has allowed me to stand in one spot for long periods of time without my knee and the connective tissue above the knee hurting. So, just becoming aware of the concept of leg posture has made me conscious of various aspects of my posture including my feet.
Thanks again. "
KMLash

More Fitness Fixer to help get your knees in shape:

• Healthy Knees shows how to easily use your leg muscles when landing from jumps, to prevent inward knee sagging that gradually grinds the joint. Easily apply this to descending stairs, walking, running, and regular daily life activities.
• Improve Stretch and Strength With Better Kicking shows preventing hyperextension that hurts knee cartilage.
• Which Shoes Help Exercise, Fall Prevention, and Ankles? shows how positioning (body mechanics and ergonomics if you like bigger words) prevent many problems that strengthening alone does not.
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending shows good bending using the half-squat, so you can bend knees without pain.
• Strengthen Legs Without Knee Pain - Standing Lunge shows more good bending that saves your back without hurting your knees.
• What Works Better Than Knee Surgery? - If you don't want knee surgery.
  
  
  

All in one sources:

• Fix Your Own Pain Without Drugs or Surgery and Health & Fitness THIRD ed (How to be Healthy Happy and Fit for the Rest of Your Life). Good books at www.DrBookspan.com/books.

It can be easy. You can get better use of your muscles during all your regular activities without stopping your day to "do exercise."

Labels: fix pain, knee, readers inspiring story

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Making Thai Massage Healthier Part II - Avoid Snapping Elbows or Knees Backward

The previous two posts told a little about Thai massage and some of the benefits and pitfalls.

Some massage practioners say that Thai massage is an "energy-based" system, not a physical one. However, there are direct physical moves that bring direct physical change, both good and bad.

Many of the stretches of Northern style Thai massage can be helpful to restore length to tight muscles so that you can restore healthy body positioning. For example, in the photo at left, the legs are lifted upward so that the front of the hip is gently stretched. The practitioner puts their foot on the back of the the person's hip to prevent the lower back from being overly-arched by the stretch and to concentrate the stretch more on the front hip muscles. This is a beneficial stretch because the front of the hip is often tight from long sitting and faulty standing positioning. This Thai massage stretch restores length to the front hip muscles.

There are a few moves that are usually better to skip. Some practitioners may straighten your elbow or knee too quickly and too much, sometimes adding a forceful snap. The elbow and knee joints are not shaped to hyper-extend. Hyperextension means to go more than a normally straight position. Hyperextending the knee or elbow can damage the joint and strain the cartilage. In the photo, the knees are bending normally.

It is not usually healthful to snap a joint, especially repeatedly over time, to reach the end of its range of motion. Although many of us learned to do this in massage school, and were taught that the snapping and hyperextending motion has benefits, it is better to skip joint snapping, and do other moves that have benefit without harm.

Next:
Keeping Thai Massage Healthy Part III - Should You Do "The Blood Stop?"

Previous Fitness Fixer Posts on Thai Massage:
Changing Thai Massage to Be Healthier Part I - Avoid Pressuring Lower Back Discs
What is Thai Massage?

Labels: elbow, hip, knee, massage, stretch

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Save Knees When Squatting

American baseball catchers have the occupational risk of meniscus tears in their knees. Yoga practitioners of certain squatting moves like "the eagle" and the hindu squat are more likely to get the same meniscus cartilage tears and early joint wear and tear. Asians who routinely squat for so many activities of daily life don't get these injuries. The difference is keeping your heels down and your feet facing in the same direction as your knees.

Sitting in a full squat with your heels down and your weight back does not pressure the knees the way squatting with heels up does. Keep both heels down and keep your weight back on your heels.

People who are not accustomed to squatting often find that they are too tight in the Achilles tendon to sit all the way down. Many of these same people do Achilles tendon stretches every day, or at least they do a motion commonly taught as an Achilles stretch, but which barely stretches the Achilles. The "lunge and lean," is the least effective Achilles stretch. The post Better Achilles Tendon Stretch tells why and gives a better stretch to do instead. The squat is another good Achilles tendon stretch. It is a lifestyle stretch for the Achilles and lower back, and a hip, leg, and shin muscle strengthener. You get healthful natural exercise from regular daily life. Even if you can't get down to full sit, bend properly with both heels down for daily bending and you will get a free Achilles tendon stretch every time you bend, which is many many times a day. Holiday Leg and Abdominal Exercise tells more on this.

The trains here in Thailand have the luxury of a bathroom, including a squatting bowl. You can tell new tourists here. They are afraid of the bathroom. When we lived in Japan, even the gleaming modern Bullet train, the Shinkansen, had a spotlessly clean squat fixture. Train bathroomsgive you balance practice too, swaying with the train as it takes you to the next adventure.

Photo by Dr. Jolie Bookspan

Labels: achilles stretch, fix pain, knee, leg press, leg strength, leg stretch, squat, yoga

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More Fun Squatting

The previous post, Achilles Stretch in the Bathroom, explains how and why the squat is a functional lifestyle exercise, good to stretch the Achilles tendon and get strong, shapely leg muscles. By keeping both heels down and your weight off the front of your foot, it can be safe for the knees. The large amount of built-in leg exercise you get from routinely sitting and rising from sitting this way strengthens the hip, thigh, and knees.

At the left is a photo of a sign that is common here in Asia. The sign instructs people who are accustomed to squatting how to use the strange seat. The drawing marked with an X shows someone standing with both feet on the seat and squatting over the bowl. That is marked as incorrect use. The user is instructed to sit touching the seat. I asked some of the locals what they thought of the "sit and touch the seat" method. They shuddered, pointing out how silly that was.

Beside strengthening and stretching the legs, squatting is a cleaner way to sit, since only your feet touch the surface. It is common to see people waiting for a bus at the street curb, sitting, not with their behind on the curb, but sitting in a squat so that only their feet touch.

Squat toilets vary, but are often clean. You leave your shoes outside and wear bath shoes. Even some public toilets have public rubber shoes thoughtfully provided.

Western sit-down fixtures are becomming more common, as more wealthy tourists demand them and locals adopt less physical lifestyles. Our friends living here told us the story of a family who decided to convert their shining clean indoor squat facility to Western plumbing. They purchased a standard raised bowl and seat. They left on a short tip while a workman installed it. When they returned, the man was proud of his installation. He excitedly told the people it had been strange at first, but he did a fine job. He led the people to his finished work and said that at first he was puzzled by the height of it, but figured out to dig a deep hole. He buried the new, shiny toilet exactly up to the seat to become the familiar floor level.

Related posts on full squats:
Save Knees When Squatting
Achilles Stretch in the Bathroom

Related posts on half squats:
Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.

Labels: achilles stretch, fix pain, knee, leg strength, leg stretch, squat, stretch

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Achilles Stretch in the Bathroom

In the airport, an obvious tourist arriving here in Asia proudly waved a travel pack of toilet seat covers and claimed to be ready for the germs of travel. Another tourist nearby announced that it was a problem for him that women couldn't go to the bathroom outdoors. I asked him why he thought they couldn't. He said it was because they can't stand up to go, and someone needed to invent a tray so that they could. I asked him if men sat to pass their bowels. He seemed surprised when he realized that everyone does natural things the same way. Both men and women have been sitting to "go" for thousands of years before plumbing and raised seats were invented.

All over Asia, Africa, India, the South Sea continents and islands, and even in places in Europe and the Americas, men, women, and children routinely and easily sit in full squat to eat, wait, talk on the phone, rest, relax, wash, and do other activities of life. The tourist with her seat covers may quickly find that squatting is cleaner than touching a seat. Many people who first encounter Western sit-down plumbing think it is unclean and barbaric. The squat is a functional and excellent leg strengthener and Achilles tendon stretch. People in their 80s and older who routinely squat have strong legs and healthy good knees, and can easily rise from the floor.

Would you like to try the squat? (Use your brain to be safe to try things or not, if you have damaged knees):

• Keep both heels down (right drawing) as you bend both knees, which protects your knees.
• One way to practice the squat if your Achilles tendons are too tight, is to hold something in front of you, like a counter or sink, and bend both knees as much as you can with both heels down.
  
• While holding the support in front of you, lean back with both arms straight so that your weight stays over your whole foot and heels, which moves your weight off your knee joints and back onto your leg muscles.
• Try to balance and sit without holding on. If you find yourself falling backward, or if your heels come up (left drawing), it is likely that your Achilles tendons are too tight for this normal activity. Put one or both hands behind you to lean on (not in the squat bathroom but just to practice).

Every time you bend around the house, use a small squat with both heels down, described in Bending Right is Fitness as a Lifestyle and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending. You will strengthen your thighs and hip, develop healthful bending that stops knee pain, strengthen your shins, and stretch your Achilles tendons each time. As this routing bending strengthens and stretches your legs, progress to lower and lower bending until you can comfortably sit in a squat. Have fun.

Drawing of Backman!™ © copyright Dr. Jolie Bookspan. Read more fun and functional stretching in the book Stretching Smarter Stretching Healthier

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Labels: achilles stretch, balance, knee, leg strength, leg stretch, squat, stretch

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Improve Stretch and Strength With Better Kicking

Thai boxing (Muay Thai) kicks are among the most devastating and effective kicks in the world. Thai fighters spend hours a day kicking heavy bags and posts, and years toughening their legs and shins for kicks and blocks by bashing them with pipes and against coconut trees. A blow from a Muay Thai fighter's leg is like a blow from a club.

When you practice moves that lift the leg for martial arts training, for self-defense, for dancing, or for exercise in an aerobics class, watch for several bad habits that increase strain on muscles and joints, and reduce effectiveness of the kick. It is not the point to kick someone else and wind up injuring yourself.

1. Look at the photo, above left. The teacher is holding his hip and neck straight. The blocking student is not. The orange arrow at the student's leg shows how, when the student lifts the left leg, the right leg pulls forward instead of remaining straight at the hip. This is a sign of tightness at the hip and poor technique. He needs to stretch the front of his hip and retrain kicking and blocking technique to prevent this common bad habit. Read more on this in the posts, Is Bad Martial Arts Good Exercise? and Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs.

2. Next, check the white arrow at the student's belt line. It is tilting up in front. The teacher's hip remains level as the leg is raised. Curling the back and letting the hip roll under, as shown by the white middle arrow is another sign of tight hip muscles in the front and back of the hip, and poor movement habits. When you raise one leg to kick, block, prepare to kick, do a knee strike (whatever), check if you curl your hip or round your back. Hold your back straight and upright for more exercise, a built-in hip stretch, and more effective technique.

3. Third, note the black arrow showing how the student rounds the upper back and neck forward, instead of holding straight. With practice, the student will learn to hold the neck straight as the teacher is doing.

For all the exercise you do (kick, block, ascending stairs, whatever is done raising one leg), keep healthful positioning. Yes, rounding the back is taught, and done for fighting, but you will be beating yourself up in the long run. You can still be an effective fighter and at the same time, prevent hurting yourself with common strains from unhealthful technique, plus get more exercise with healthier ways.

Previously:

• Thai Boxing

Related Fitness Fixer:

• Fast Fitness - Hidden Source of Groin Pulls
• Fast Fitness - Don't Shorten Hip When Stretching Hamstring
• Black Belt Hall of Fame - Black Belts and Black Tie
  
• Muay Thai Monks on Horseback
  
  

Labels: disc, fix pain, hamstring, hip, injury, knee, leg strength, leg stretch, lower back, martial arts, neck, partner exercise, posture, shoulder, spirit, upper back

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Holiday Leg and Abdominal Exercise

Many people are taking down Christmas trees even as the Russian and other Eastern Orthodox families are putting theirs up for Christmas, coming this Saturday Jan 6th. The Russian Snow Girl (Snegurushka), and DedushMoros (Father Frost) have already come to visit. S nastupaiushchim Novym godom i s Rozhdestvom Khristovym - Happy New Year!

Here are two lifestyle strengtheners (and a free Achilles tendon stretch) to build into your fitness as a lifestyle for 2007:

If you would like to get strong legs for the New Year, don't bend over wrong to lift things (upper drawing, left). From now on, make all your bending the way that strengthens your thighs and at the same time prevents back and knee pain (upper drawing, right). Keep your upper body upright and bend your knees. Prevent knee pain and get better use of your leg muscles by keeping both knees down and back over your heels. Each time you keep both heels down while doing healthy bending, you will also get a built-in Achilles tendon stretch. The post How Often Should You Be Healthy? tells more on good bending.

If you want to stop "mystery" lower back pain for the New Year, check to see if you lean backward when you reach upward (lower drawing, left), carry things, or when you are just standing. Leaning back creates overarching of the lower back called hyperlordosis, which pinches and pressures the soft tissue and joints of your spine. People with this kind of pain feel they need to lean over forward or sit to relieve the pain. Instead of doing remedies for pain, it is smarter and healthier to stop the cause of the pain.

The "hip tuck" or "pelvic tilt" to reduce overarching and straighten the spine (lower drawing, right) is described in the post Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique. The muscles you use to move your spine out of unhealthy overly arched position and into straighter position are your abdominal muscles. By simply standing and moving with a healthier spine position, you get free exercise for your abdominal muscles. "Tightening" the abs is not what exercises the abs or prevents back pain. Tightening also does not let you breath or move properly. Tightening is not how to have healthy abdominal function. Instead, use the abdominal muscles to stop overarching and maintain healthy position while going about your daily life and exercise. The post, If Better Abdominal Muscles Are Your New Year's Resolution, Try This, shows how.

If your New Year's Resolution is to have a healthier low back, Achilles tendons, and abdominal muscles, you can do that all at once during your regular daily activities.

Labels: abdominal muscles, achilles stretch, disc, fix pain, knee, leg press, leg strength, leg stretch, lordosis, lower back, squat, strength

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Healthy Christmas

The days are becoming longer and light is returning in the Northern Hemisphere. Native Americans, Shinto, Iranian Zorastrians, Buddhists, Christians, and non-faith based traditions all celebrate the winter return of light and life and enlightenment with trees, and lights, and cleaning the house, and giving presents, and lifting things.

In many of these traditions, is written that pain and darkness is high before the return of the light. The upper photo shows pain - unhealthy bending. The lower photo shows "seeing the light" - healthy bending.

For healthy holidays, check your bending for all the cleaning and lifting you do. Don't lean over. Keep your body upright and bend your knees. This bending gives healthful exercise and prevents straining back muscles and herniating (slipping) your lower back discs. Many people think that lifting bent over strengthens back muscles. The problem is that, over years, it also degenerates your discs. Bend right to strengthen without also damaging. Other people refuse to bend right because it hurts their knees. But, done properly with both knees back over your heels, and your weight back over your heels, not toes, you shift body weight off your knee joints and back to your thigh and hip muscles. You will feel the difference as soon as you try it. Healthy leg and hip strengthening without back or knee pain.

Check the posts for how to do healthy bending: Disc Pain - Not a Mystery, Easy to Fix, and How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending, and Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.

For all my friend readers in the Northern and Southern Hemispheres, make healthy bending a New Year's Resolution and part of your healthy holidays and stronger New Year.

Bad bending photo by subscription to Clipart.com
Good Lifting photo (without halo) by iwona_kellie

Labels: disc, fix pain, knee, leg press, leg strength, lower back, squat, strength

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Getting Stronger Without a Gym

I often hear from trainers, and read in exercise books, that you cannot get stronger without lifting weights. They say that body weight is not enough. Then I watch the trainers and read what the exercise books say to do to strengthen. Often the weights they teach to lift are far lighter than the resistance your muscles get from moving your own body during a real life activity.

I see women in exercise classes lifting little two and five pound hand weights, then bend over wrong to put the weights down and bend over wrong again to hoist up their 20-pound handbag. I see knee pain patients in rehab centers with two and three-pound weights strapped on their ankle, sitting down to do little leg raises. Or, they pull stretchy bands with their leg. Then they get up and walk away with injurious body mechanics, letting their knees and ankles sag inward because they are not using their leg muscles to stop it. The unhealthy sagging grinds away joint cartilage and prevents full use of the leg muscles. They don't understand why their knees, ankles, and feet still hurt even when they "Do their exercises."

Your body weight is the most important thing you need to lift. Following are things to start with, to strengthen without a gym or equipment. The main idea of these activities is not to "do" them as an exercise 10 times, but to use them to retrain your muscles how to hold your body in healthy position, then use that healthy positioning for all daily life:

1. Hold a pushup position, called the plank, described in the post Change Common Exercises to Get Better Ab Exercise and Stop Back Pain. Understand that the point of the plank is to learn how to hold your spine straight without sagging under your body weight. I see people doing the plank all the time in gyms and fitness classes, with their bottom hiked up in the air and their low back looking like a hammock, sinking under their body weight. That is not the normal lower back curve. It is injurious overarching. Done poorly this way, the plank does little to strengthen and just pressures your lower back. Done well, the plank is excellent to strengthen your wrist. The wrist is neglected in fitness, and the resulting weakness is a common source of injury. I will post more about wrists. Do the plank every day - that is how helpful and important it is. If you can't even hold up your own body weight, you may have serious weakness.

2. Use the squat for daily bending, described in the post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending. The point is to use this healthy bending all the time instead of bending wrong. In posts to come, I will show another way for healthy bending using a lunge position with one leg in front and the other in back.

3. If you can't sit and rise from the floor without your hands, you are too weak and tight for ordinary daily life. Try Quick and Easy Strength and Balance Exercise. Also practice getting up from your chair (safely) without using your hands or leaning forward.

4. Stand to put on your hosiery, pants, and shoes: Better Balance by Christmas.

5. Hang from a chining bar, a branch, a pipe, a doorjamb, or any secure overhead. Don't worry if you cannot do full pull-ups, just hold on and hang. When you can do that, hang for as long as you can from a bent-arm position, and begin trying to raise yourself (do a pull-up). Maybe you will need to start by stepping up on a box to help raise yourself, and letting yourself slowly lower without using the box. Work up to full pull-ups. If that is easy, use fewer fingers to hold on.

6. Try the Quick and Fun Arm and Body Strengthener.

When the above body weight activities become too easy, do them carrying functional weight, such packages, children, books, and other common things. It is crucial to health and independence to be able to lift and move your own body weight. In posts to come I will show you how to do more with these body weight activities for more strength and fun being active. Until then, do these every day and send your photos and stories of how you got stronger and happier.

Make it your New Year's Resolutions to be strong for real life in real ways.


Photo by quailwood

Labels: abdominal muscles, achilles stretch, aging, arm, balance, fix pain, hamstring, hand, knee, leg press, leg strength, leg stretch, lower back, practice of medicine, shoulder, side, squat, strength, stretch, upper back

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Don't Confuse Exercise With Real Fitness

Reader Dr. Zoe Eppley e-mailed, "I have been trying to apply your "bending right" approach to my daily activities. I find my tight leg and hip muscles seriously limit my ability to squat. Could you please recommend some stretches that will help?"

I receive this inquiry often. People are realizing that they are too tight to move in healthy ways for normal everyday life. I hear it from instructors of aerobics, yoga, Plates, personal trainers, and many others. This is an important epiphany. If you are too tight to move in healthy ways, then it is likely that you spend every day of your life moving in tight ways that create pain and perpetuate tightness.

The good news is you do not need to "do" stretches and exercises. Keep bending right and you will get exactly the stretch and strengthening you need. My most important message that I stress in all my work about exercise is not to "do exercises" but get crucial, functional, effective exercise by moving in healthy ways during normal everyday life.

People spend fortunes on treatments for pain, gadgets, potions, pills, prescriptions, adjustments, and ongoing medical scans and tests. Tightness and body pain is often made to be a mystery because it persists even after surgery and exercise programs. The reason is that they don't stop the cause. My successful techniques for fixing pain, even the most resistant back, neck, knee, and other musculoskeletal pain, emphasizes that you don't "do exercises" but simply stop the source of the injury by stopping unhealthy injurious movement patterns, and using healthy ones. Many people do ten repetitions of an exercise and hold each stretch for 30 seconds, then go back to unhealthy moving, sitting, bending, walking, exercising, and everything else that caused their pain and tightness in the first place.

If you are too tight to use your legs to bend down and get back up without using your hands or getting help, you need the hard realization that you lack normal function. It may be common in Western society to not be able to lift your own body, but it is dangerously unhealthy weakness.

Dr. Zoe e-mailed me a second time and mentioned watching an Indi-pop movie. She noticed the healthy posture and flexibility of the actors and how easily they squatted. She wisely reflected that she had probably lost much flexibility by not using normal bending and from "spending my life in chairs."

Keep bending right with your heels down, knees back, and your body upright. You will stretch your Achilles tendon and hip, and strengthen your thighs and knees hundreds of times a day - every time you bend.

One fun way to greatly help your bending is not a specific stretch or exercise but another normal daily activity: apply the same healthy positioning to ascending any set of stairs. I will post more about stairs, as it is interesting and enlightening. Until then, any time you go up stairs, notice if you tilt forward and let your heels lift. Instead:

• keep your heel down as you step up,
• keep your knee back over your ankle as you step up, instead of sliding your knee forward,
• keep your body upright.

Use healthy positioning for both bending and stairs and you will quickly gain functional and healthy strength and flexibility.

Related Fitness Fixer:

• What is "Fitness as a Lifestyle?"
• Bending Right is Fitness as a Lifestyle
• Healthy Aging Starts Now - Part II
• Good Life Works Better Than Bad Ab Exercise
• Fitness and Health as a Lifestyle for Thanksgiving
• Want Weightlifting? Plant A Food Garden
• Fast Fitness - Balance, Strength, Stretch, and Socks
• Better Balance by Christmas

Labels: achilles stretch, balance, fix pain, hip, hip strength, knee, leg strength, leg stretch, lower back, practice of medicine, squat, yoga

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Conference on Aging Dec 2, 2006 in Midtown New York

The Greater New York Chapter of the American College of Sports Medicine (ACSM) will hold a conference on aging on Saturday, December 2nd, 2006 at the Flatotel, 135 W. 52nd Street between 6th & 7th Avenue, in New York City.

In one fast moving day, there will be nine lectures by authorities on metabolic changes of aging, cardiovascular changes and the benefits of exercise, exercise in older patients with heart failure, neuromuscular training for the older population, psychosocial aspects, physical training for older clients with special conditions, and nutritional needs of older populations. I will be giving a lecture called "Three Quick Techniques for Three Musculoskeletal Problems Confused for Aging."

Many of the declines that come with doing less are often confused with aging. A stiff and rounded upper back, for example, is not necessarily aging, but practice. Are you sitting rounded forward reading this right now? Do you spend your day rounding over your desk and steering wheel, then go to the gym and bend forward for crunches, leg lifts, Pilates, and toe touches? Do you bend your neck down to do biceps curls? No wonder it's hard for you to straighten out. How long will you practice unhealthy bent forward position before you get stuck that way? There is no need to exercise in the very way that is not healthy when you do it sitting at your desk. There are better ways.

Much of the loss of strength and balance over the years is from disuse not aging. Many people do not use their legs for the hundreds of times each day they need to bend. They bend wrong, throwing their weight on their spine. Their back hurts and their legs and hips tighten and weaken. Eventually they find they are unable to sit comfortably on the floor, and more worryingly, cannot rise from the floor, or even from their chair without using their hands. This is debilitating weakness, and a dangerously unhealthy cycle of use or lose. It is not aging. In cultures where sitting and rising from the floor is a daily activity, people of 90 have the strength and balance to do it. They do not suffer the rates of falls, osteoporosis, arthritis, and cardiovascular disease of less active populations.

My lecture will cover three easy techniques to maintain and improve spine health and muscle strength. Come say hello. The meeting is designed for allied health practitioners, but is open to the public, with reduced registration fees for members of the American College of Sports Medicine (ACSM) New York Chapter. Contact Felicia D. Stoler, MS, RD (732) 946-4436, or e-mail fstoler@att.net

Labels: aging, arthritis, balance, disc, education, fix pain, hip strength, knee, leg strength, leg stretch, lower back, osteoporosis, sitting, squat, strength, stress, stretch, upper back

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Fitness and Health as a Lifestyle for Thanksgiving

If you think you won't have time to exercise over the Thanksgiving holiday, here is good news. This post will show you how to move in healthy ways so that you have healthy exercise built-in to all the cooking, shopping, furniture moving, and social interactions. Here is more good news. You don't have to go to a gym to work off the stress and eating too much of the Thanksgiving holiday. Life is not supposed to be a poison that you deliberately take, then need an antidote to offset.

Here are four of the healthiest, quickest ways to make your Thanksgiving into fitness and health as a lifestyle:

1. To pick up chairs, babies, and grocery bags,
   to move furniture, and for lifting things from the floor, bend your knees, keeping your weight back toward your heels, and your body upright.
   
   
2. To carry chairs, babies, grocery bags, furniture, and any loads in front of you, don't lean back. It is a common bad habit to lean the upper body backward, increasing the lower back arch. Leaning backward shifts the weight of the load off your core and arm muscles and onto your lower spine. Get free, built-in exercise for your abs and arms and save your back by standing straight. Don't lean and arch backward to carry things.
   
   
3. Notice all the times you round and hang forward over things that you can easily reach by standing upright. Check your upper back positioning when standing over counters, sinks, grocery bins, vacuum cleaners, cribs and baby-changing tables, and when setting food tables. Don't let your body weight hang over and forward. Stand upright, chin in, and just tilt your head downward in relaxed manner to see what you are doing. Relax shoulders downward. Smile. Breathe.
   
   
4. Preparations and family interactions are no excuse to do unhealthy behaviors out of habit like smoking, overeating, and arguing, then blame it on stress. The bad habits are even more stress on body and mind. If something is wrong, see about fixing it in a good way. Don't suffer in silence with people telling you that you have to be happy just because of a holiday. Make your home healthy for yourself. There is no place it matters more:

• Get exercise cleaning the house of junk and clutter. Take the extra clothing, toys, and household items to a shelter. Carry the bags with healthy positioning to the people who need it.
• Make a healthy meal with family or alone, without television or phone. Carry the meals to shut-ins and isolated elderly in your neighborhood, and the homeless on the street.
• Volunteer at a soup kitchen. Do grocery shopping, cooking, and vacuuming for those who are too sick or disabled or alone to do it for themselves. If you think you don't have time because you have young children, take them with you to help carry things and to teach them healthy ideals, and how thankful they can be for the home you provide.
• Don't smoke, drink soda (diet soda is just as unhealthy) eat junk food (even if it has marketing words like "organic" on the label), or undo the health benefits of fruit and vegetables by junking them with cream, sugar, and cornstarch. Add up all you spend on cigarettes and junk food that take a healthy body and give it health problems. Take the money and give to the poor. With what you save on prescriptions and treatments for all the pain and jitters you cause yourself, you can feed a village and still take a vacation.
• When you eat the Thanksgiving meal, say thankful things. Taste your food. Turn down seconds. Breathe. Smile. Help clean up. Shoulders back. Enjoy the roof over your head. That is health as a lifestyle.

Drawings and more ideas on healthy positioning - see the book Stretching Smarter Stretching Healthier

Labels: abdominal muscles, achilles stretch, arthritis, balance, disc, facet joints, fix pain, green fitness, hamstring, holiday, knee, leg press, leg strength, leg stretch, lower back, neutral spine

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Bending Right is Fitness as a Lifestyle

Readers asked for more pictures of healthy bending around the house and workplace during daily life. They've been getting excited about the idea that daily life is the way to physical ability and health, instead of stopping life to do a bunch of exercises. People spend time and money for endless treatments and gadgets for back and knee pain and tight Achilles tendon. Healthy bending prevents the commonest sources of all of these.

• A major predisposing factor of knee and hip arthritis is weak thighs.
• A major risk factor of hip osteoporosis is lack of weight bearing exercise.
• A major risk factor of falls is weak legs and poor balance.
• The Achilles tendon gets a natural stretch with each time you bend right with heels down, and loses this constant normal source of stretch without good bending.
• The most important contributor to making a lumbar disc degenerate, or slip out of place (herniate), and press on nerves causing sciatica, is bad bending forward.
• The biggest contributor to upper back and neck pain is keeping the upper body rounded and bent over forward.

If you would like to reduce risk of falls, osteoporosis, bad discs, sciatica, achy upper back, and arthritis, get a built-in Achilles tendon stretch, and get strong shapely legs all at the same time, just use your legs with good body position for daily healthy bending.

Why go to the gym or to physical therapy to do knee bends to strengthen your legs, then spend your "real life" weakening your legs and degenerating your lower back discs with bad bending, and say, "I don't have time to exercise."

You will get free built-in exercise just moving in life. My friends and family in Asia are astonished when I tell them I teach Americans how to bend to look in the refrigerator, and that Americans tell me it is too much work to bend right to load dishes in a machine that washes for them. Then they pay money to go to a gym or buy equipment to exercise their legs.

Here is a fun way to change mindset to exercise as a lifestyle:

Count how many times a day you bend and how many times you can choose to harm yourself or help yourself.

If you would like to try "fitness as a lifestyle," this is the best place to start. Think of it:

1. when bending to make the bed,
2. to pick up laundry,
3. look in the refrigerator,
4. load and unload the dishwasher,
5. to pick up your shoes,
6. open a lower cabinet,
7. lift a child or pet,
8. feed a child or pet,
9. pick up things from the floor,
10. pick up hand weights to do exercise,
11. put down weights after exercising,
12. many daily activities.

Related Fitness Fixer:

• Fast Fitness - Count How Many Times You Help Or Hurt Your Body Daily
• Readers Count - Second Missed Cause of Back Pain With Golf
• How Often Should You Be Healthy?
• Better Balance by Christmas
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending
• Common Exercises Teach Bad Bending
• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures

Books:

• Learn bending, reaching, and fixing knee and back pain: Fix Your Own Pain Without Drugs or Surgery
  
• Get built-in lifestyle exercise, fix back and knee pain, learn health and fun at the same time: Health & Fitness in Plain English THIRD edition.

Labels: achilles stretch, arthritis, disc, fix pain, knee, leg press, leg strength, leg stretch, lower back, osteoporosis, practice of medicine, sciatica, squat, strength, stretch, upper back

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Healthy Knees

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.

• More on keeping knees healthy during exercise, in the book Healthy Martial Arts and Fix Your Own Pain Without Drugs or Surgery

Labels: aging, ankle, arches, fix pain, injury, knee, leg strength, martial arts, orthotics, posture, pronation, strength, stretch

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How Often Should You Be Healthy?

A reader thoughtfully sent in the photos at left to help readers recognize unhealthy bending, and asked, "What is your advice when someone is having to bend to put dishes in the dishwasher? It just seems so uncommon to think to squat while loading the dishes."

There is no better time to bend in healthy ways than your real life. The whole point of fitness as a lifestyle is that your daily life is healthy movement - not to change clothes to do squats at a gym three times a week, then change clothes again, go home, and bend wrong all day. Healthy bending is for every time you bend. How often is that? The post How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending showed how we estimated that you bend an average of 400 times every day for ordinary activities. Why harm your back and miss free exercise for your legs hundreds of times a day?

Most people know and repeat, "bend your knees" if you quiz them on healthy bending. Bending knees slightly, as in the above photos, does not make bad bending healthy. Bending over forward pressures your lower back discs, whether your back is rounded (photo above left) or straighter (above right). You are still bending over and the leverage point is your lower spine. Bending right is simple:

• With feet side-by-side, comfortably apart, bend knees, keeping your torso fairly upright - as if not wanting something to fall from a shirt pocket (right drawing).
• Keep both heels down and shift your weight back to your heels.
• Pull your knees back over your heels. Don't let them droop forward under your body weight. When you shift your knees back, you will feel the effort shift away from your knee joint to your thigh muscles.
• Don't stick your backside out or exaggerate the lower back arch.

Unless you are moving in healthy ways for your real life, it is not a lifestyle and it is not healthy. Healthy bending is easy and life changing. It is free exercise and injury prevention. When should you do it? Each time you want your daily life to be healthy.


To Be Healthy:

The post Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending shows exactly how to make good bending a healthy normal part of your daily life for the hundreds of times you bend.

More photos and description of bad sitting and bending that causes back and disc damage and what to do instead - The Cause of Disc and Back Pain

Check the exercises you do for the same body positioning that would be recognized unhealthy if they were not renamed "exercise" - Are You Making Your Exercise Unhealthy?

Photos of readers using these practices in daily life - Household Fitness in the New Year

Click the labels under this post for all Fitness Fixer on each topic.

Books showing step-by-step good bending and getting built-in lifestyle exercise: Fix Your Own Pain Without Drugs or Surgery, and Health & Fitness in Plain English THIRD edition on my web site books page - www.DrBookspan.com/books.

---
Read success stories of these methods and send your own. 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, take a Class, get certified - DrBookspan.com/Academy.
---

Photo by Healthline reader
Drawing of Backman!™ © copyright Dr. Jolie Bookspan

Labels: disc, fix pain, hip stretch, injury, knee, leg strength, leg stretch, lower back, posture, practice of medicine, squat, upper back

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Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs

Tuesday night my martial arts students showed they had improved. When I came in they were waiting in two neat rows. I still had to cue them to sit up straight.

In the post Is Bad Martial Arts Good Exercise? I mentioned showing the class not to let their neck, back, and hip round forward when kicking. By straightening, strength and stretch are built into regular movement.

Several readers e-mailed me that they noticed for the first time that they let one leg pull forward when lifting the other (notice the standing leg in the left-hand photo, at left). They said they felt a good difference when they straightened (right photo).

If the front muscles of your hip are tight, when you lift one leg high you may find that you round your back and bend the other leg. Watch for this during kicks in martial arts and aerobics, when lying on your back raising one leg overhead to stretch the hamstrings, and ascending stairs. The common practice of allowing the other leg to bend forward perpetuates a tight anterior hip, which in turn, contributes to walking bent forward and back pain.

In martial arts, you don't want your standing leg completely straight. That is an invitation for your opponent to kick your knee, snapping it backward. But for both health and effective martial movement, you don't want to bend the leg more than a small amount. Bending the back, hip, and leg when kicking decreases force of the kick, pressures your discs, and reduces stretch on the hip and hamstrings. The rounded-under hip position keeps the hip tight, a hidden cause of groin pulls. It also looks weak and unskilled. For lying hamstring stretches with one leg overhead, it is often taught to keep the second leg bent to "protect the back." However, keeping the leg (and body) flat on the floor give a far better stretch and is healthier for your back. Even in slow easy motions of stair climbing, leaning forward and allowing the second leg to pull forward reduces the normal hamstring and hip stretch, decreases the exercise on your hip and leg muscles, and reduces the back muscle activation for holding the straight position you need for health and back pain prevention.

It is said the martial arts gives you discipline and strength. It won't if you practice unhealthy habits. When raising one leg, hold your neck and back upright. Prevent the other leg from pulling forward. You will get a built-in hip stretch, one of the places you need to stretch most. You will get back and hip exercise in the way you need to move in real life, and prevent tightness and weakness that leads to poor movement and pain. You will change from kicking like a bent over old lady to a young strong athlete. Exercise as a lifestyle is not something done "for body parts." It is built into your normal movement to make it healthy movement.


Photo (and more healthy techniques) from the book Healthy Martial Arts

Labels: achilles stretch, balance, chest, disc, hamstring, hip, hip stretch, knee, leg strength, leg stretch, lower back, martial arts, neck, posture, stairs, strength, stretch, upper back

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Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

My Tuesday night martial arts students had another good class tonight. At the beginning of class, I showed them how to greatly strengthen their punch using a technique that also stops a common cause of lower back pain. The reason both benefits occur from one technique is that it changes body positioning to shift the effort and leverage of the punch off your lower back and onto the muscles of your abdomen and back. You can use this technique any time you punch, or push anything from a baby carriage to a piece of furniture to a car.

One of the commonest misconceptions in fitness is that you are supposed to stick your behind out in back. It is not cute or healthy. It is a major source of pressure on the joints and soft tissue of your lower spine.

There is supposed to be a small inward curve to the lower back for shock absorption and protection of the discs. (But only a small curve.) When people lose the needed small inward curve by rounded forward sitting, standing, and bending over wrong, it pressures the discs and eventually damages them (Disc Pain - Not a Mystery, Easy to Fix). The problem is that people hear they need a small inward curve, so they make a big one by tilting their hip and/or leaning their upper body backward. This overarches their lower back. You can see this silly-looking and unhealthy over-arching in many fitness classes and gyms, and fitness publications and videos.

By straightening your hip, you will have the healthy small curve without sticking your behind out in back. When standing, your hip should be vertical, not tilted, from the top of your upper leg bone to the middle-point of the crest of your hip. To reduce the large lower back arch, tilt your hip under you as if you are starting an abdominal crunch while standing up. Do not push your hip forward, just straighten your back by changing the hip angle. This is called a pelvic tilt. This is what we did in class. Try this:

• Look at the double photo above left, and stand facing a wall as in the photo, with one arm outstretched. Put the knuckles of your curled fist against the wall as if you had just punched the wall. Elbow slightly bent.
• Stand badly, as shown in the left-hand photo. Stick your behind out in back. Let your lower back arch inward. Let your upper back lean backward. Press your fist hard into the wall. You will probably feel pressure in your lower back.
• Now, keep pressing your fist hard but stop the bad positioning by tucking your hip under you, shown in the right-hand photo. The movement is like a hip thrust or a standing crunch. The arch in your lower back reduces.
• The first thing you will notice if you do this right is your back stops hurting. You should also notice a stronger push against the wall and new strength in your arm and upper body. You will feel the muscles in your trunk and abdomen working.

I developed this technique and called it The Ab Revolution, because it uses your ab muscles all the time for real life. Don't stick your behind out to lift weights, to exercise, or to stand and walk. Use your muscles to position your spine so that your weight does not sag on your lower back. You will get free built-in exercise and back pain prevention while doing all your normal activities. You will stop one of the commonest silly-looking mistakes in fitness. You will also be able to throw a surprisingly strong punch.


Photo from the book Healthy Martial Arts

Labels: abdominal muscles, arm, fix pain, hip, knee, lordosis, lower back, martial arts, neutral spine, posture, strength

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Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending

If you think that not having time to exercise is the problem, here is good news. Thinking that your life and your health are two separate things is the problem. You don't have to stop your life to get exercise.

The last post explained that you bend many times every day as part of normal life (How Good Would You Look From 400 Squats a Day - Just Stop Unhealthy Bending). This post shows one way to do healthy bending when you are bending with feet side by side - the squat bend.

Look at the drawings, above left. The left-hand drawing shows bad bending - letting weight rock forward, heels lifting, and overly arching the lower back. The right-hand drawing shows healthy bending - keeping weight back, heels down, and the lower back in healthy position, not rounded and not overly arched. Look at the right-hand drawing and try it:

• Keep your upper body as upright as you can, instead of rounding over forward
  
• Keep both heels down as you bend your knees (right drawing).
• If you find you lift your heels, use your leg muscles to deliberately pull your knees back so that your weight shifts back over your heels. Shifting your weight back keeps your weight on your leg muscles and off your knee joints. There should be no knee pain with good bending.
• Keep your knees back toward your ankles. If you just let your weight flop, the knees will come forward past your toes. Don't allow your knees to shift forward.
• Don't overarch the lower spine (overly sticking your behind out in back). Keep neutral spine. If you overarch, tuck your hip (tailbone) under you just enough to prevent having a too large arch (inward curve) in your lower back. Although it is often taught in exercise and weight lifting classes to stick far out and overarch, increasing the arch increases pressure on the joints of your vertebrae, called facet joints, and the soft tissue of your lower back. Overarching is a major hidden cause of lower back pain and injury.
  

Use good bending every time you bend - even to look in the refrigerator and get in and out of your chair. Don't use your arms to lean on the arm rests to sit down and get up; use leg muscles. If you need to use your arms, or you lean your body forward to sit or rise, you need to improve balance, Achilles tendon stretch, and leg strength. Bending properly does all that for you. (Practice safely. Don't fall down.)

Have a friend (or a camera set on timer) take photos of you from the side as you stand and bend, showing how you fixed your bending from unhealthy to healthy during whatever you do all day for work and at home. Write a fun summary and e-mail your photos and stories to me. If you can, put the photos on a photo sharing site. That is easier for me to retrieve and post on Fitness Fixer. I can put the best photos and most fun stories up in lights.

Realize that a big part of your health is the way you move in real life. Make a conscious decision to change your idea of exercise, fitness, and health from stopping life to "do exercise" to how you live. Have fun - the best health.


More:

• Fast Fitness - Count How Many Times You Help Or Hurt Your Body Daily
• Readers Count - Second Missed Cause of Back Pain With Golf
• Household Fitness in the New Year

Labels: abdominal muscles, achilles stretch, disc, facet joints, fix pain, hip, knee, leg press, leg strength, leg stretch, lordosis, lower back, neutral spine, posture, squat, strength, upper back

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Is Bad Martial Arts Good Exercise?

This week marked several beginnings. The equinox began the journey of the sun away from the northern hemisphere bringing longer nights. The festivals of Ramadan, St. Sophia, Navarati and others celebrate origins and understanding. The university semester began, including the full-to-capacity martial arts class I teach on Tuesday nights at Temple U's Center City campus.

When I arrived, students were sitting on the floor waiting. Some sat in bad rounded posture that you know is unhealthy at your desk. They straightened when I asked them to. In past semesters there were students who refused. Once, one stormed out shouting she didn't understand why she had to sit straight when class hadn't started yet. She didn't know that class is always in session.

Students got their equipment - bending wrong to yank weights out of bins. I told them, "Healthy bending. This class is for health." Some didn't understand the connection. Others tapped those still bending wrong, "Teacher says bend your legs." Several looked surprised. One said, "I'm getting leg exercise before class even begins." I told her that class is always in session. I reminded students to use healthy bending at home and work for every time they bend (Disc Pain - Not a Mystery, Easy to Fix). I showed them how to get more exercise by helping others who came in late.

We began stances. Students sometimes have a stereotyped idea, sometimes learned from aerobic boxing classes. They stand with shoulders hunched up, upper back rounded, head and chin jutting forward, and their behind tilted out in back. I mimicked them. They giggled at how bad it looks. I told them, "You don't look tough. You look ninety." It's true that you use shoulders to block some strikes, but you are not supposed to hunch. Don't do things to harm your neck in order to protect your neck. Overarching your lower back so that your behind tilts out in back is a frequent cause of back pain in daily life (Fixing the Commonest Source of "Mystery" Lower Back Pain) and injury when giving or receiving a blow. It's silly to go to boxing class and beat up yourself.

Look at the photo above. It shows terrible positioning that injures, and perpetuates the tightness that causes more troubles. When you lift one leg to kick (or stretch or take the stairs), notice if your other leg pulls forward. That shows tightness in the front of your hip. Instead, stand straight and keep the standing leg from pulling forward. Don't round your body to lift your leg. You will get built-in anterior hip stretch, one of the places you need to stretch most, and prevent several problems that I will cover soon.

The point of exercise is to improve life. It is missing the point to exercise in unhealthy ways, training unhealthy habits. If you are interested in learning how to retrain healthy movement in martial arts or aerobic boxing classes that you transfer to daily life, let me know and I will post more on what my students learn.

Book:

• Healthy Martial Arts - www.DrBookspan.com/books. Winner of the Black Belt Hall of Fame Readers Choice Award.

Labels: hamstring, hip, injury, knee, leg strength, leg stretch, lower back, martial arts, neck, posture, shoulder, strength, stretch, upper back

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Disc Pain - Not a Mystery, Easy to Fix

Discs are tough cushions between your spine bones (left-hand drawing). They are living parts of your body. When you bend forward, the front of your vertebrae (back bones) squeeze closer together. The space between the back of each vertebrae opens. After many years of bad habits of sitting rounded forward, bad bending over forward, and stretching by bending over forward, the discs are forced backward, like squeezing the front of a water balloon (right drawing above). They begin to break down (degenerate) and move outward to the back, also called slip or herniate. Herniation can continue over years until it suddenly causes back pain with one more bad bend, until the disc moves backward enough to touch the nerves going down your leg causing sciatica and other nerve pain, or even press on your spinal cord. This is avoidable and easily reversed.

Discs can quickly heal without surgery, if you change your bending and sitting habits in simple, healthy ways:

1. Sitting. When you sit, don’t round your back. You don’t need an expensive ergonomic chair. No chair makes you sit right. You just use your own muscles to sit right. Make sure you don’t tighten and strain to sit straight. Pull your chair in closer to the desk, and lean your upper back against the seat back. Don’t round forward or push your lower back against the seat. Many seat backs are rounded so that you have to sit poorly if you rest your back against them. Don't let this happen. I will write more about healthy sitting in future posts.

2. Bending. The average person bends hundreds of times every day for daily activities like laundry, kitchen, pets, gardening, children, household chores, and everything else. Check to see if you are bending badly each time, hurting your discs. Check at the gym if you add more forward bending for toe-touches, weight lifting, and exercise class. The post Are You Making Your Exercise Unhealthy? shows some easily missed sources. The post Common Exercises Teach Bad Bending shows more. Bad bending puts herniating forces on your discs hundreds of times every day. No wonder your back hurts.

Here is one way to get healthy built-in leg exercise and stop back pain by bending well for every time you bend to reach things very day:

• Stand with feet side by side, comfortably apart.
• Bend both knees. Keep both heels down touching the floor.
• Keep your upper body upright, as if you don’t want something to fall out of your shirt pocket.
• As you bend lower and lower, peek down and make sure you can see your toes. If you can't, that means you are letting your knees come forward, which shifts your weight to your knees.
• Keep your knees back over your ankles to keep your weight on your leg muscles. Many people won't bend with their knees because it hurts their knees. This good bending stops knee pain too.

With healthy bending habits, you get free exercise hundreds of times a day, strengthen your legs, stop knee pain, and let your discs heal, all at the same time.

Many Fitness Fixer posts tell more about the large contribution of good daily bending, sitting, and moving habits to healthy lifestyle and stopping the source of disc injury. Click the links in this post for more examples and information. Click the labels under this post for all Fitness Fixer posts about that topic, for example, for good bending, click "squat" and "lunge," for healthy sitting, click the label "sitting." For all posts explaining discs or sciatica and how injury occurs and can heal, click those labels.

Labels: disc, fix pain, injury, knee, lower back, lunge, sciatica, sitting, squat, strength, upper back

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What is "Fitness as a Lifestyle?"

To many people, fitness means stopping your "real life," changing clothes, driving somewhere else, and doing uncomfortable things without similarity to movement in daily life. Then they go back to "real life" - slouching, bending wrong, walking heavily, sitting rounded, leaning back to carry packages, taking elevators, and avoiding movement.

At the gym, people do squats with a trainer, paying to learn proper form and upright back, then bend over wrong to put the weight down when they’re finished. They do proper lunges for their legs in exercise class, then bend over wrong without using their legs to pick up their things when they leave. They work with weights to isolate arms but never learn how their entire body stabilizes a weight, then hurt their back opening a window at home. They work on a treadmill or elliptical trainer but sprain their ankle when out walking because they haven't trained balance and stabilization. They sit hunched in bad posture waiting for exercise class to start. In modern life, exercise is something you go and specially "do," then destroy and ignore your health the other 23 hours a day. Fitness has become “fast food” – stripped of value, sweetened up, and mass produced, even when unhealthy.

Changing your real life into healthy movement is a big and inspiring area of rethinking and retraining. Instead of sitting slouched then stopping to stretch because your back hurts, sit and stand well so that you do not get stiff and sore in the first place. Instead of lifting packages, babies, groceries, laundry, and everything else wrong all day, then stopping to do back exercises because your back hurts, lift properly. I will show you exactly how in posts to come. You will get built-in exercise, strengthen your knees, and save your back. You don’t need to go to a gym; move, balance, and reach in healthy ways in order to do your real life. Instead of thinking you must stop your life to get health and exercise, fill your life with built-in healthy movement.

Photo: National Cancer Institute, Linda Bartlett (photographer)

Labels: aging, ankle, balance, children, fix pain, injury, knee, lower back, lunge, nutrition, performance enhancing modality, posture, practice of medicine, sitting, spirit, strength, stress, stretch

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Welcome to the Fitness Fixer

A recent injury survey by US military revealed that 62% of American injuries in Iraq are occurring in the gym. The same is happening at home. How can this be? Several things are happening. Just as not every medicine is healthy, not all exercises and stretches are healthy.

Just as smoking "works" for weight loss, but is not a smart or healthy way to do it, many exercises "work" for cosmetic results, but result in long-term injury, and promote bad movement habits. Other common exercises don't work your body the way you need to move in real life, resulting in strains and injuries when going about daily activities.

This Fitness Fixer blog will show you hundreds of simple ways to change your exercises, stretches, and daily movement, to make them fun, healthy, and the way you really need to move for healthier daily life. In my laboratory research in human physiology, and my sports medicine clinical practice, I see patients every day who are hurting and unhappy, despite all the exercise and fitness they do. Many of my patients are yoga teachers and Pilates teachers with back pain, hip pain, and neck pain. I see personal trainers with herniated discs and knee pain. I see body builders with back pain, despite all the abdominal exercises they do. I see patients, including fitness instructors, who aren't getting more flexible no matter how much stretching they do. I see people who are stressed, tired, achy, and not in shape, even though they spend hundreds of dollars a month on supplements and pills, gizmos, equipment, trainers, and classes. The answers are simple, and this regular column will cover many easy changes you can make so that your fitness becomes not only more effective, but fun and healthy.

Labels: abdominal muscles, disc, fix pain, injury, knee, lower back, nutrition, practice of medicine, spirit, strength, stress, stretch, yoga

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