The Poor Knee. Caught between a Rock and a Hard Place

imageI’m sure sometimes the knee just wants to give up! Think about it. It’s designed to be primarily a hinge joint, like the hinge of a door functioning mainly in opening and closing. What happens if the door hinge is crooked? It means something shifted and is no longer aligned properly. The door might begin to rub on the top or bottom depending on how it’s hanging right? Or possibly the hinge itself will wear out from the stress and break! Like the door our knee is designed to mainly open and close or as we say flex and extend or you might say bend and straighten. This works great if the leg is straight such as in walking a straight line. What happens when we cross our legs or need to make a turn to go somewhere? That movement requires pivoting which comes mainly from the hip socket and even from the ankle. Those joints are built for multiple directs, 3D!

The knee is caught between a rock (the ankle) and a hard place (the hip)  with nowhere to go. The lower portion of the knee (tibia) is dependent on the ankle to tell it where to go. If the foot wants to support the body to squat down to sit in a chair the ankle has to bend and the knee must obey. Just try to stand and bend your ankle without bending your knee! Impossible!

The upper portion of the knee (femur) relies on the powerful 3 dimensional ball in socket hip to tell it what to do. In the same squat analogy to sit down the hip has to bend and roll backwards. Try to do this without bending the knee! Ha. Now you just look funny!

So it’s fair to say that the simple act of sitting in a chair requires good communication between the hip and the ankle with the knee as the in between, monkey in the middle! One false move on anyone’s part and the knee gets it!  The more complicated the move the harder it is on the knee if the other parts aren’t doing their job. Most of us have experienced tightness in the legs or stiffness in the joints. What can you do about it? How can we train the knee to be ready for all of these movements?

Like everything else you’ll learn from me there is a way to help these movement patterns and that is through 3 dimensional training using lots and lots of repetitions throughout the day to create Muscle Memory!!

Here’s a few pictures of some athletes in action showing just how much our knees actually do move and why it’s important the hip and ankle are ready for action. There is one picture that shows an injury occurring that maybe could have been prevented with this type of training and there is one pic that, well, you just cannot prepare for! Ouch! Can you find them?

A video to follow will give you the start of an exercise matrix that is designed to prepare you body for movement in all directions. We use arm movements to drive the hip and knee into a change of direction. It’s in the deceleration part of the movement where the most benefit takes place. If we can control our slowing down of a movement and control a sudden change in direction then we are well prepared and at less risk of injury.

Try performing these steps with each leg without the arms, then add the arms moving in the same direction as the leg (in sync), then opposite directions (out of sync), then try it at different speeds, then try it with a 5lb medicine ball and so on with your own creativity. It seems simple but sometimes that’s what we need! You may be surprised at the results though. Enjoy!

3D Warm Up and Flexibility – Lower Body

elephant-balance-300x199The following  video demonstration shows a simple warm up for the entire body which allows communication between all joints from the ground up. It is important to establish this communication of movement to the muscles so that they become aware of the action the body is about to demand on them. Remember from our previous post about Balancing the Hip that the joint commands the muscles so why would you just do a static hold of a stretch for 30 seconds or so as a warm up? Doesn’t make sense now, right?

The second half of this short clip will show you how to warm up the back hip (hamstring, glute), front hip (hip flexor, quad), side hip (adductor, IT band) and ankle (calves, achilles). Some important things to note about these movements:

  1. The movement is full body, meaning that as you move it should start at the ankles and move up through the hips into your upper body. The communication between joints connecting as a chain is the key to proper flexibility. A restriction in one area can lead to compensations in others.
  2. Perform the warm up on both sides! If the demo shows the right foot forward be sure to do the same moves with the left foot forward.
  3. Avoid the Cheat! During what I call the ‘Stride Warm Up’ I will often instruct the athlete to hold an object overhead such as a baseball bat, golf club, Lacrosse stick or any straight item. This helps to improve the quality of the warm up by the unavoidable ‘cheats’ the body may try if, say, the upper body tension is preventing a full body stretch you might see an arm drop in compensation.
  4. Power in the Pelvis! Remember that the hip is a ball in socket joint where the ball is the top end of the femur bone and the pelvis has the socket part. When trying to warm up the HIP we are fixing the ‘ball’ in place and moving the ‘socket’ around it. So, don’t just move your arms in the directions you see, be sure to let the pelvis lead the way. I tell people to use their belly button as a guide.
  5. Kneeling before Standing. In the demo you will see the same movements performed kneeling then again standing. When starting out with 3D hip flexibility it is best to eliminate any kind of ‘cheat’ the body will look for. If we take away the knee as compensation we will allow the hip to achieve more range of motion so start with the kneeling ones until you can feel the proper warm up in the right places. You’ll begin to see how many knee injuries can be avoided by simply allowing the hip to do it’s job. More to come on KNEE safety!
  6. Speaking of safety PLEASE, if you feel pain when performing these movements consult with your movement specialist physician before continuing.
  7. m&m Principle applies! The more often you perform these movements the easier your body will remember them and the more efficient and reproducible your movements will become. More is better! Move Better. Perform better.



Balancing the Hip

hip balance

Are your Hamstrings tight?

Ever been told that your Hip Flexor needs stretching?

Suffering from IT Band Pain?

Have you stretched and stretched and foam rolled and tried therapy only to end up with the same problem of feeling tight and stiff?

If you answered yes to any of these questions then your unbalanced hip might be the culprit.

The hip is considered a ball in socket joint which means it should roll in all directions, forward and back, side to side and rotate out and in. If it does then that means you can handle a change in direction while you are in motion. Ever turn around quickly because you forgot something or someone called your name? If it happened without incidence then you have a balanced hip to thank. If you are an athlete running down a court or field and have to make a cut to the side to avoid your opponent and did so without error then your hip is likely well balanced too. But if you are like many of us the hip joint is the most common to become stiff and tight therefore restricting it’s movement.

I describe the communication between joints and the muscles that move them as the joint being the Commander in Chief and muscles being the obedient soldiers. If the joint has trauma or inflammation in or around it then it will command the muscles around it to protect it at all costs. This means that we can stretch that muscle all day long and it won’t release because it’s doing it’s job of protecting. Joint inflammation can come from overuse or disuse such as prolonged sitting or of course trauma. The key to getting the muscles to relax is to treat the joint first. Sometimes ice and medication just doesn’t work and it simply needs to be coached or taught again to move slowly and gently in all directions. We call this 3D or 3 dimensional flexibility training. If you can gently get into a traditional stretch, say of the hamstring in the back of the thigh, and begin to move your hips in different directions side to side or turning your body each way while in the stretch you will begin to feel the muscle slowly letting go. It’s because the joint is realizing that you want it to move while the muscle is trying to stretch. The ‘soldiers’ are reporting back to the ‘commander’ that all is clear and it’s ok to move out again. This 3D flexibility can be applied to all muscles and traditional stretching patterns. It should be pain free except for the tolerable feeling of the stretch. Some people can tolerate more than others but it is NOT a no pain no gain concept!

Remember that to really gain long lasting flexibility you must create Muscle Memory (m&m)! This occurs by frequent repetition of the movement pattern sooooo……IT’S BETTER TO PERFORM THESE MOVEMENTS FOR 10 SECONDS 20 TIMES PER DAY THAN ONE SESSION FOR 20 MINUTES!!!! More is better!

Perfect balance around a joint allows for efficient movement and maximal strength. What does it mean to have perfect balance? Don’t worry it doesn’t mean you have to stand on one leg while sitting in an imaginary chair, although that is pretty impressive. A balanced joint means that the tensions around the joint are equal and the range of motion of it is maximal in all dimensions. That seems simple but trust me it is less common than you think.

Your first step in gaining a balanced hip is to perform the 3D movement pattern (stretch) for each muscle surrounding the joint. Start with the larger ones like the hamstring on the back side, hip flexor on the front, ABductors on the outside and ADductors on the inner thigh. Use the principles of 3D movement described above to the stretches you already know for these muscles and you will be well on your way to moving better and performing better!

Getting Back in the Game

Popular phrase, ‘Getting back in the Game…”. It can mean so many things to different people. Are you literally getting back into a sport after an injury or season off, getting back into the workforce or getting back into the game of life? No matter what it means to you the common thread to all is that you were once “out” of something and now you have the desire, the “drive” to get back “In”. It’s that drive that I want to discuss here.

Webster defines the word ‘drive’ as ‘To direct the movement of…’. Movement means a change in direction, a shift. When we desire to move in a different direction than where we are it usually means we are sick and tired of where we’ve been. This is true for me in regards to wanting to create a shift in the thinking of how to keep our bodies moving so we are never out of the game. I’m calling it The m&m Movement!

m&m stands for Muscle Memory. The old saying of ‘if you don’t use it you lose it’ stands true. Wouldn’t it be nice if every game we played as an athlete was our best, we were in the zone and it felt so easy?  What if we had grandchildren and couldn’t play with them on the floor because we just can’t get up very easily anymore? Or if we had an injury or surgery and the doctor told us we couldn’t exercise anymore or limited our activity that was fun? How can we fix this?

We can start by understanding movement patterns essential to daily living. Next we learn about creating a memory of that pattern so it becomes easy, effortless.

Our earliest movement patterns started as infants. We first learned to roll over. Rolling over taught our core muscles to fire as our arms and legs were in motion. We knew without anyone telling us that in order to one day stand and walk we must develop these muscles and movements first. How many of us have complained of aches and pains when rolling over in bed today?? Could this be a lost movement pattern for you? If we can’t roll over easily how do you think we are walking?

Next we learned to sit up.Have you ever looked at the perfect posture of an infant just learning to sit all by itself? Now look in the mirror at your sitting posture. What happened!? Again as infants we are demonstrating the need for a stronger core to accomplish these more complicated acts. The balance it takes and strength in our spines to be able to hold this posture for long periods of time. What happens when we fatigue? Even as infants we end up face first in a plate of mashed potatoes! As we age though and our bodies become more and more imbalanced and we become more dedicated to our work or social media or computer blogging we learned not to flop but to slouch. We could learn alot from our infant nature….when you’re tired take a rest! Well, not in your mashed potatoes of course!

What comes next? Oh, yes, the arduous task of going from sitting to standing! Now, this can be quite comical to observe even in the infant as they try continuously to succeed despite many failed attempts. But if you watch closely they eventually end up in a squat position. A perfect squat at that! The balance in the foot and ankle coordinating with the hips and glutes telling the core to get ready because I’m about to get taller here and I need you to support me. The arms kick in for assistance until the core realizes what is happening and voila! We stand!!! What an effort by an entire team of participants. Great work guys! Probably the most important movement pattern learned for us functioning adults. If we lose the ability to squat and stand how can we expect to walk efficiently let alone run?

All of these early development patterns are essential to our daily life. The order in which we learned them and the amount of repetitions in took to get us there is key. Movement efficiency is the reason children don’t typically complain of body aches and pains. What happens to us as we age is that we stop performing the essentials and become imbalanced with the demands of the world. Even though our bodies were designed and developed to move in multiple directions, 3D if you will, our environment demands only one in many cases. For starters we only walk in a forward direction, lift objects in front of us and typically move in the same direction day in and day out. Think of how you get out of bed the same way, walk the same path to the bathroom, kitchen and car. The way we sit at a desk and get up is all the same. These patterns become very efficient, a no brainer. Yet what happens if we suddenly have to move in an opposite untrained direction? Muscle pulls, pain, stiffness all can be felt because we lost the balance  in our system.

Thank about our perfect developing bodies as children running, skipping, jumping in all directions. Just try to catch us. Then by age 5 we are told to stop moving, sit in a desk for 6 hours at time then a bus and then home for more sitting with homework and dinner and then bed. Wow! What a change in lifestyle and shock to our system. Unless we exercise specifically to balance these unavoidable circumstances we will become inefficient movers, stiff, achy and at risk for injury.


This blog is a way for me to educate you on exercises that promote efficient movement and also share with you some success stories of patients that I’ve helped with conditions you might know or have experienced yourself. If you have a topic you’d like me to discuss just send me a mail and I’d be happy to oblige.

Thank you for being part of The m&m Movement! Let’s Get Back in the Game!