Category Archives: Aging and Exercise

Common training troubles – Knees

After my last columns on the problem areas of the lower back and shoulder, I couldn’t decide what should be number three on my list of common training troubles. One of my clients helped me to decide that knees should get the nod.

A year ago Wayne Deans’ right knee was swollen, painful and debilitating. After an MRI his doctor told him he had no cartilage left on the joint surfaces, and he needed joint replacement surgery. I’m going to share how he’s been able to avoid surgery so far, and at 66 years old, is currently very active and 100% pain-free.

The knee is a relatively simple hinge joint, but it does have its share of problems. Because of the amount of stress we impose on our knees through weight-bearing activities like running, cycling, golf and skiing, the internal structures of the joint can become damaged and worn. This leads to painful, progressive conditions like arthritis. In Wayne’s case, years of high-level competition in hockey, squash and triathlons had taken their toll.

In addition to wear and tear, acute knee injuries are common. Torn cartilage or ruptured ligaments can happen to anyone, at almost any time, and will often need surgical repair. I’ve had a major knee reconstructive surgery myself, as a result of a soccer injury. It was performed 25 years ago by Dr. Brian Day, and because I saw the top surgeon and was diligent about my rehabilitation, the knee has been 100% functional since.

In the case of Wayne, myself, and dozens of other clients, the most important aspect of managing knee injuries is to minimize the stress to the joints through proper body position and movement strategies, while optimizing strength and flexibility in the legs.

Always remember to perform a progressive warm-up before training or sports, and get medical approval before beginning a new fitness program.

Knowledge – It’s pretty hard to address a complicated, painful joint condition without knowing exactly what is causing the problem. A good practitioner can often accurately diagnose a knee condition through a detailed history and careful assessments, however appropriate imaging like X-ray or MRI is sometimes necessary. Once you’ve determined the cause, an effective management strategy can be put in place.

When I first injured my own knee, the sports medical practitioners in my hometown put me through almost 6 months of passive treatment, like ultrasound, etc. Every time I would try to play sports I would re-injure the knee and it would swell up like a balloon. Finally I came to Vancouver to see Dr. Day and in 2 minutes he told me that my ligament was ruptured and I would need surgical repair. All the therapy in the world wouldn’t have made a difference. The right diagnosis was essential.

 

Treatment – Just like the other areas that I’ve discussed, if you do have a knee problem, whether acute or chronic, try to get an assessment and treatment by a qualified practitioner that you trust. Once you’ve learned the cause of your issue, I’m going to bet that a good portion of your treatment plan will include strengthening the muscles that support the knee joint, and stretching the muscles that surround it.

Even in a condition like Wayne’s, where the joint is seriously worn and the bone-on-bone contact is causing pain and inflammation, a simplified approach of improved strength and flexibility can yield great results. Where he used to have a 6-8” deficiency in the flexion of his right knee, Wayne has worked hard to achieve full range of motion, getting his heel to his buttocks. We’ve also re-programmed how he stands and moves to properly utilize his muscles and joints. Through a combination of better body position, core function and movement quality, Wayne now uses the correct muscles, which keep his knees healthy rather than harming them.

Prevention – What can you do if you’ve never had a serious knee issue, and want to avoid them? As far as I’m concerned maintaining strong, flexible legs should give you the best chance of living your life with healthy knees. Of equal importance is making sure you move your body in a way that doesn’t cause wear and tear. I’ll use Wayne as an example again. As part of my assessment I determined that every time Wayne transferred his weight onto his right leg, his glute and hip musculature was less active than it should be. This allowed his pelvis to slide too far outward, rather than staying in line with his body, and put too much weight forward onto the ball of his foot. This shift of the pelvis off-loaded his strong, stable hip joint and transferred excessive load and rotational stress to the knee joint. Every step was aggravating his knee. Changing this pattern has been a big part of his success.

Active Gardener-Strength Exercises

It’s been another excellent weekend, and I’m sure many of you have put in more long hours in the garden. I’ve talked with my neighbor, and exercise model Marg Tingley and I know she’s been regularly performing the exercises I showed her. It won’t be very long before she’s feeling the benefits.

As discussed in last week’s column where I focused on flexibility, it’s also very important to make sure that your muscles are strong to help stabilize your joints and make every movement you do easier and less stressful on your body. If every bend, squat and lift is easier, imagine how much more energy you’ll have left over after a day of working in the garden, playing sports or performing other favorite activities.

Muscular strength and endurance can be developed in many ways, and you certainly don’t need to go to the gym to build up your gardening muscles. It was easy to come up with a number of great exercises for Marg that used objects found in most yards or gardens. The important thing to remember when you begin to strengthen your body is to use common sense and pay attention to your body position and joint alignment. For example, you don’t have to be a kinesiologist to know that your knee joint is supposed to hinge forward and backward, and shouldn’t really be twisting or bending sideways. When you do your leg exercises, or when you move around in your daily activities, try to keep this in mind.

Following are 3 good strength exercises you can do in the garden on a daily basis. I’ve chosen exercises that will engage the upper and lower body, and also involve the core muscles. Always consult your physician before undertaking a fitness program or making changes to your current routine, and remember to do these when your body is properly warmed up.

Chair squat

When we don’t use our muscles, they atrophy and lose strength quite quickly. The silver lining is that the muscles bounce back when you start using them again. If your legs have lost muscle mass and don’t feel as strong as they used to, rest assured that regular strengthening exercises will bring quick results. A simple exercise that uses many of the muscles of the lower body is the chair squat. Stand with your back to the chair, and your feet about shoulder width apart. Initiate the movement by reaching your hips back as if you were about to sit down. Keep your feet flat on the ground and your knees aligned over your toes as you slowly lower your hips. Hold your arms in front of you to help with your balance, and keep your core engaged to protect your lower back. Go down about half way to the chair, pause for a moment, then return to the top position. Repeat this for 3 sets of 15-20 repetitions. If this is too easy, go a little lower the next time. If you get pain in your knees, try to limit the movement to a pain-free range of motion. Breathe comfortably throughout the exercise.

Front raise

To strengthen many of your lifting muscles, including your spinal stabilizers, find a small plant, or other light object that you can lift. Hold the object with both hands in front of your body, and stand in a strong, balanced position with your hips and knees slightly flexed and your body slightly forward. Keeping your core muscles engaged and your head and chest upright and in good posture, slowly raise the object in front of you at arms length. Try to extend and lengthen through your upper spine to reverse the effects of ‘stooping’ when you’re gardening. When the object has reached the height of your chest, pause momentarily and lower it back to the bottom. Perform 2 sets of 10-15 repetitions. Try to keep your shoulders back and down throughout the movement.

Wallclimber

This full-body exercise is excellent for developing core control when you’re crawling around on your hands and knees in the garden. Start by finding a low wall or railing and lean forward onto your hands. Keep your body in good alignment with your core system engaged. You should be leaning far enough forward that you can feel your body working to hold itself in position. Starting with your feet close together, bring one knee up toward your chest, trying to prevent your pelvis from twisting or shifting at all. Switch legs, and repeat for 20-30 repetitions. The further forward you lean, the more stable you keep your body, and the wider you position your feet, the more difficult the exercise. Be constantly aware of maintaining good posture and core stability. Eventually you’ll be strong enough to do this with your hands on the ground!

Rob Williams is a kinesiologist, elite personal trainer and posture specialist. He has been practicing for 20 years and currently operates an exclusive private training studio Mixx Fitness Studio, with a team of 10 trainers, as well as a multi-disciplinary posture facility, Performance Posture Clinic. Rob’s parent company is Williams Health Group. Rob is an accomplished writer and speaker in the fields of fitness, posture and nutrition. He is a sought-after posture and performance coach for professional and amateur athletes and celebrities.

Active Gardening Flexibility

Most homeowners take advantage of warm, spring weekends to get out in the garden and get started on the yard work. This weekend was perfect for pruning, cutting and trimming, and I’m sure there were a lot of people bent over in their gardens, working away and using parts of their bodies that haven’t been used for the last few months.

This weekend I got a nice email from my neighbor and close friend, asking if I could write a column for elderly people like herself, who struggle with knee pain and back pain when gardening. Marg has had one of her knees replaced in the past and has noticed that every year she starts the gardening season with a little less strength and mobility than the previous year. This usually leads to progressively more knee and back pain throughout the spring and summer.

With activities like gardening and landscaping there is a lot of forward bending and lifting. To handle this stress, it’s vitally important that the knees are healthy, the legs are strong, and the back and core musculature are functioning properly. I explained to my neighbour, Marg that as her legs become weaker she won’t trust them as much. When she needs to crouch or bend she will default to using use her back. Gradually her leg muscles begin to tighten, reducing flexibility around her hip and knee joints. Less strength and flexibility in her legs eventually results in more stress at her knees and spine.

Following are 3 good stretches you can do in the garden to help your knees and spine. Next week I’ll discuss strengthening activities. Always consult your physician before undertaking a fitness program or making changes to your current routine, and remember to do a proper warm-up.

Hamstring Stretch

If your hamstrings are too tight, they’ll constantly pull down on the back side of your pelvis and put tension across the back of your knee joints. As you try to bend forward in the garden, this will prevent your pelvis from tilting forward and will cause you to bend excessively through the spine. Marg has noticed that this has contributed to an increased rounding of her upper back. To keep her hamstrings loose, I showed Marg a simple standing hamstring stretch that she can do multiple times daily, no matter where she is. By resting the heel of her foot on a low step and flexing forward from the hip joint, Marg easily felt a nice stretch in her hamstring. By putting her toes against the front of the next step, Marg also felt a strong stretch in her calf muscle. I always encourage people to maintain a long, tall spinal position, with a square pelvis and upright head. Perform this stretch twice on each leg for approximately 30-45 seconds, focusing on a breathing comfortably throughout.

Hip Flexor/Quad Stretch

With the goal of maintaining stable knee joints and a healthy lumbar spine, it’s important to keep the quadriceps and hip flexor muscles flexible and balanced. Since you’re often kneeling in the garden anyway, it shouldn’t be too difficult to step forward on one foot while keeping the core muscles engaged and the body upright and tall. Most people will feel a stretch in the front of the rear leg as soon as they get into this position. If you don’t, just press your hips forward slightly, while keeping your core tight. Be certain you don’t arch your back as you hold the stretch for 30-45 seconds on each side, then repeat.

Chair Extension Stretch

The constant forward flexion during gardening causes rounding of the upper spine, and tightness in the muscles of the chest. This needs to be balanced out one way or another to allow for healthy posture and mobility. I regularly encourage my clients to find a convenient location to perform extension stretches to open up these areas and maintain better alignment. For Marg, I suggested a seated extension stretch performed in one of the ornamental chairs in her garden. Every time she passes the chair she should stop, sit and stretch by putting her fingers behind her ears and extending her upper spine over the back of the chair. As she breathes deeply and exhales she should be able to gradually extend further, pulling her elbows back to open up her chest. It’s important to keep the head in neutral, without looking too far up in the sky, which could stress the neck. By holding this stretch for 45-60 seconds and breathing comfortably, Marg will begin to reverse her tight upper-back curvature.

Rob Williams is a kinesiologist, elite personal trainer and posture specialist. He has been practicing for 20 years and currently operates an exclusive private training studio Mixx Fitness Studio, with a team of 10 trainers, as well as a multi-disciplinary posture facility, Performance Posture Clinic. Rob’s parent company is Williams Health Group. Rob is an accomplished writer and speaker in the fields of fitness, posture and nutrition. He is a sought-after posture and performance coach for professional and amateur athletes and celebrities.