Knee Bone Connected to the PF Bone.
Last week I was teaching a Squat class at the Institute when a physical therapist asked, “How do we protect the knees in such a deep squat?” I found it such a telling question, because the primary reason our country’s knee health is so poor (yes, we’ve got the highest incidence of osteoarthritis) is because we don’t squat. The most true answer to the “how to we protect the knees” is squat more often. The bigger issue is, once you have “bad knees” (I really dislike this term. What did your knees do, rob a bank?) it seems like you can no longer squat without pain, right? Well that, we can do something about.
One of the first things you should know is, OSTEOARTHRITIS IS NOT A DISEASE. I can’t type this big enough (I need bigger font!). One of the largest disservices done by the medical community is not clearly explaining this fact. Osteoarthritis is not an autoimmune disorder like regular arthritis, which means a joint inflames for no reason. Osteoarthritis is the damage caused by user-induced friction of the joint. What does this mean? Let’s make a little math formula:
Damage: Ripping, tearing, burning up, or acidic damage to joint tissues like cartilage, meniscus, bony surfaces, etc.
User-Induced: That’s YOU, your gait pattern (quality of movement), and the amount you move (quantity of movement).
Friction: Put your palms together and, pressing hard, rub them together for one minute. The interaction of the the palm on palm surface is friction. The heat in your hands after rubbing them together for one minute is the result of friction.
User+Gait Pattern & Tight Muscles= Friction=Heat=Joint Damage
or more simply,
User+Gait Pattern & Tight Muscles=Joint Damage
If you vigorously rubbed your palms together every time you took a step, you would eventually tear into the flesh of your hands. This doesn’t happen because you know how to pull your hands apart. What you don’t know how to do is pull the joint surfaces in the knees apart, which is why it’s so easy to think of OA as a disease. ‘Cuz you can’t do anything about the space in your joints…it’s just genetic, right? Wrong! Joint space is determined by the tension in the muscles that cross over the knee joint. How tight are your calves and hamstrings? If they are really tight, that’s awesome! It means that with just a little stretching you can increase space, decrease friction, and decrease heat. It means you can get better whenever you choose to.
When you have Osteoarthritis of the knee, what you really have is the constant rubbing of the bones in the knees. This is not a disease, but a mechanical situation that can be changed at any time. Elevated heels on shoes, extreme tension down the backs of the legs, and the habit of tucking the tailbone under have arranged muscle fibers into short, tight muscles that increase friction in the knees.
Did you notice the mention of the tailbone being tucked? Chances are, if you have pain in the knees you may also be having issues of the pelvic floor (as mentioned in other squatting and pelvic floor blogs on this site). One of the reasons pelvic floor exercises like the kegel have been invented is because we aren’t walking with the correct “pushing off” (hip extension) motion. This pushing back motion tones the glutes (naturally), which (naturally) keeps the pelvic floor long and contracting eccentrically (instead of shortening during contraction), and minimizes the falling forward action most people do when they think they are walking (using the knee’s cartilage for each crash landing is a good way to burn through the knees quickly). Can you see how it’s all connected? The good news is, the very same movements that get the pelvic bones aligned and the PF strong are also the same stretches needed to increase joint space in the knee (and in the hips too).
If your muscles have been super-tight for a super-long time, begin to open your joint space with these exercises. They can be used for knee and pelvic floor issues and are a gentle way to prepare your body for a future squat.
Do you sit all day? Wear heels? Tuck your pelvis under because it is the “proper” way to stand? However your pelvis became tucked, the double calf stretch is a great way to see if your pelvis can even move! Place your hands on the seat of a kitchen or desk chair and step your feet up onto a thick, rolled towel. Line up the outside edges of your feet and straighten your knees all the way. Your weight should be back in your heels and all your toes lift-able. See if you can lift your tailbone up the the ceiling without bending your knees. No? Do this exercise a few times a day, holding up to a minute, until you can.
If you have always been a pelvis “tucker” the groin muscles can become very tight. Start with this groin stretch before moving onto the more advanced “Legs on the Wall” shown later. Lie down with your belly flat on the floor. Reach one leg out to the side without bending the knees! Relax your head and neck on your hands. Try to bring your leg up until it is at 90°.
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Fracking Awesome!! ‘xcuse my Gallactica language =P
I have been a chronic stretcher, I was a professional dancer and I am inherently flexible. Doulble jointed. I taught stretch classes and I am also a personal trainer. I have horrible osteo arthritis in my right hip and I have very limited ROM in that hip.
I had a labral tear and arthritis that the doctor did an arthroscopic surgery on, he scraped down my bone and filed the bone spur off. I just had another MRi and they are thinking hip replacement is in my future. I don’t want one and hope to find a solution that involves a holistic approach. The surgery has only made my pain worse, not at all better.
Ideas?
Heather,
People who are hypermobile aren’t usually stretching their muscles, they move their muscles out of the way of the stretch with very subtle rotations and allow their ligaments to take bear the burden of the tension. I am assuming, like many dancers, you are very post-tilted and internally rotated at the femur. I’m not sure if you’ve read through the other blogs – please do – and then consider the PF webinar – the course can be used for your issue as well. The obturator (a PF muscle) and a single-sided psoas spasm are usually what allows the hip tissues to die. You need to learn to stretch with stabilization to give yourself joint space! – Katy
Last century–after I had my knee surgery–I was told to avoid exercises that taxed my knees, to lift weights (tons of reps) for my quads to shorten muscles for protection and to “pull the kneecaps back into place”…and to expect osteoarthritis by my mid-30s. (I was only 19; and frankly, they just didn’t know squat.) Except for weight training on the quads for a while, thank goodness I ignored pretty much everything else, including the arthritis. In the 21st century, I’m guided by Restorative Exercise principles that embrace body mechanics so that I can surrender to correcting my specific challenges. RE welcomes my active knees, 21st-century-style.
Thanks Katy! I will look for it! Thanks for your quick response! How does a person know if they are stretching their muscle versus the ligament?
When you stretch a muscle you feel the muscle. If you can flop open into a position, then you don’t have any muscle to stretch! If you’re really hypermobile, you have to use bony markers to train yourself to not bypass the muscle. I am betting when your feet are aligned straight (see the bunion blog) the backs of your legs (the knee hinge) is on the outer part of your leg and not the direct back (you’d have to bend over in front of a mirror. It’s common in about 90% of the population. I’ll try to blog about it later this week to clarify…
I have had three knee surgeries, so when my birthing teacher told me to squat, I didn’t believe I could. Now, 5 years after my last knee surgery, I can squat with the best of them, just because I practice!
Meg! I know, we’ve got it so backwards regarding what our knees and hips need for health (full flexion) and what they don’t (loads of impact and minimal bending.)
Good job on the squats!
-Katy
Do you have any recommendations on what people with hip replacements can do to stretch the adductors (since exercises 2,3,4,&5 shouldn’t be done with a hip replacment)? Is there anything we can give these clients?
Can you do more description of the positions? I am not able to see the pictures for some reason. I’m using IE, and tried all sorts of solutions, but no luck.
Nevermind. Apparently, I had to leave a comment to see the pictures! :~)
That’s the big negative about joint replacements. Once you have one, you limit your health forever… You can try forward bent with ext. rotation to at least innervate them…Katy
I can’t see the pictures either – I’m leaving a commnet so I can see the pix (if that is the solution)
I continue to be amazed at the elegant simplicity and efficacy of your solutions to “diseases”. I have met the enemy and he is me. The good news is I can reverse that any time I want. All it takes is some work.
Can someone with a hip replacement do legs “straight” up the wall? How about one leg at a time straight up in a doorway? Thanx so much for the edu.
I stumbled onto your blog and think I could be here all day, but want to ask a quick question. When I was young a Dr. told me I was double jointed in my hips. I know I have great ‘ballet turn-out’ but other then that don’t really know what it means. I’m now 8 months preg. with my second baby and my hips are killing me! I had hip pain with my daughter too but nothing like this. I’ve tried stretch’s, lots of exercise ball sitting etc. but nothing seems to help. I have to wonder if my hips and PF are the problem. I don’t have any trouble doing the exercises. For example with #4 my left leg is on the floor and my right is about 2 inches off. Any ideas??
Karie -
There’s no “real” condition of “double-jointedness”, but many times there is hypermobility that is caused by walking around in turn out since a super-young age. I would recommend you straighten your feet RIGHT NOW and practice walking with your feet straight. Your hips have no stability in turn out (which is why ballet dancers use that position – they get maximum range of motion, but very little stability (did you know that most prima ballerinas end up with hip replacements?)
You need to strengthen your hips and pelvic floor (the deepest hip muscles are PF muscles). Your increasing mass and probably pelvic thrust are putting way to much pressure on your hips for the little strength they have in turn out. I would bet that while your hips just fall open your hamstrings are super tight…
Keep me posted! Katy
My cousin recommended this blog and she was totally right keep up the fantastic work!
Thanks Katy- you’re right my hamstrings are a mess. Going to keep working on it.
Can’t see pictures, will this make it work?
Anti-Inflammatory guide to eating
hi katy, do you have any recommandation about that ?
I have no idea where to look.
Sharon,
There’s a book called The Anti-Inflammation Diet (I think that is what it is called) – search on Amazon.com. My mom used this one and really liked it – she got her inflammation down and a whole bunch of weight came off! She felt and looked fantastic…so much healthier!
Thank you for your help
Exactly! We have to ask – why are the bones rubbing on each other? Are the supporting muscles not strong enough to prevent it? How did that happen? Inactivity? How often do we here about osteoarthritis in active individuals? Runners? Catchers? Not often I bet. Prevention is certainly the key!
Janice –
Most people are unaware of how to use the tiny rotation muscles down the long bones that position the heads of the bones in the joints with enough space. We’re pretty comfortable using about 25% of our muscles, but most people have no idea 1) how to innervate the other 75% or 2) that they are actually turning their muscles off with their positional, cultural, and lifestyle habits! -Katy
I love, love, love your blog! I’m interested in walking more – and walking more properly. How does it look and feel when you’re walking correctly? How will I know if I’m doing it right? Thank you!