Ok Runners, how far can you drive on a flat tire?

Have you ever driven on a flat tire?
I did once, we were stuck in the middle of nowhere and the only way to get help was to stick it out. The faster we went the harder the car shook. I thought the whole thing was coming apart, but thankfully we didn't have to go far. In this post we're going to relate the flat tire to the muscle imbalances/functional limitations that living in today's society creates (which were discussed in this post).
Why do I see so many "Runner's knees"?
It's no secret we are a sports based practice, and as such we see all types of athletes. One of the injuries we address on a daily basis is "Runner's Knee" (Patellofemoral Pain Syndrome or PFPS) which is a problem with your knee cap/knee joint.
The back side of the knee cap (patella) is lined with soft and smooth cartilage, exactly like what you see on the ends of chicken bones. The patella fits right in to the groove in the front of the knee, "Runner's knee" occurs when the patella is pushed out of position from imbalances in the thigh (quadriceps) muscle over a long period or overuse (1). Since the knee cap is designed to operate in it's groove, when it doesn't the cartilage gets inflamed and degenerates.

The return of the bad neighbor.

In a recent post we discussed how glutes get "turned off" (It's all in the hips), from sitting too long or overdeveloping the front of our bodies(muscle imbalance), and it's effect on lower back pain.  Guess what-hip weakness also causes our knee to react and  over time develop incorrectly, that's right MUSCLE IMBALANCE strikes again! 

This illustration shows the effect of a weak glute on the hips and subsequently the medial collapse (valgus collapse) at the knee..

A. Normal glute support B. Weak glute 

The body makes it work, even if it's bad for it.

We cannot build strength on poor movement, but the body will sacrifice quality for mobility.
Endurance is a form of strength and the body will adapt to the new, poor movement. Unfortunately the result is over development of the lateral knee muscles (IT band syndrome) and improper tracking of the knee cap (patella). This situation in essence is "driving on a flat tire"; sure, you can run on it but how fast are you going to drive? How far? When will you "car" finally call it quits?

Anyone have a spare tire?

Knee problems are very common and are on the increase (2). The answer to maintaining your running/exercise routine lies is finding the faulty link through functional testing. Surgical intervention or knee replacement is devastating to any workout routine  (and has a low success rate).  Since we don't have interchangeable parts, consider making muscle balance a part of your over all workout.

We welcome shares, the more we can reach with this knowledge the less will suffer and anguish. 

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

1.Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Gregory R Waryasz^12* and Ann Y McDermott¹³

Ann Intern Med. 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004.

2. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data.

How movement analysis helps us help you

Once upon a time..
Like most doctors/P.T.'s, I used to use a standard process of finding what was wrong with my patients. It usually consisted of testing the affected area with orthopedic tests.  As I pursued my rehab specialty I found that there is more to consider, that the hip bone is indeed connected to the thigh bone. I was taught to look at the whole, as opposed to the sum of it's parts.  In previous posts I mentioned how the hip can be a major contributing factor in lower back and knee issues(see "The bad neighbor"), today I want to share how we find just that.
Our body is a moving chain?

At least that's what I used to tell everyone, but really it's alternating series of mobile and stable links. Life is dynamic, and we ask our bodies to move and conform to every imaginable task we set out to perform (sit, stand, crouch, squat or crawl).  There is a  new approach in manual medicine(Chiropractic and Physical Therapy) called Functional Movement Analysis is a new approach that we use to figure out why certain movements, or lack thereof, are causing the body to overuse and break down. It tells us if the areas that should be moving are moving & if the areas that are supposed to be stabilizing are stabilizing.  These patterns are universal to all of us and when disrupted or absent create undo stress to certain critical body parts.

What's in a test?

Any movement can be a functional test, something as simple as watching someone rise  from a chair, squat down or jump down off of a box.  Lets consider the squat. By analyzing figure 1 the squatter on the right needs to work on the amount her upper back can bend backward (extend). She could also use some lower back stability training and ankle mobility as well. Hopefully it's easy to imagine the squatter on the left being able to endure more squatting without injury over the squatter on the right, because that is the case.

Figure 1 courtesy of NASM

These female athletes were asked to drop off the box and then jump as high as they could, you can see that the athlete in figure A maintains the space between her knees while the athlete in figure B collapses. The second athlete has a much higher rate of ACL tears because of the hip weakness, she shows in this movement test. Finding and correcting that flaw may save her athletic career.

figure 2

figure 2

The news is getting out.
Several recent studies performed by orthopedist are being published supporting this theory of "the bad neighbor". That shoulder problems and knee problems are greatly affected by related body parts, and that just treating the affected area is just sweeping the dirt under the rug. Study on how shoulder pain is connected to hip issues. As well as a great post on the influence of hip and ankle on knee pain.

Good enough for world champs?

These "functional" testing procedures not only allow for detection of impending injuries but we also use them as a baseline to measure future progress.  After finding these underlying problems, specific corrective exercises are prescribed to correct it. (mentioned in this post). In fact we usually see improvements in the first treatment. There are many systems of testing out there, all of them have merit and while we favor a select few, we use most of them in some form or another.  The Super Bowl winning Seattle Seahawks use this as a guide for off season training and injury prevention, and if it's good enough for them, well you know how that goes...

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

Strength from the ground up

Functional exercise
Today we are going to dive right into the  new phenomenon of "Functional Exercise" seen in many of the gyms & exercise magazines. If you look back at my previous posts your aware of the reasons we stiffen. As adults we quickly lose mobility which robs us of moving correctly, or what we in the rehab world call "Functionally". One of the primary purposes I began writing this blog was to explain the importance of movement. A big part of getting you moving again, without compensations that  harm you, is getting you back to your developmental roots.
Developing our motor skills  occurs when we are infants. We first learn to roll over, then crawl, eventually we get up on one knee and ultimately we stand. As infants we have all the mobility in the world, it's the stability that needs to be learned. In rehab we use these positions as "resets" to reestablish movement patterns that are essential to correct functional movement, and functional exercise(more on this in future posts).

Why are we doing this again? 

Many trainers are adding functional exercise, not understanding the reasoning  & it's became a novelty.  Functional exercise is most effective when used to improve a deficiency.  As a Functional Movement Screen practitioner, I use the findings of the screen as the basis for prescribing the exercise. 

This will end badly...

When we look at one of the most fundamental movement not only in exercise but in life; the squat, this concept can be better understood..

Whoa, slow down there tiger

As you can see our young friend can easily sit in a deep squat while playing, while our weight lifting friend is about to get a chance to meet yours truly (after he sees every other provider without relief). The weight lifter is trying to build strength on poor movement. While he may get away with it for a short time, this strategy is sure to fail, this is the scenario I'm attempting to save you from. The functional movement that I referred to applies not only to the squat but many other exercises & activities that will be spoken about frequently in my posts.
Baby steps
Nobody wants to have to take a step back, but in order to "Live to Move", we will need to go through prescribed corrective exercises to get the movement right, before we start adding resistance and accentuating our faults. The more the individual strengthens their faults, the more work there will be in reversing that process.  An example of stepping back to master the squat would be for someone to learn to hinge at the hips, build mobility in the hips ankle and upper back, followed by learning to master the glute bridge,  and  finally progress to face the wall squats.

 Putting it all together

By taking a step back and making sure the way you move isn't hurting you, you will create and maintain an amazing foundation to move better, feel better, work better and train better. The squat is a tremendous and fundamental movement most of us have difficulty performing.  It's also one of the best exercises for loosing fat and adding muscle when performed correctly, and when we add functional movement it's also one of the safest. 

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.