On Knees

The knee is often considered to be the most complicated joint in the human body. It is a large and often injured structure. Many of us, of all ages, struggle with knee pain, and it annoyingly can get in the way with exercise.

The catch-22 with exercise is that too much of it can lead to overuse injuries, commonly of the knee, and too little leaves muscles and joints prone to accidental injuries if you’re not careful. And once you have an injury, you are even more likely to sustain another in the future. So what’s the solution?

My best advice if you are suffering from knee pain, but there hasn’t been a formal “injury” to the joint, is to take preventative action! That goes for people who have had knee injuries in the past as well. Keeping the surrounding muscles and tendons strong is the best way to get rid of the pain and help prevent an injury from occurring. My knees have begun to bother me due to the athletic stress and unpredictability of over 13 years of modern and classical dance. They pop and crack constantly. So my compromise is to run on an even treadmill instead of hilly concrete, which has made all the difference in keeping my knees from hurting after long runs.

The vastus medialis is the muscle of the quadriceps on the inner part of the thigh. Strengthening this muscle is often prescribed for relieving knee pain when squatting, sitting or going up or down stairs. The muscle inserts into the quadriceps femoris tendon and the medial (inner) part of the knee cap. As a part of the quadriceps it’s basic action is to extend (straighten) the knee joint. But due to its location, it is believed to activate most when the knee is fully extended.

Strengthening the abductors and adductors of the thigh will also help stabilize the knee joint. Other stabilizers of the knee, which are a little less intuitive, are the hip extenders such as the hamstrings and the gluteus maximus. Weakness in these muscles can sometimes cause rotation in the leg which can agitate the knee joint.

The exercise below are targeting these muscles in an effort to relieve and prevent knee pain. Form is very important in these exercises, you want to make sure you are targeting the right muscles and not setting yourself up for a different injury. Have a mirror or a friend ready to help you if needed.

Stability ball leg extensions: (quadriceps) Sit up straight on a stability ball with your feet flat on the floor, knees at a 90 degree angle.  Find your balance, and a tall spine by taking a few moments to tilt your pelvis forward and backward. Settle once you find a neutral pelvic position. On an exhale, extend one leg out in front of you. Be careful not to lock the knee joint completely but try to concentrate on flexing your quadricep muscles. Relax that down and repeat on the other side. Do four sets, trying to keep the leg out in front of you at a 90 degree angle for a couple of slow breaths.

Ballet demi plies: (quadriceps, external rotators of the hip, hamstrings, adductors) Stand tall with your feet together. Now slightly turn out (externally rotate) your thighs so your feet are making a small V shape. You aren’t training to be a ballerina so really take it easy on the rotation and only go as far as feels comfortable. Your inner thighs and rotators (underneath the glutes) should be working in this position. Inhale and bend the knees slightly so that the heels of your feet are still on the ground. On the exhale, press into the floor and squeeze the inner thighs together to come back to a standing position. Repeat slowly 8 times and then again separating the feet a little beyond the shoulders (2nd position in ballet).

Ball squats: (quadriceps, glutes, hamstrings) These are good to do if you don’t want the stress of regular squats. Stand feet parallel and hip width apart with a stability ball behind your lower back and against a wall. Let the ball guide you down into a squat aiming to get into a sitting position. Press your feet into the floor and squeeze your glutes to come back to the starting position making sure your shoulders are over your hips and your abs are engaged throughout the entire exercise.

Sitting leg lifts: (quadriceps) Trying to target the vastus medialis, sit against a wall with your legs stretched out in front of you. On an exhale, tighten your abs and lift the right leg flexing the quadriceps muscle. Hold for a few counts then slowly lower down. Repeat on the other side, Do 5-8 reps.

Quadruped leg lift series (hamstrings, glutes) On a mat, or putting a towel underneath the knees, get into a quadruped position (all fours). Make sure your shoulders are directly above your wrists and your knees directly under your hips. If your wrist begin to hurt during this exercise, feel free to come down onto your elbows maintaing a neutral spine. Keep the abdominals engaged and extend the right leg straight behind you. Pulse the leg up 15-20 times in a quick 1.)lift a few inches 2.)hold 3.)lower a few inches pattern (controlled pulses). Repeat to the other side. Repeat with the knee bent at a 90 degree angle with your heel going straight up to the ceiling, then again with the thigh externally rotated.

Inner thigh leg lifts: (adductors) Lie on a mat on your left side with your hips and shoulders stacked directly over each other extend the bottom leg long and either bend the top knee and put the foot on the ground in front of your left thigh or get a yoga block and rest your knee on a block in front of your left thigh.Keep the abs lifted and engaged as you lift your bottom leg off the ground using your inner thigh muscles. Your hips should not move. Lift and lower the bottom leg 16-20 times then hold it up and trace a tiny circle with your heel 10 times in both directions.Then extend your top leg straight out and hold it at hip height. Bring your bottom leg up to meet your top leg, squeezing the thighs together before lowering the left leg down. Repeat 8 times then switch to the other side.

Lunges: (adductors, abductors, hamstrings, glutes, quadriceps) Start in a standing position feet parallel and hip width apart, hands on hips. Take a big step forward with the right leg keeping the shoulders over the hips and your abdominals engaged. Don’t let your knee track beyond your toes but make sure it is tracking in a straight over the middle of the foot. Your pelvis should lower into a 90 degree angle from ankle to knee to pelvis. The shin of your left leg will be roughly parallel to the ground and you will probably get a little stretch in the front of the left hip. Bring the left leg up to meet the right as you stand up then repeat on the left side. Take 16-20 steps moving around the room, then try to reverse the lunge by stepping backwards.

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Dynamic Opposition

Dynamic opposition creates stability. This is one of the less frequently talked about principles of the Pilates method. I was familiar with this concept because it came up a lot in dance classes. Dancers tend to do this fairly naturally because it promotes a total body awareness, and three dimensionality that is great for performing. Basically dynamic opposition is the conscious decision to think about every action in two directions. If I’m thinking, “sit up straight” I’ll try to sense energy shooting through the crown of my head, but also energy grounding me down through my tailbone. If I’m thinking draw the shoulder blades down, I’ll also be thinking open the chest, broaden the shoulders.

For every action there is an equal and opposite reaction. 

This way of thinking keeps us from floating away, or getting pulled to the ground. We are always trying to search for the appropriate middle area, the elusive feeling of balance. Whether you are looking at your posture or your form when exercising try imagining pulling forces of energy. It turns out it is a lot more effective and much simpler than trying to list all of the things you think you should or should not be doing simultaneously. You might just find that things fall into place and find a more natural harmony.

 

Feeling Tense?

Sometimes as I’m walking down the street, or sitting at my desk I”ll suddenly become aware of my shoulders hiked up by ears. The muscles that elevate the shoulders (rather the shoulder blades) are the upper Trapezius, the Levator Scapula and the Serratus Anterior. The upper Trapezius being the largest muscle of that group is considered the main culprit. Our bodies tend to tense up as we get stressed, as we pent up emotions or just out of habit. Many of us hold this tension in our neck and shoulders, it is a little instinctual. Constantly elevating the shoulders causes the muscle to become tense and short which is why a good shoulder rub can feel so good!

To relieve some of the tension in the upper trapezius, take both hands and grab hold of the fleshy muscle on top of your shoulders and pull them forward. For an added stretch tilt your chin up and let your fingertips gently massage the muscles. You can also sit up tall, pull your shoulders down and back slightly then drop your head forward letting the weight of the head stretch and lengthen the upper trapezius, which attaches at the base of your skull.

The best thing to do when you realize you hold tension there is to become aware of it. Notice when your shoulders are up and consciously bring them  back to neutral. Roll your shoulders back opening up the chest and gently pull the scapula down using your lower trapezius and your Latissimus Dorsi (these are the largest muscles of your back, the traps and lats). You should automatically feel a little taller and maybe even a bit more confident! Take a deep inhale without letting your shoulders ride up and a long exhale imagining the tightness of the shoulders melting away.

Irene Dowd Interview

I ran across this old interview with Irene Dowd that was published in Dance Magazine back in 2005. I love the way Irene describes movement and anatomy. I’ve had the pleasure of taking a workshop with her looking at the shoulder girdle and the anterior serratus. She is such an amazing teacher with the ability to break things down to a functional and graspable thought that can be applied to any movement practice.

In the interview, I especially love the question about visualization. Before we move we have to have some sort of idea of what the movement is going to be so we all use visualization whether we are conscious about it or not. Our brains are constantly communicating with the rest of our body. This becomes important when trying to correct old habits or change the way we initiate movement. Irene has extensive experience in re-training motor control processes and she does this through visualization techniques. You can re-train your body, it takes a bit of conscious thought and practice, but it can be done.

The question and answer below is great as well:

DO WE GET INTO TROUBLE BY HAVING A “RIGHT” IDEA OF HOW TO MOVE?

“Right” varies according to the movement goal. We are artists first, and our goal is to serve our art. “Right” is constantly changing. Mabel Todd used to say, “The mind is an instrument of thought, not a museum.” We are constantly learning.