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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Why is the gym so intimidating?

I haven’t been to a gym in years. I have relied on time spent in the studio dancing, running and doing Pilates for my exercise routines. But since I’ve always had a bit of an issue with my knees from years of athletic modern dance, lately running on concrete around the neighborhood hasn’t  been feeling too great. So I decided to check out the options for nearby gyms. Running on a treadmill doesn’t bother my knees, so even though it’s not as entertaining as the outdoor adventures, it’s much better than laying on the couch with ice on my legs after each run. (And apparently, I’ve learned recently that icing doesn’t do much to help sore muscles feel better or heal faster!)

I walked into the cheapest option that was down a couple blocks from my apartment and almost immediately turned around. I wasn’t looking for a fancy spa like atmosphere but if I can’t stand the smell of the place, I’m never going to want to come back to work-out. And you get what you pay for though, at ten dollars a month, I was warned never to use the lockers unless I want my things stolen.

I declined that membership and walked on to the gym that’s just around the corner from my apartment. Smelled fresh, the place was spotless, the front desk staff was friendly enough. I asked to speak to someone about membership options. Although the membership staff could have been more welcoming, the gym had all the amenities I would ever need and then some. It even had a hair and nail salon on site. Ridiculous, yes, but maybe convenient? It was big, CLEAN, and no funky smells. Everything checked out except the price. Of course the year membership cost was way more than I had intended to spend.

I checked out a few other places but they were smaller, and I was afraid that the treadmills would fill up fast at peak hours, and they were all off the beaten path, so to speak. I ended up deciding that since going to the gym was going to be a new challenge for  me anyway, I might as well choose the one place I wouldn’t dread going to in the first place. I took the easy, if slightly expensive, route.

My knees have been thanking me since the switch away from concrete, but I’m taking it slow to start out. I haven’t worked with weight machines since college so I’ve been a bit hesitant to venture to the weight room. It doesn’t help that everyone there seems so serious, I’m almost intimidated to go wait by a machine for it to free up. Why is everyone so somber? The treadmill that I’ve been using faces the weight machines so I’ve been doing a lot of people watching to pass the time. Its surprising how much people are lacking in form. I’m not a personal trainer, but when you are using momentum more than strength to flex your bicep, my guess is that your not doing a whole lot to benefit your muscles.

I see all kinds of strange forms and exercises that seem like they are more painful than anything else. And everyone has a straight face and attitude as if they know exactly what they are doing. Does it have to be like that? There is something about being surrounded by people working out that makes me insecure about my own fitness. I’m sure other people must feel that too.  Even if I think I know what I am doing, and know exactly what I want to do, I feel myself second guessing it all and then deciding to do my core work at home in my living room instead.

Maybe it’s the gym I chose, or my own self doubts of being back in a gym environment, but it’s something I’m going to have to figure out for myself.

Concentration and Control

When working with clients who are new to Pilates, sometimes the hardest part for them is finding the abdominals. The exercises seem too easy for them in the beginning when they are recruiting muscles outside of the core to do the work. We want to avoid this! Isolating muscles groups will help retrain the clients’ movement patterns.

As you become familiar with the movements you can concentrate on the abdominals and find the challenge of the exercise. It hasn’t gotten easier for me in the eight years I’ve been doing Pilates because as I have gotten stronger I have pushed my self to make the movements more difficult.

The Pilates exercises weren’t designed to be confusing. The movements are simple and to many people look familiar and similar to exercises done in traditional conditioning techniques. The difference lies in the approach. The principles of the Pilates method promotes awareness of the body and concentration so that you can’t cheat your way through the motions.

While it might be frustrating to start out small and simple in the beginning it is only after you locate and get used to engaging the proper muscles will you get stronger and start feeling the difference.

Sit up straight!

Posture is simply the position of the body when sitting or standing. While you might think it would be a rigid position, it should actually be anything but static. Good posture aligns the bones and muscles to work the most efficiently so that it requires the least amount of energy. Any posture that forces certain muscles to strain is going to have repercussions. The body is designed for movement so keep that in mind when “sitting up straight,” it’s usually not a great idea to try to lock joints and muscles into place.

The word posture also has some other connotations dealing with projecting attitudes, often in a way to impress or mislead. This seems fairly logical given that we can read a lot about a person by their posture. And it works both ways. Try feeling confident slouched over in your chair…. Now sit up tall, shoulders wide, chin lifted horizontally- it’s like being a totally different person.

Most of posture correcting techniques or methods deal with breaking bad habits. Once you recognize when you are not in an ideal posture it’s easier to change into a more supported position. Having a sense of body awareness is crucial, not only for correcting posture but also coordination and balance. Body awareness and posture also play a role in overall body language, which sometimes speaks louder than you might think.

But the real kicker with bad posture is that it contributes to chronic back pain. A lot of people spend most of their time sitting in front of a computer. It’s important to make sure you are getting up to stretch your legs and walk around periodically throughout the day. Staying in one position for a long period of time is stressful on the body. In order to improve your posture you will need to strengthen the muscles that run on either side of the spine. These muscles, especially the erector spinae, support your spine in an upright position. The reason why it’s often difficult to keep the back straight when sitting down is because of weak erector spinae.

The baby swan exercises in Pilates targets this muscle. By extending the back without using your hands to push you up, you are forced to use the muscles of the back. Do these exercises very slowly to make sure you are not using momentum or letting other muscles compensate.

Lie down on your stomach, engage your abdominals and place your hands, palm over palm, underneath your forehead. Slowly lengthen your spine to lift into an arc coming up only as high as you can control. Just as slowly lengthen the spine to lower back down. Do 4-6 repetitions and then stretch out the back by sitting in child’s pose or cat pose on all fours.