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I’m a huge supporter of Daniel Leiberman’s theory that humans look and move the way we do because of endurance running.  As we evolved, there was a point when we began benefitting from running and therefore adapted traits that helped us run more efficiently, which led to us to become very efficient endurance runners.  Many new studies have been coming out that give more detail as to why humans need to be moving to be healthy.  Believe it or not, simply standing is healthier than sitting.  Standing work stations are becoming more popular for people who are stuck at computers all day.  Even though standing doesn’t raise your heart rate there are significant health benefits.  The most profound benefit of standing during the work day is how the production of the enzyme Lipoprotein Lipase, which is minimal when we sit and much higher when we stand, affects us metabolically.  Standing and increasing production of this enzyme has a very positive effect on our physical health.  Standing also prevents muscles and tendons from tightening up, specifically hamstrings and hip flexors, which directly affects runners.

Now, looking beyond the physical benefits, new research is indicating that physical activity may help maintain brain health- more than simply helping us clear our mind after a long, stressful day.  The New York Times article- Exercise and the Ever Smarter Human Brain is based on research that goes a little more in depth about the theory of why and how exercise helps our brains.  Researchers theorize that physical activity helped to mold the structure of our brains over millions of years.  If that’s the case, then it’s likely that physical activity remains essential to brain health today.  Similarly, we evolved as social creatures and we still need social interaction to be well balanced.  I use this example because the social aspect is something that we can easily perceive and are more attuned to.  We have the desire to spend time with others, to talk to people, to solve problems or to feel loved and accepted.  Many people enjoy running with another person or group of people.  I think this is a deeply rooted instinct that comes from when we ran and worked together for a successful hunt.  See my post on persistence hunting to see how people ran and work together to chase down their prey.

Researchers have found evidence that “regular exercise, even walking, leads to more robust mental abilities.”  This does not mean that every couch potato who starts running will become a genius.  In stark contrast, Stephen Hawking has been wheelchair bound and unable to feed himself since the mid 70’s, yet is one of the most intelligent people in the world.  We all fall somewhere under the bell curve and everyone has their potential.  The bottom line is that physical activity can help with decision making and keep our memory sharp, helping each individual achieve their full cognitive potential.

Unfortunately, the brain experiences a similar use-it-or-lose-it phenomenon that skeletal muscle does.  Other research has shown that animals who were showing cognitive improvement from exercise demonstrated signs of decrease after just one week of inactivity. Within three weeks of inactivity, the exercise group had results very similar to the group that had never exercised.

So if someone you know has been excessively inactive, try to get them out walking either during lunch or after work.  Suggest an up/down work station for their desk.  Any light activity will help them both physically and mentally and may be the catalyst for an overall healthier lifestyle.

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There is a lot of talk about the importance of recovery with running.  This is especially true if you are training to run a marathon or other competitive race.  A common word of advice for runners is get plenty of sleep in order to facilitate the recovery process.  However, the quality of sleep we get may be something that we pay little attention to.  We sometimes wake up in the morning still feeling tired, like we didn’t get enough sleep.  It may be because we didn’t get enough sleep but it could also be the result of poor sleep hygiene.  In the modern world, we have grown accustomed to having distractions all around us through the day – lights, cell phones, computers, traffic and various types of stress.  At night, we may minimize these distractions.  While there are some distractions we can’t control, we allow others to remain, and they could be having a greater negative impact on us than we think.

sleep-1

Sleep hygiene includes the pre sleep routine or habits that we perform in the last few hours before going to bed.  It also includes our sleep environment.  Better sleep hygiene leads to higher quality and more restful nighttime sleep, which in turn helps us be more alert and less fatigued the following day.

Sleeping well helps maintain health, reduce stress, rebuild tissues after exercise, improve memory and replenish energy stores to name a few.  It can also improve performance indirectly.  It has been found that a tired person is less pain tolerant than when they have had a good night of sleep.  The goal of this post is to make people more aware of habits that might have a negative affect on sleep and how to avoid them.

When we sleep, we continually cycle in and out of 4 stages of Non-Rapid Eye Movement (NREM) sleep followed by Rapid Eye Movement (REM) sleep, each stage of REM sleep lasts longer than the previous.

Stage 1 of NREM sleep is the light, drifting off stage where we are easily woken up.  Through stages 2 and 3, we continue falling into a deeper state of sleep as brain activity slows down.  Stage 4 of NREM is where our bodies do most of the repair and regeneration work, as well as strengthen the immune system.  Brain activity is very low at this time and a person is very hard to wake.  The last stage of sleep is the famous REM sleep.  Brain activity increases, our eyes move in quick random movements while muscle activity in our limbs is inhibited.  Most of our dreams occur in, but are not limited to this stage.

Pre-Sleep Routine

Sleep experts suggest establishing a consistent pre-sleep routine at night.  This includes turning off the television at least an hour before going to bed, doing your nighttime tasks in the same order and going to bed at the same time every night, even on weekends.

The following have also been found to disrupt sleep and should be avoided 4-6 hours before going to bed if you’re feeling chronically tired: alcohol, heavy meals, caffeine, excessively spicy and sugary foods.  While it’s not recommended to go to bed with a full stomach, an empty stomach is also not optimal.  A light snack that contains the amino acid Tryptophan will improve sleep.  The most common foods with Tryptophan are:  Bananas, turkey, seafood, milk (animal & soy), nuts & seeds, eggs, cheese.

Light reading (nothing work or school related) 20-30 minutes, somewhere other than bed, helps take your mind off the stress of the day and slow your brain down.

Once in bed, if you’re not able to fall asleep within 20 minutes, get out of the bed and find something else to do that will make you feel relaxed.  If possible, do this in another room. Your bedroom should be where you go to sleep. It is not a place to spend idle time when you’re bored. Once you feel sleepy, go back to bed.

The Sleep Environment

even light from this can disrupt sleep

even light from this can disrupt sleep

Light:  Researchers have recently discovered that our eyes have structures (intrinsically photosensitive retinal ganglion cells (ipRGC)) that have the specific task of detecting light to regulate our circadian rhythms.  Some people and animals that are blind maintain the ability to sync their behavior to the daylight because of these structures.  These ipRGC’s are sensitive to very small amounts of light.  Even the light from an alarm clock is enough for the brain to get the signal – ‘it’s still light out,’ which prevents our brain from fully resting.

Darkness triggers the production of melatonin, a hormone that in turn regulates sleep/wake cycle.  A person may be perfectly capable of falling asleep during the day or with a light on, but our brain does not produce the levels of melatonin that help us enter the deep sleep mode where our bodies are most efficient at repair.  Over time, this wears away at our bodies causing us to feel sluggish, unmotivated, irritable, chronically tired etc.

noreadinbedComputer screens and televisions emit high levels of blue light which is one of the wavelengths that the ipRGC’s are most sensitive to.  One way to improve sleep hygiene is to avoid looking at lighted screens at least an hour before going to bed.  Additionally, using minimal lighting around the house before bedtime will help increase the production of melatonin and help you fall asleep faster.  Any light in the bedroom, even the glow from a charging cell phone can be detected by the ipRGC’s in your eye and cause decreased melatonin production.  A completely dark room is recommended to get the best quality sleep, or try a sleep mask.  If you have to get up in the middle of the night, use a dim flashlight and try to avoid turning lights on.

Sound:  Falling asleep with the T.V. or radio on is a bad idea.  Our sense of hearing is one of the last senses to ‘shut down’ during sleep.  Similar to exposure to light, we are usually able to slip into the sleep state with a T.V. on, but our brain does not enter a deep sleep because it’s continually working to process the sound, especially if it’s conversation.  White noise (radio static, water running, AC unit, a fan) on the other hand can be a benefit to sleeping because it can drown out ambient noise.  Our brain can not separate out any one part of white noise and eventually disregards the sound, allowing you to sleep.

Other Distractions:  Having a home office or other work space in the bedroom can indirectly sabotage sleep.  Most of us associate the computer with work of some sort, paying bills, homework or checking e-mail.  Seeing the computer on your way to bed can trigger the mind to begin thinking about work related topics instead of relaxing.  Again, your mind should associate your bedroom with relaxation and sleep.

The above recommendations are not meant to take the fun out of life, but give some direction toward better health by improving sleep quality.  If you are someone who always feels tired, evaluate your evening habits and try adjusting something.  Even making one or two small changes will help you sleep better.  Sleeping better means you recover from a race or tough workout more quickly and have a better chance of avoiding injuries.

Sleep well.

sleeping stickman

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The Escarpment 30k Trail Race is the type of event that doesn’t just chew you up and spit you out – exhausted, wounded and mud covered, it also points and laughs at you!  Running the extremely technical 18+ miles from Windham, NY to North Lake in Haines Falls, NY demands the ability to focus on a narrow trail 3-4 feet in front you for several hours.  Lose that focus for more than two or three seconds and it’s likely you’ll be on the ground, before you even knew you fell.  Despite one’s best effort however, the rocks and roots will still probably reach up and grab your foot at some point during the race.  Maybe you’ll fall, maybe you won’t, but you’ll probably fall.

A look at the Escarpment website and it seems that the race founder and director, Dick Vincent spends more time dissuading people from doing the race than inviting them to come attempt it.  He makes it very clear that you need to be an experienced runner with a history of trail running to toe the start line of this race, otherwise he will be pointing and laughing at you.

2013 start

2013 Start – by: Paul Mueller

This year rain was added to the mix.  The ground was fairly dry prior to race day and was able to absorb a lot of the water, so mud wasn’t a huge factor.  It was the wet, smooth rocks boulders, ledges etc. that made things a bit more interesting.  This was my second Escarpment race and despite the rain, I was able to take 6 minutes off my previous time, finishing 6th in 3:18:39.  This race remains the most challenging endurance event I’ve ever done – more mentally demanding than the VT Spartan Beast, harder than the Boston Marathon and more exhausting than a 50k x-c ski marathon.

Since the race was at the end of July, too much time had passed and I’d given up trying to put together a mile by mile race report for this year.  But then I found this race report by Kirk Kittell.  It’s a very entertaining and well written recount of the race.  It was written after the 2010 race but is fitting for any year.  Enjoy!

top of Blackhead Mtn.

Top of Blackhead Mtn. – by: Mountain Peak Fitness

Have you run the Escarpment Trail?  Or are you planning on running it for the first time?  Please share your experiences, advice or questions in the comments section below!

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Here at On Track we have a new weapon to battle the sidelining effects of running injuries.  It’s called the Alter G antigravity treadmill.  I should clarify that the benefits of this machine extend beyond injured runners.  People with neurologic disorders (M.S., M.D., stroke, polio) or elderly who need the help of a cane, walker or wheelchair probably realize the most profound benefit of this machine – the ability to walk with a more normal gait, letting their arms swing freely.  People recovering from knee, ankle or foot surgeries are able to walk much sooner and without pain.  When a person moves without pain, they are instantly able to move using proper biomechanics which in turn facilitates healing and prevents secondary complications.

Alter G Treadmill

Alter G Treadmill

By secondary complications, I mean something like ankle surgery leading to back pain.  I have a patient who had ankle reconstruction surgery.  After a couple weeks of walking around in the big heavy immobilization boot, they began to say that their back was hurting a lot.  Their biomechanics were affected from the boot so much that their hip and back were not moving correctly.  Due to the rehab protocol, they had to wear the boot for several weeks and could only limp around for short distances without it.  Once I got the person on the Alter G they were immediately marveling at how they were walking normally, without pain.  At first it was only while they were on the Alter G that they were walking without any pain or limp, but after a relatively short amount of time they were walking around the clinic, home and then out in public without a problem.  This person also wanted to return to running.  Once we were confident that the ankle had sufficient time to heal, they were running on the Alter G much sooner than they ever imagined they’d be running again. After a couple of weeks, they then progressed to running on a regular treadmill.

As you can see in the picture above the person’s legs are enclosed in a large air filled chamber.  The Alter G adjusts the air pressure inside the chamber and can fine tune the weight of the person using the treadmill.  This is done by wearing a pair of compression shorts with a kayak-type skirt around the waist.  You zip into the top of the chamber, let the machine calibrate your weight (which it doesn’t display) and you then select your body weight percentage anywhere from 100 to 20%.  I can say that once you get to about 75-80% of your body weight, you really feel light on your feet!

This Seven Days article tells other success stories and does a nice job of describing the machine more in depth.  You can also check out the Alter G website here:  http://www.alterg.com/

Do you think you’d benefit from using the Alter G treadmill?  Please feel free to stop in to try it out!!

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This is the third post in the knee pain series.  Part 1 started with a quick anatomy overview of the knee.  I then moved on to the most common type of knee pain- lateral knee pain.  Anterior knee pain is the second most common knee injury I see in the clinic.  As the image below demonstrates, anterior knee pain (in red) can include the area above or below the kneecap, under the kneecap, or any combination of these.  Medial knee pain (in green) is usually the inner edge of the knee and can be a little above or below the actual joint line.

anterior knee pain

sites of medial & anterior knee pain

This is where internet diagnosing becomes more problematic.  So let me start by saying that what follows is most appropriate for runners who have not had an “event” like falling, tripping, hitting your knee etc. that resulted in immediate knee pain with swelling and/or bruising.  Additionally, if your knee has a painful click, pop, locking sensation, feeling of instability, or other feeling that’s “not right” – you should go to have your knee looked at by a physical therapist or other knee specialist.  Those symptoms are the signs of something more significant like a meniscus or ligament injury.  Knees that pop, click etc. without pain are typically not something to be concerned about.

Whenever someone describes knee pain located above or around their kneecap, I immediately become suspicious of this person’s quad flexibility.  A tight quad will lead to improper patella tracking and eventually pain.  When the subject of patella tracking issues come up, it’s common to hear medical professionals recommend strengthening the vastus medialis oblique (VMO) muscle.  This is outdated information.  Unfortunately, there are still websites and people that give this advice.  While you won’t hurt anything or make the problem worse by doing these exercises, there are more effective strategies to correct this type of knee pain.

The first thing I have people do is work on stretching their quads.  By that I mean REALLY stretching their quads- not just grabbing their foot and bending their knee for a few seconds.  I recommend the following “lunge stretch”.  It focuses on the quads and hip flexors.  There are two versions to this stretch.  If you’re not very flexible, start with the left image.  Once you begin noticing some improvements, you can try the more advanced version on the right.

  • Begin by kneeling on a knee-friendly surface next to something that can be used as upper body support, preferably something on both sides
  • The opposite leg goes forward in a lunge position, arms/hands holding on to a stable surface allows your lower body to relax more
  • Keeping your head up, torso upright and hips facing forward, slowly move your hips forward and down until you feel a stretch along the front of your thigh of the kneeling leg
  • HERE IS THE IMPORTANT PART!  Hold this stretched position for 30-45 seconds.  Yes, it seems like forever.
  • Repeat other side then alternate back and forth three times each side
  • To make the stretch more intense, grab your foot or shoe and slowly bring your foot up toward your hip

 

Shortly after stretching has been incorporated into a person’s daily routine, the next step is to begin strengthening the running specific muscles.  Again, refer to Knee Pain Part 2 for descriptions of these exercises.  The above stretch, combined with hip and hamstring strengthening has helped many people.  If this stretch does not seem to help within a couple weeks of consistent effort, seek help from a medical professional.  As always, please send any questions along to me if anything is unclear.  Good luck!!

***This blog is intended for information purposes only.  It is not intended to diagnose or treat any injury.  Please consult with your doctor or physical therapist if you have any knee pain and prior to beginning any exercises or treatment plan on yourself or others.

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On Sunday, I ran in the first annual Sleepy Hollow Mountain Race.  This race is the first of six in the USATF New England Mountain Running Series, with other races in Vermont, Massachusetts and New Hampshire.

S.H. Mtn Race

The race was co-organized by 2011 U.S. and World Mountain Running Champion Kasie Enman and held in her back yard (literally) on the trails of the Sleepy Hollow Inn and X-C Ski Center.

With the preceding two weeks of wet weather here in VT, it was expected that the 10K course would be on the muddy side… and muddy it was!!  There were sections of ankle deep mud and saturated meadows that looked dry until you ran through them.  There were also sections of runner friendly single track and wide grassy trails.  Oh, and hills.  There were a few hills to run up, and down.  After all, it is part of a mountain series.

Uphill Start

Uphill Start

The race started with a climb for the first 9/10 of a mile to the highest point.  To make things interesting, there was a special prize (VT Maple Syrup of course) for the first man and woman to reach the top of the first climb.  The entire second mile was downhill.  This is where we encountered some of the first serious mud of the day.  Mile three sent us back up hill rather abruptly for the longest climb of the course.  Just over a mile long, the second climb continued with the muddy-trail motif.  Mile four sent us back down hill, this time on some drier terrain.  Mile five offered a little more single track, less mud and less climbing.  Mile 6 was all down hill again along a wide soft grassy road that let you enjoy the run instead of deciding where and where not to step.

Choosing an aggressive soled shoe for this course was very important.  I decided to wear my Inov-8 Oroc 340’s because of the giant lugs on the bottom and because I converted my Talon 212’s into road shoes by shaving the lugs off them.  I noticed that the Inov-8 Talon 212 was a popular choice for this race, as was the Roclite 295. As a Physical Therapist, I really like the Inov-8 brand.  I think they have a great philosophy and design.  I was curious to see what other styles of Inov-8 were at this race.  Here’s what I found.

X-Talon 190

X-Talon 190

Roclite 295

Roclite 295

Terafly 303

Terafly 303

F-Lite 230

F-Lite 230

Oroc 340

Oroc 340

I noticed that even Scott Mason, the race photographer had Roclites on.

Race Photographer Scott Mason

The race photographer – Scott Mason

There were 136 runners at this years race and ZERO injuries that required medical attention!!  Overall it was a great day!!

Kasie

Kasie

A much deserved rest

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IT band syndrome and IT band friction syndrome are two common diagnoses that mean the same thing for lateral knee pain.  I know first hand how painful and annoying this type of knee pain can be.  Years ago, I was on a run two days before a big race when I started feeling a slight pain along the outside of my left knee.  I figured it would go away.  But within five minutes it had progressed to a very sharp pain, like a knife was being jabbed into the outside of my knee every time my foot hit the ground.  I had to stop and walk home.  Over the next two days, my knee felt tight & sore and stairs remained painful to walk down.  After a few days of rest I tried running again but the pain returned, this time more quickly.  A trip to the knee doc and an MRI only intensified my frustration.  He said there was nothing showing up in the MRI.  And his advice – my blood pressure still goes up even thinking about this –  ”I don’t see anything wrong with your knee.  Maybe you just shouldn’t run so much.  Do you like biking?”  WHAT!!!!!?????  Are you kidding me!?  I couldn’t believe THAT was his answer.  Fortunately, I was half way through the Physical Therapy program and eventually figured out that I had IT band syndrome.  So I’m always very excited when I can prevent other people from having that same frustrating experience.

Like I said in part 1, there are always exceptions to types of knee pain.  Not everyone will have the exact same intensity of pain that I had.  Also, there are other causes of lateral knee pain (see disclaimer below).  But for runners who haven’t fallen or had some other traumatic knee injury, IT band syndrome is usually the problem.  Below is an explanation, beginning with a self-assessment to help you better understand what’s going on.

Start by standing in front of a mirror with shorts on so you can see our knees.  Stand relaxed and look at your kneecaps.  Do you see one or both oriented somewhat inward instead of straight ahead?  In an extreme case, a person might even notice their knees are closer together than their feet. Next, you’re going to tighten your glutes, AKA: squeeze your butt muscles (not with your hands, I actually had a guy do that once) – watch what your knees do – they’ll slightly rotate laterally to the point where your knee caps are now facing more forward.  Tighten and relax your glutes a few times and you’ll see your knees rotating in and out.  As you’re tightening your glutes you’re externally rotating your hip, which directly affects your knee orientation.  If your knees face inward when you stand relaxed, then the hip external rotator muscles that should be maintaining the alignment of your hips have become weakened.  This leads to knee pain.  So when you need your muscles to support your hips in the proper position while running (which is much more demanding than standing), they eventually fatigue to the point where they can no longer do their job.  This is why your knee pain doesn’t set in until you’ve run a few miles.  Over time, the distance you could run would lessen, stairs would become more painful and eventually you’d have knee pain all the time.

Side view of the knee

Side view of the knee

What’s causing my knee pain if the problem is in my hip?  The IT band starts at the hip as a wide tendon where it attaches to the hip bone (Ilium), the glutes and a small muscle called the tensor facia lata (TFL).  It runs down the outside of your thigh to just below the knee, attaching to the tibia.  This is why it’s called the “IT band.”  It connects the ilium to the tibia.  As the IT band approaches the knee, it rubs against the lateral condyle of the femur (see small image).  I like to use the car front-end alignment analogy to explain this:  If the alignment is off in a car, the tires wear more quickly.  The problem is not the tires, it’s the parts that align the tires.  In our knees, the IT band pain is the same as the worn tires, just a symptom of the root problem.

IT Band

IT Band

How is this related to running?  Think of your knees as simple hinge joints, similar to a door hinge.  They can only go forward and back.  Our kneecaps point in the direction that the hinge is facing.  So if you’re running forward you want your knees to flex straight forward and back, not at an angle.  If your knee is rotated inward, the friction of the IT band on the lateral condyle is greater and things become irritated, especially during repetitive movements like running.  When you see runner’s with their feet kicking out to the sides when they push off, you’re seeing the poor biomechanics of hip internal rotation in action.  They probably have painful knees.

How did this muscle weakness happen?  The short answer is sitting.  When we sit for hours at a time, the muscles are not active.  The use-it-or-lose-it philosophy rings very true here.  Over time, the muscles become more accustomed to being at rest and lose their strength.  I’ve noticed a trend when I talk to people about this subject.  The knee pain usually starts after about 5-6 years of working at a desk job.  Unfortunately, you can count graduate school as a sit-down job.  Incidentally, sit-stand work stations are becoming more popular and I strongly encourage people to consider those if they’re stuck behind a desk work.

How do I fix it?  The permanent fix is to re-strengthen the hip external rotators.  I’ll describe a few exercises below.  In the mean time, there are a couple of things to try that might give some temporary relief.

You can never go wrong with putting ice on the painful area.  This will help decrease any swelling and pain.

Many people try using a foam roller on their IT bands.  That works, but it can be quite uncomfortable and not everyone has positive results.  In the clinic, I do a manual technique called the IT band release.  The closest thing I can describe that a person can do on their own legs is to work up and down the outside of your leg (4-5 times) pressing down and twisting, similar to how you’d open a medication bottle.  You do this WITHOUT any massage cream or lotion.  The idea is to get the layers of fascia, muscle and connective tissue to move independently of each other under the skin. It will feel like a dull ache as you apply pressure.  You can have another person do this for you as you lay on your side, just be careful because your leg will be very sensitive the first few times.  If done correctly, when you stand up and walk around after, your knees should feel lighter and easier to move.  This usually carries over to running.

Exercises: A person will benefit from any exercise that involves hip extension.  I encourage people to avoid machines and do functional exercises.  Functional exercises are more dynamic, require balance and often include the core.  That being said, some functional exercises will be too advanced for someone with significant hip imbalances.  Below are some good basic exercises to start off with.

Standing hip Extension:  Start with a thera-band or cable machine passed under your foot and the handle or loop around your heel.  Stand tall with knees slightly bent.  Without tipping forward or bending your knee, extend your leg backward 1-2 feet (don’t strain to achieve more movement).  Hold for 1 second and SLOWLY return to start.  Try to stay balanced on one foot the entire time as you do 12-15 repetitions.  You should feel your low back, glutes and hamstrings working.  Repeat other side.  Alternate sides, doing 2-3 sets each side.

Standing Hip Extension

Standing Hip Extension

Hamstring curl on a ball:  Lay on your back with heels on an exercise ball and arms out to the side for balance.  Lift your hips up so your body is in a straight line through your knees, hips and shoulders.  Bend your knees and roll the ball toward you with your feet until your knees are bent to about 90 degrees.  Keep your knees, hips and shoulders aligned the entire time.  At this point, you may feel like most of your weight is on your shoulders and upper back.  SLOWLY straighten your knees returning to the start position.  Repeat 12 times, 2-3 sets.  If you have trouble lifting your hips all the way, raise them as high as you can and avoid touching the floor when you straighten your knees.

Hamstring Curl On A Ball

Hamstring Curl On A Ball

Ball squat:  Place an exercise ball against a wall and lean against it with your low back.  Feet should be ~12-16 inches out in front of your hips.  Keeping your back straight and your weight on your heels, SLOWLY squat down as far as you’re comfortable, not letting your knees bend past 90 degrees.  If your knees go out beyond your toes, move your feet forward so knees are above the middle of your foot.  Push through your heels and straighten your knees.  Do not bend forward as you press up and do not let your knees quickly snap straight.  Repeat 12-15 times 2-3 sets.

Ball Squat

Ball Squat

Step Up:  A small weight (3-5#) is helpful in this exercise.  Start with the weight in your right hand and your right foot on a 5-8 inch step.  Step up on the right foot and simultaneously raise the weight straight up and lift your LEFT knee to hip height (as if a string was attached from your right elbow to your left knee).  Hold for 1 second.  Lower back down.  Repeat 12 times.  Switch the weight to left hand, place your left foot on the step and repeat.  Alternate sides for 2-3 sets.

Step Up

Step Up

In the next knee pain post I’ll be talking about anterior knee pain.  The type of pain that feels like it’s under your knee cap or just above or below the knee.

Have you experienced this type of knee pain? Has this post been helpful? Feel free to ask specific questions in the comment area!

Please let me know if any of the exercise descriptions are unclear and I’ll try to fix it.

***This blog is intended for information purposes only.  It is not intended to diagnose or treat any injury.  Please consult with your doctor or physical therapist if you have any knee pain.  Please consult your doctor or physical therapist prior to starting any exercises or treatment plan on yourself or others.

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