Participants: John Leaman, Dick Nunez, Greg Morikone
Series Code: BAS
Program Code: BAS000057
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00:15 Ever experienced knee pain?
00:17 If you have, you definitely want 00:18 to stay tuned to Body & Spirit. 00:49 Hello, I'm Dick Nunez, Wellness Director 00:51 of the Black Hills Health & Education Center. 00:52 Welcome to Body & Spirit. 00:54 Today, we're going to be talking about knee problems. 00:57 I've seen so much of that in my career, 00:59 people have trouble getting around or you'll have people 01:01 come into you all the time saying, my knee hurts, 01:04 and they want to know why and where and how. 01:06 So we're gonna talk about a few different things today. 01:08 We're gonna talk about how we can correct that, 01:12 but we'll also identify what causes 01:14 some of these problems and what are the most 01:16 common causes of knee problem. 01:17 So this is going to be a program that all people 01:20 can benefit from, whether they're very young 01:22 and want to avoid knee problems, or if your knees 01:25 are already very painful and you're wondering 01:26 what you could possibly do to get 01:28 yourself up and going again. 01:29 We'll be able to help you out. 01:31 So if you're ready, let's get started. 01:33 Today, we're going to be helped out by Greg and John. 01:40 And we have our chairs here again, 01:42 but we're not going to jump right into them yet. 01:46 So don't get comfortable, 01:47 we're going to still stand up. 01:48 In fact, we're going to just loosen up 01:50 our shoulders, just swing around a little bit. 01:59 And then, we haven't done push ups for a while, 02:03 so we're going to do a few of those today. 02:05 We've been anxious to do that. 02:08 Okay, and let's reverse it and go the other way. 02:17 Okay, good, now, we have a chair here, 02:20 so we're going to do a modification 02:22 of a push up as if we had a wall. 02:27 And Greg, we're just gonna let you get on the floor. 02:32 But what we're going to do with you, 02:33 John, is we're going to have you do a modified push up. 02:35 You're gonna do a push up here and I'll block 02:37 the chair, so you don't flip over. 02:41 Okay, just go ahead and do some push ups. 02:45 Now you can also use a wall 02:48 and John's using the chair here 02:50 which makes it quite a bit easier for him. 02:54 While Greg is just doing straight forward push ups. 02:57 Okay, Greg, go to your knees 02:59 and do it as a female style there. 03:02 Now when people do this type of push up, 03:04 automatically they think that what they need to do 03:07 then is put their hips way in the air. 03:09 So, Greg, I want you to do that. 03:11 Okay, like that, now this is improper, 03:13 you don't want to do that. 03:14 You see how John's line is nice and straight. 03:17 Okay, Greg, go back and do it properly. 03:18 Now, you see his back into a straight line. 03:21 Okay, go back and do regular push ups again. 03:26 Now, they look a little slower this time, 03:28 Greg, than they did the first time around. 03:31 John, you're doing okay? Yeah. 03:33 Okay, good, good. 03:34 Well, that's enough of that for you. 03:35 You can get down on the floor now. 03:38 Aha! Okay, go ahead. 03:47 Also, if your push ups become easy, 03:49 you can do them slower. 03:50 Are you starting to get tired, Greg? 03:51 Okay, let's do 10 more. 03:54 One, two, three. Oh oh! They're both getting tired. 04:00 Okay, that's good. Okay. All right. 04:06 Good determination. Good, good, good. 04:10 All right, let's go ahead and stretch the chest back. 04:18 You're tired already? Okay, bring it across. 04:25 And then back again and bring it across. 04:32 Good, okay, what we're gonna do today is, 04:39 we're just gonna -- we're going to bend over, 04:41 we're going to draw our elbows back like that 04:44 and then trying to flare our back out 04:45 as we come forward. 04:47 So we're flaring out, and flaring out. 04:52 Good. Okay, what we're doing here is we're just pulling 04:56 the elbows back, good, and then we're going out. 05:00 So you feel the contraction here of the scapula, 05:04 reach out, you feel it stretching the lat area. 05:10 Good. When you come back, arch your back a little bit, 05:14 so you squeeze the shoulder blades and then 05:15 when you go out, you will flare. Good. 05:20 So we get the range of motion there 05:22 and the stretch of latissimus dorsi 05:24 and you're squeezing the major muscles 05:28 between the shoulder blades there, 05:31 and reach way out and act like 05:35 you're pulling something. 05:36 Good. Then push the muscles out. 05:42 Now we've already discovered that 05:43 just by flexing muscles hard, we can get 05:46 a good stimulation and effect on the muscles, 05:49 without even having to use resistance. 05:56 Many remember, Charles Atlas back 05:57 in the 40s and 50s, who made a lot of money off 06:02 of his concepts of dynamic tension 06:04 by just using muscle against muscle. 06:06 Most of his exercise were just isometric in origin, 06:10 well we do range of motion on ours. 06:14 Okay, good. Okay, let's stretch the back out now. 06:24 Okay, and switch it and we're going to hold 06:29 each stretch for about 10-15 seconds. 06:33 Okay, good. Okay, let's do a little shoulder training. 06:38 I want you guys go ahead and sit in the chairs there. 06:45 And I want you to bring your hands up into this position. 06:48 Okay I want you to alternate pushing and arm up. 06:59 Often times, it's good if you work out with somebody 07:02 and they can help you with that, so for example, 07:05 on this exercise, if I'm working out with Greg 07:07 and he's pushing, I can actually give him some 07:11 added resistance and make it more difficult 07:13 for him or of course, we can use weights as we do this. 07:22 Okay, keep that going. 07:29 Okay, now go down to the side. 07:31 Do some lateral raises out to the side. 07:35 Once again you can help the other person out. 07:40 I'm giving -- I don't know is this 07:41 helping you out, I'm not sure. 07:47 We'll give him a little resistance or once again 07:49 we can use some dumbbells to make them more difficult. 07:55 Okay, just hold your arms out to the side. 07:57 We're going to hold that contraction for 30 seconds. 08:03 You should be able to feel that 08:04 in the deltoid area there, you might feel 08:06 a little burning and discomfort, that's okay. 08:09 I don't want to get too intense. 08:11 We do these static holds because it really 08:15 helps to accentuate the effect especially after 08:18 you've done a range of motion workout. 08:20 Now we hold that static statically we get 08:23 an even better overall effect on the muscle area. 08:26 Okay. We've got about 10 more seconds to go. 08:32 Make sure you feel it there. 08:36 Four, three, two, one, good. Okay. 08:41 Bring your arm across, let's stretch the deltoids, 08:49 and you should be feeling it stretch 08:51 very nicely onto this area. 08:55 Okay, switch over. 09:03 Okay, very good, okay, from a seated position 09:07 I want you to just brace the palm of right hand 09:12 on the front of your wrist and curl up and try 09:15 and give yourself enough room that 09:16 you can go down to a full range of motion. 09:23 This will give you little variation, allow you to do 09:26 the exercise in a seated position. 09:28 There are benefits from doing exercises seated 09:32 because it gives you a stability of your low back. 09:35 If you do an exercise standing up, 09:37 people can tend to strain too much leaning back 09:39 too much and they'll get hurt. 09:40 In this case, when you're sitting in a chair, 09:42 it's very safe to go ahead and do an exercise 09:46 and actually put a little effort into it. 09:49 We're doing that here. 09:53 Okay, let's go five more. 09:57 It's important to try and keep the palm up 10:01 and even turn the hand out a little bit 10:04 as the biceps function that actually curls the elbow, 10:07 but also supinates in terms of palm up. 10:11 Okay, let's switch to the other side. 10:13 Okay, you wanna brace, there you go. 10:21 Once again, the harder you go, 10:23 the more you're gonna get out of this. 10:27 You wanna push down hard, give you 10:29 some good resistance on the way up. 10:32 Good. You're really working, 10:35 still should be able to feel it. 10:41 Okay, let's go five more. 10:48 And two more. Okay. 10:53 Now we can focus over here on John, 10:56 I'm going to do like a buddy type workout 10:59 for the tricep area, want you to just 11:01 fold your hands like this, John, put them up 11:03 over your head, okay, and you're gonna 11:07 resist against me coming down. 11:10 Okay, now back up again, then back down. 11:14 You can do this with no resistance at all. 11:17 I'm just showing what you can do if you have 11:21 somebody who will work with you 11:22 and as I've mentioned on several occasions, 11:24 it's always good to have a workout partner, 11:26 if somebody's working out with you, 11:28 you can get even better workout still. 11:30 And it helps also for accountability. 11:36 Often times if somebody doesn't feel like doing it, 11:38 they have a workout partner, that workout partner 11:40 can help carry them through a workout 11:41 and then another time the other person 11:44 may not feel like it and the same happens, vice versa. 11:46 I found in life that most of the time both partners 11:50 don't come to the gym feeling like they don't want 11:52 to work out, usually one of them is ready to go. 11:58 And another thing, of course, that I find 11:59 is most people do workout 12:00 they feel so much better after that. 12:05 Okay, we're going to do three more, John. 12:11 And one more time, fight it hard, 12:14 come over here and push it down. 12:15 Good, good, good, good, good, excellent. 12:20 Okay. Did you feel that? 12:22 Good, you wouldn't want to do 12:23 much push ups now, would you? 12:24 No. Okay. 12:26 We're going to focus now on knee problems. 12:30 Knee problems take on lots of various dimensions. 12:35 When somebody says, they have a sore knee, 12:37 the first question I usually ask is, 12:38 where does it hurt at? 12:40 When you do have knee pain, if you decide for 12:43 where that's at, it makes a big difference 12:45 on how you would attack the problem. 12:47 So I don't know if we can get a focus over 12:49 here on Greg on the knee area. 12:51 In fact, why don't you stand up 12:52 for a moment there, Greg. 12:54 When we look at the knee, is a way 12:56 we can zoom in there a little bit. 13:01 The muscles of the quadriceps, 13:04 the vastus medialis and the vastus lateralis 13:07 are the main muscles that sweep down into here 13:10 and then they cross over in the patellar tendon. 13:13 and come down to the patellar ligament 13:15 as it crosses over the joint. 13:17 So if somebody comes to me and says, 13:19 I have pain right -- right in here, 13:24 on the side of the knee, towards the center, 13:26 then often times that's a cartilage. 13:30 I gave lot of information there or it feels like 13:32 it locks up on them all of a sudden. 13:34 There's a semi-lunar shape tissue in there, 13:37 the cartilage, and if that gets inflamed, 13:40 it starts to cause problems. 13:41 If it is out further on the outside, 13:43 then it's going to be a ligament 13:45 usually causing this pain. 13:47 Once again we're not trying to diagnose anything, 13:50 we're simply assessing some of the things 13:53 that might be going wrong here. 13:54 Sometimes people will feel a swelling in the back 13:57 of their knee which should be bursal sac 13:59 or some inflammation in there and it's 14:01 the body's way of trying to get 14:02 the person to restrict their movement. 14:04 Tendonitis is very common, up into the top area here. 14:08 This patella tendon will get sore, patellar ligament 14:11 can get sore, so that's a very common problem 14:15 that people will have at their knees. 14:16 One of the worst things that we hear happening 14:20 is ACL problems, anterior cruciate ligaments. 14:23 Sometimes you see a football player or somebody 14:26 hits them from the side, their knee goes out 14:29 or their leg goes out at a very strange angle 14:31 and they tear those ligaments under the knee cap 14:35 to cross to add stability to the knee 14:37 and then they have to go onto a surgical repair. 14:40 One of the common things we hear about 14:42 is a condition called chondromalacia, 14:44 which is simply a roughness under the knee cap 14:47 caused by improper tracking of the quadriceps muscles. 14:51 So when people talk to me about knee problems 14:54 or say that they have the roughness or a bad tracking 14:57 under the knee and they really don't know 14:58 what that is, but what I have them do is 15:00 tense their muscle hard so put your leg out straight, 15:03 Greg, and flex the leg hard and then what I do is 15:08 I assess the medialis and the lateralis 15:11 of the quadriceps group and see 15:13 if one feels dominant over the other. 15:15 Unfortunately, often times you'll squeeze 15:17 in this area and you don't feel anything, but mush. 15:20 It's not because they don't have muscle there, 15:22 they're there, there's just, 15:23 there's no tone left to them. 15:24 So when you feel down here, then you feel 15:26 absolutely nothing except tissue, soft tissue, 15:31 emphasis on soft and they really can contract anything. 15:35 That means there is no stability coming down here. 15:38 Some of the top athletes or body builders 15:41 or power lifters or football players, 15:43 you'll see their quadriceps come sweep down 15:45 and come way down into their, towards their knee 15:48 and it just engulfs the knee with muscle 15:50 and allow these athletes to get here occurred 15:52 a lot of worse because they 15:54 did not have that great stability. 15:55 Another thing we find is if one side is more developed 15:59 than the other, then the knee cap 16:01 is going to pull to that side. 16:03 So if the vastus medialis is much larger 16:05 and the lateralis isn't as well developed, 16:08 then it's going to be pulling the knee cap 16:09 towards the center, thus it's not gonna be 16:11 tracking properly, and if we simply get them 16:14 doing an exercise routine to try and emphasize that 16:17 other area, then we can get some good effect to that. 16:21 So we're going to try and act like we have got 16:24 some problems here and trying to address it 16:27 from there with the time that we have left. 16:28 So the first thing we're going to do, Greg, 16:32 is we're going to have you lay on the ground. 16:33 In fact, I'm gonna go ahead and have 16:34 both of you guys do that. 16:36 Go ahead and lay on the ground there. 16:41 And we're going to act like you've got bad knees, 16:44 you're going to be looking to go into surgery 16:46 or you're coming out of surgery, 16:47 you need to get started on an exercise program. 16:49 So what I want you to do is put one leg straight, 16:52 it's okay to keep the other one bent. 16:54 Okay, now I just want you to lower it down, 16:56 touches barely off the floor and back up again. 17:01 Okay, keep going. Okay, go a little bit faster. 17:09 I want you to do ten of those. 17:13 This is just a straight leg raise and it's going to help 17:16 the connective tissue of the knee to help stabilize that. 17:21 Okay, bend the knee just slightly. 17:28 Okay, raise up and down. 17:30 Remember, the various tissues that we're dealing 17:33 with are the cartilage, which is the tissue 17:36 in between the joint to add cushion and support. 17:39 And we're dealing with ligaments, 17:40 which connect bone to bone and then 17:42 we're dealing with tendons, which are going to 17:44 connect the muscle to the bone. 17:46 Okay, bend it just a little bit more. 17:48 Okay. Now, we're going to keep the knee 17:50 the same bend the whole time. 17:52 You do the raise, you're keeping the knee 17:53 the same bend the whole time, 17:55 just focusing on the raise. 17:58 Okay, you feeling that on your thigh a little bit. 17:59 Okay, even those are very simple exercise 18:02 people will feel this in those areas and some 18:06 excellent way of starting rehabilitation, 18:08 because we're not extending the knee 18:10 at all we're simply holding it in a static position 18:12 while we do the raising. 18:14 Okay, let's go the other leg. 18:15 Just make the leg straight and go up and down, 18:18 keeping it nice and tight. 18:22 Good, good, it's important to understand that, 18:28 let's say for example both John and Greg 18:30 had just had their right knees operated on 18:32 and so the right knee was the first leg we did, 18:35 because that's the one they so desperately 18:37 want to rehabilitate, but even after they get done 18:40 with that, it's important to still do the side 18:42 that has not been operated on, just to keep 18:45 the balance as we go through the exercise. 18:47 Okay, let's bend the knee slightly. 18:51 People often times neglect that, where especially 18:54 if they're looking to try and get back to where 18:56 they have some type of muscular balance 18:57 between their sides, thus simply do the one area. 19:00 But it's important to do the other area as well 19:03 to work on the balance of the muscular strength. 19:06 As we do this particular exercise, we're really 19:08 focusing on not extending that knee out, 19:11 we're just keeping it in a locked position, 19:13 and that's a very important component to this exercise, 19:16 and it can be difficult, the natural tendency 19:19 is to extend it, that's okay. 19:21 Now bent it just a little bit more. 19:22 Okay, let's do ten more. Good, good, keep it going. 19:33 Okay, two more. Okay, good. 19:37 Okay, let's go and come back up to the feet. 19:43 Okay. One of the exercises I have people do a lot 19:47 to also help in this rehabilitative process 19:49 is called the wall sit, now we're not close enough 19:53 to a wall to do that, but I know you guys 19:55 can act like you're sitting against the wall 19:56 and just do without it, right, okay. 19:59 So what you're going to do is you're just gonna, 20:01 you're gonna just squat down and although 20:03 you're gonna have to be bend forward just a little bit 20:04 because you're not going to be in front of a wall. 20:06 I want you to just squat down and hold your position. 20:09 Okay, remember, we're going to still do it properly. 20:13 If you're on a wall, then you're gonna be able 20:14 to sit back into it, we cannot do that 20:17 because we can't counterbalance. 20:18 But I want you to go down a little further, okay, 20:20 now if you're just doing the rehab, 20:22 you might just go just a little bit, go to that spot 20:26 where you're just trying to feel a little bit, 20:27 but you don't want to go into the discomfort spot. 20:29 Go down and static hold, now, if you just looking for 20:33 preventative measures, then you can go ahead 20:34 and squat down further, just go ahead and get down, 20:37 down, down, down, okay, okay and just hold it there. 20:42 Okay, get your -- there you go. 20:45 Why are you cheering here? 20:46 You wanna enjoy every second of this. 20:49 And when you do a wall sit, a minute is good. 20:55 We're not gonna do that, cause you're not sitting 20:56 against the wall, we'll keep track of you here, 20:59 let's go 10 more seconds, it'll be okay there. 21:03 Now actually this is fairly easy for them to do, 21:06 but we just did some leg exercises 21:08 so it makes them more difficult. 21:10 Okay. Now, we got three more seconds. 21:17 All right, now go and lay face down on the floor there. 21:24 And I want you to curl your legs up. 21:26 Good, and back down. 21:30 Okay, we can do this in various ways. 21:33 If we have a partner, you can use a towel 21:36 or you can just use it manually and you can give 21:39 them some resistance coming up and down. 21:41 What we're doing here is we're simply giving 21:45 the antagonistic muscles some work as well. 21:48 Remember, in a joint, there's going to be 21:53 two sets of muscles involved, 21:55 there's going to be the contracting muscles 21:56 and the antagonistic muscles as well. 21:58 So in this case in the knee, the quadriceps 22:02 extend the leg out, they extend the knee, 22:05 the hamstrings flex the knees, 22:07 so we try and do both areas. 22:08 You can do a little variation to this. 22:10 Let's alternate now, curl one leg and then the other. 22:13 Okay, well one's going down the other one's coming up. 22:19 And try to contract your hamstrings 22:21 as you're doing the exercise. 22:26 Okay, keep it going. Let's do about 10 more. 22:30 Okay, just a little bit faster, John. Here we go. 22:39 You guys are losing your synchronization here. 22:44 Okay, five more. 22:47 It's one, two, 22:51 three, four, and five. 22:56 Now while you are in that position, 22:58 put both legs down on the floor, now I want you to 23:01 raise one leg up, keeping it straight, 23:03 okay and down, okay, just go up and down that way. 23:07 Now this is also going to work the hamstring area. 23:09 Let's just do one leg, just stay on one leg, John. 23:15 This will also work the hamstring area and also 23:17 bring the gluteus maximus into play 23:19 as we contract up at the top. 23:25 Yes, keep it going. 23:29 Let's do 10 more, one, two, three, 23:35 four, five, good, six, seven, 23:43 eight, nine, and ten. 23:47 Okay, switch to the other side. 23:52 Again, I can emphasize enough how important 23:54 is to try and keep both sides equally strengthen up. 24:04 When you do an exercise, it doesn't have 24:06 weight resistance, then it makes even more of a key 24:10 for you to be able to feel the muscle as you work. 24:13 And often times when people do workout, 24:16 they tend to use too much weight and they don't feel 24:18 the exercise properly when they reduce the weight 24:21 and they can feel it much more effectively. 24:23 Okay, ten more, there's two, 24:25 three, four, feel that contraction each one, 24:30 five, six, seven, eight. 24:35 Two more, nine and ten. 24:39 While we're in the position still we're going to 24:40 finish off the contractions here. 24:42 We're going to put the hands behind the back 24:43 and now we're going to do some low back work. 24:45 Up and down. 24:51 The body all ties in together so we're just 24:53 working our way right up the line here 24:55 and the low back will also help with 24:58 the stability of strength. 25:04 And let's do five more. 25:10 Three more. 25:13 Okay, now over on your backs. 25:17 Just go into the crunch position. 25:21 Hands behind the neck. 25:22 Okay, let's do some abdominal crunches. 25:26 Chin up as you come up, good, 25:30 focus on the abdominal wall. 25:40 John's wondering what it feels like to have me 25:41 stand on his abdomen, I can tell. 25:46 Okay, keep crunching it. 25:50 Focus on the abdominal muscles each time 25:52 and you can also tip your pelvis up a little bit 25:54 give even a little more of an effect as you crunch up. 26:02 Okay, let's do ten more. 26:08 You notice as they're doing this, 26:09 they're contracting abdomen in, 26:11 they're not pushing out at all, 26:12 it's so important to breathe out and contract in. 26:15 That will encourage the abdominal wall 26:17 to stay nice and flat we don't want to protrude it. 26:24 Okay, good, up. 26:29 Okay, let's do some trunk rotation. 26:34 Turn, I notice we don't just bounce these around. 26:38 We simply constant doing good stretch and turn. 26:46 One more time. 26:52 Okay, good. Thanks a lot, fellows. 26:57 There's no magic to make the knee better, 27:01 but with consistent exercise and knowing 27:03 what you're dealing with is always helpful 27:05 to have a doctor diagnose what the problem is 27:08 and then the therapist who is working with you, 27:10 can help you by setting up the exercise program 27:13 that can be best suited for working that area. 27:16 I want to once again reemphasize that simply by 27:19 having an imbalance of muscles down 27:21 the quadriceps region, if one side is dominant 27:23 over the other, that's been a major cause 27:25 of so many people's knee pain. 27:27 As they walk improperly or they just feel that 27:29 discomfort starting developed and it 27:31 encourages them not to do anything. 27:32 And then of course over time, 27:34 quadriceps get weaker and their knee pain is enhanced. 27:39 So by doing regular exercise we can 27:41 maintain a good level of strength. 27:44 Remember, we can do all things 27:45 through Christ who strengthens us. 27:47 God bless and we'll see you next time. |
Revised 2014-12-17