Body and Spirit

Knee Pain

Three Angels Broadcasting Network

Program transcript

Participants: John Leaman, Dick Nunez, Greg Morikone

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Series Code: BAS

Program Code: BAS000057


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.


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Revised 2014-12-17