 or knee pain when you bend, run, or go up and down stairs? How about hip or low back pain when you're simply walking or getting up from a chair? Aloha and welcome to Movement Matters. I'm your host Christine Linders, physical therapist and board certified orthopedic clinical specialist. My show is designed to bring you not only the most effective physical therapy tips, but also holistic information to help you achieve total body wellness. Today, I'm going to teach you simple tips and strategies to correct how you move when you walk to decrease your pain right now. Also, you will learn quick and easy home stretches and exercises for each of these areas to end your pain. You might not know that how you point your foot when walking affects the joints above at your hip, your knee, and your low back. If one foot is turned out, you can be setting your body out for plantar fasciitis, Achilles tendonitis, knee pain and injury, hip bursitis, and even low back pain. Here's why. So when you stand and your feet are symmetrically pointed forward, something that's called the chain reaction happens efficiently when you walk. Your heel hits the ground, your toes hit the ground, your arch collapses slightly, the bone in your shin rotates inward, the bone in your thigh rotates inward, and your powerful gluteal muscles fire and they stabilize your pelvis on that leg. I know that sounds like a complicated concept, but it's really important if you want to avoid plantar fasciitis, Achilles tendonitis, knee arthritis, and hip arthritis, which can also lead to low back pain. Let me give you an example. So I know a woman who is 77 years old right now, actually 78, and she walks with a very crooked knee and it's identifiable. And one of the things she suffered with since she was, I think in her 50s, was painful bunions on her foot. And this one was the worst one. So to avoid the painful bunion, she tended to walk with her foot out. Not that that helped, but it kind of was what the body said to do. When you walk with your foot out, your arch collapses too much. Your shin bone rotates too much. And since you're walking forward, your thigh bone rotates more, but not too much so that you get this little twisting at your knee. So one bone rotating inward too much while the other one has to go straight because you're moving forward, even though your foot is out, creates wear and tear at the meniscus of your knee, creates wear and tear of the cartilage of your knee and leads to painful knee arthritis. So this same person was having so much pain going up and down stairs. So I suggested that she turn her foot from here with the crooked knee, say here to align that so that the shin bone wouldn't have to dive in so much, creating that twisting at her knee. And of course, she had so much less knee pain. Another problem with walking with your foot turned out is plantar fasciitis. Plantar fasciitis is something that I have had so many complaints of lately. And it's sad because with the shutdown, retirement, people gaining weight from being at home, everybody's trying to be more active now to lose weight, to be more healthy to get moving. And I'm seeing a lot more injuries from walking, which is something that we do on a regular basis. Now, why you can get plantar fasciitis is if your calves are too tight, then your ankle won't bend as much. And then your arch has to collapse more. And then the tissue on the bottom of your foot gets wrung out and twisted. And you get this painful, painful condition I've had it in your arch, in your heel. And how you know it's plantar fasciitis is you get out of bed in the morning after a nice restful sleep, and you step down and your heel comes down and you go, and you hobble your way down to the bathroom in the morning. That's plantar fasciitis. So I have a video right now to show you that will explain one of the best things to do for plantar fasciitis to get yourself out of pain right now. I know rolling your arch over a ball is exhausting, right? Even I want to yawn watching that. But anyway, it's actually quite very soothing. So the fascia gets these little micro tears in it and it forms scar tissue. And if you were to rub your thumb on the fascia on a healthy foot, it would feel kind of smooth. But if you would run your thumb on the arch on the fascia of an unhealthy foot or one that has fasciitis, you'll feel these little bumps. And that's because it's scar tissue forming over those micro tears. Now what the ball does is it irons are the scar tissue, so it becomes smooth again. So a ball like I use is about the size of a lacrosse ball, a tennis ball. I use a golf ball. I've had plantar fasciitis so many times I have extremely high arches and I used to run Ironman triathlons and things like that. So my feet are very mobile and I'm doing a long distance running or was. So golf ball comes with me everywhere I go, but that's one of the fastest way to get a plantar fascia pain right now. Now let's look at video number two, which is the next thing you want to do. Okay, to stretch your calves, it's really important to put one foot directly in front of the other pointing straight and not turned out. So you'll go one foot in front of the other and then you bend the front knee, keeping the back knee straight. You want to make sure that you don't fan your foot out. You want to look down to make sure it's in a straight line. That stretches the one big calf muscle that crosses your knee joint. Then you want to make sure that you bend the back knee to stretch the other big calf muscle that doesn't cross your knee joint. You shouldn't feel any pain during this stretch. Just a pulling back here on the first stretch and a little bit lower. Enjoy your walk. So why I emphasize keeping your foot straight is again when your foot is turned out like it's almost natural for everybody to do when they stretch their calf, the arch will roll in and you end up stretching your fascia more than the tight calf muscle. So you want to make sure that foot is pointed directly straight. So you direct the stretch into the calf muscle so that you can help the fascia not be so strained from having a tight calf. So I have a question. Thanks so much for sending this in. Can foot pain be caused by back problems? The answer to that is yes. And I know because I experienced it when I herniated two discs when I was living in New York City. So I had terrible foot pain and I had weakness in my leg. So my foot was moving in and out like this when I walked in. I didn't even know it. I knew that my leg was getting weak because it was getting skinnier on that one side. And I had a lot of numbness, but I didn't realize how my foot was doing. I didn't feel off balance at all until I started having pain. So your nerve can get compressed in your back from a disc injury or another back injury that will cause irritation in that nerve. And the nerve runs out of your spine down your buttocks, into your thigh, into your calf and all the way down to your foot supplying the muscle. So that definitely is true. And also, should someone complete at least one course of physical therapy before considering surgery? In my opinion, yes. There's exceptions to that rule if you've had a back injury, however. So you do need to go see your doctor and that's who would refer you to physical therapy. But most doctors now are sending people to physical therapy because they're having good results in getting rid of their pain and also getting that education and core awareness and how to bend and move and stretch so that you can maximize the outcomes of your surgery if you actually need it in the end. So that's a great question. So now you've stretched your calves, you've rolled your arch out and that's something you need to do every day a couple times a day. You'll need to ice your plantar fascia before you go to bed. And in the morning, when you wake up, you'll need to move your ankle up and down like this because the reason why it hurts in the morning is as soon as you sleep and you sleep like this. And then you get up and you go like this and you step on it and you re-tear the fascia. So you want to move your foot up and down like this before you get out of the bed. I always say 20 times and all my patients come in and tell me, wow, that's so fantastic. I feel so much better to get in the morning, get up in the morning. And also it's important, especially here in Hawaii where none of us wear any kind of shoes in the house. If you have plantar fasciitis, you need to get a pair of house slippers or shoes or something that has an arch support. I did a previous show where I mentioned Vionics or Scots where they have the arch support. You can see it on the inside. I can even show you, I'm wearing one right now. See this dome right here? You have to have arch support there while you're in your house walking on your hard floor. My patient came in yesterday and said that she finally got house slippers. She doesn't even walk down the hall to the bathroom in the morning without the slippers and her foot is 80% better. So take that to heart and get some house slippers that you can wear inside until you get rid of your painful foot pain. Now let's go to video number three. To strengthen the intrinsic muscles in your feet if you're suffering from plantar fasciitis, you want to curl your toes or curl your toes into a towel or curl your toes into the sand. Here in Hawaii, we have endless stretches of beaches. So a great thing to do is walk and curl your toes around the sand or simply just stand and curl your toes in the sand. But when you are walking in the sand, you want to curl and stretch. I think I'm going to get taken out by a wave here. I was up on the North Shore and earlier in the in the morning the waves were breaking and there were some surfers out there and they were coming up the beach though with the waves. So that was a little funny to do in that video. But yeah walk in the deep soft sand and curl your toes into the sand. Strengthen the intrinsic muscles that run between your toes and in your arch here in the foot and that will help you recover faster from your plantar fasciitis. Okay, let's go on to knee pain. So let's say you have knee pain. It could be on the inside. It could be on the outside. It could happen when you're walking up or downstairs running. It could happen when you go to get up from a chair or get up from the toilet. You could have just torn your meniscus doing aggressive household remodeling and gardening. Whatever it is let's look at video number four to see what you need to do to get pain-free. If you have knee pain all of a sudden or if you have osteoarthritis and you're getting too much wear and tear or you even have a meniscal injury that you just suffered because you were gardening, the first course of action is of course ice your knee if it hurts. Then what you want to do is massage your knee. There's a lot of tissues around the knee. I like sports cream but you just start on the sides. You massage your IT band. You massage your quad. You massage the back of your knee and where your calf comes up and attaches up here like your hamstrings come down attached down here. You massage around the kneecap. I like to take my fingers on either side of the kneecap and go around the patella tendon here. You don't want to push down on the kneecap and grind in there because that can cause pain if you have arthritis. So you massage your knee the back. That's your first course of action. The next thing you want to do is you want to re-educate the quad muscle because if you have swelling it will shut down the inside one. So you want a tense. You press down. You hold it. You can hold it for five seconds, 15 seconds, 30 seconds and relax. If it's too painful to push down you could take a rolled towel put it under your knee and then push down like that even lifting here as long as it's pain-free. And the next thing that you want to work on is restoring your alignment. You want to walk with your foot straight. You want to make sure your knee is diving in and you want to make sure that your hip is not weak which is I'll show you in the next video. Okay so I was stumbling over my words there a little bit. I'm one of those one-take wonders when I do these videos. You want to make sure that your knee is not diving in. That's that crooked knee syndrome I mentioned in the beginning of the show. It's very important that your knee stays over your foot and does not dive in. I forgot that very critical knot in there. Okay so you're going to do that to help decrease your knee pain right now but also if you remember me talking from the beginning about keeping your foot straight now you also have to start working on the alignment of your leg when you walk, when you open downstairs, when you go to get out from a chair. So I want you to if you have knee pain look down when you're standing and see if that foot is turned outward more than the other. It can be very subtle so even my patients sometimes have a hard time noticing it. Other times they look down and say oh my oh my gosh I never knew I was working walking with my foot out. So you want to when you before you go to get up you want to look down at your foot and if it's turned out that painful knee side turn it straight and then go to stand up. If you have stairs in your home and you go to put that foot up look and see is it turned out. I guarantee you it will be if you're standing and it's turned out. Turn it straight and start to improve your alignment. My patient yesterday came in and told me I'd seen him last year and now he's back. He has very severe osteoarthritis in his right knee and his right hip and he's waiting for a joint replacement. But he told me yesterday because I said he was doing so much better. He said you know what I remembered what you said about turning my foot straight and I'm doing it so much more now and it feels so much better and he said he'll never forget when he met me last I think February or March. The first thing I said to him was turn your foot straight. He had terrible pain radiating down his thigh from his hip into his knee and he said it was a miraculous how much that helped with his knee pain. Now he'd been walking like that for years so he got the wear and tear leading to end stage osteoarthritis in that leg yet when he still turns it straight now even though he's going to get a joint replacement surgery he still feels better. So alignment is so important. I want everybody to really grasp that concept. Let's look at video number five. One of the most critical things to keep in mind when it comes to knee health is alignment and your knee relies heavily on the alignment from the hip and the alignment from the foot below. So if you're having knee pain as I see it so frequently in the clinic people tend to be walking and their knee is caving in like this or crooked and there's two reasons why that can happen. It can happen because your foot is rolling in and you're over pronating. Well you can see my foot but the foot is rolling in the arch is collapsing. The other reason is the hip is not strong enough because for various reasons and so the hip is dropping like this when you walk and you can see when my hip drops this hip my knee rolls in here so if I'm standing on this leg and my hip is stable I can do a squat and have alignment perfect. If my hip drops my knee goes in behind the other one so it's very important to strengthen the hip and it's very important to strengthen the foot. The number one reason for over pronation at the foot when your arch collapses is tight calves which I showed you earlier so stretch your tight calves. If your arch is weak use strength in your arch and if your hip is weak then you do these next exercises. Okay so let's go straight into video number six to see the next exercises for your hip. There are many ways to strengthen a weak hip. Here are just two of my favorites. It gets the gluteus medius which is the muscle that's responsible for keeping your hip and your pelvis stable when you're on one leg. So you're gonna put, this is the harder of the two, you're gonna put a band around your ankles. You want to make sure there's no pain in your knee and how you make sure that is you pull your toes up and you press your knees down. You squeeze your buns that keeps your pelvis stable and you slide your legs apart. You don't lift because it uses a different muscle you want to use the one in the back. You slide your legs apart for 10 times that keeps your pelvis stable, works your gluteus medius, do not let your knee unlock because that could hurt your knee. Then you want to do one leg at a time so you pull your toes up you squeeze your buns tight, you press your legs down and you slide to the side. Keep your foot straight though because remember we're working on alignment you're retraining your big brain how to hold your body you'll do 10 then you switch to the other side you keep squeezing your buns you keep pressing your knees down and you do three sets of 10 an easier one that works the rotators is to put the band above your knees sometimes it's a better place to start you keep your spine and your spine again and you open up your knees that works the rotators you can also do this one in sitting it's just to help strengthen your hips you can also open up your knees and lift your bottom that's a bridge that gets the big gluteus maximus so these are just a bunch of exercises to start working your hip muscles to stop hurting your knee so those are just a few exercise there's many that you can do but I wanted to give you the ones I think will help you right now to end your pain right now so I have another question how do I know when to use heat or cold to treat muscle pain that's a little bit of a tricky one to be general about so let's say you wake up in the morning and your neck is stiff and you feel very tense after a hard day at work that's a great time to use heat your muscles have been tight like white knuckling it your knuckles get white they don't have blood flow and you put heat on to bring blood flow to the muscles so it can just relax and go ah when you don't want to use heat is let's say you just had a car accident you had a bad whiplash or you were running and you pulled your hamstring or your calf muscle that's an acute injury that is over you're going to have an inflammation response you don't want to put heat on that because that fuels the fire of an inflammation response that you'd want to use ice for for a muscle injury I hope that's helpful I know it's hard to generalize okay so let's get into the hip now we kind of breached on how to strengthen the hip and how to turn your foot to help your knee but now what if you have hypersitis from running or you just have hypersitis and it's painful to lay on it at night because that bone there is just pressing into the bed for hours or you have hip osteoarthritis or you have IT band syndrome which is pain down the outside of your leg from running or walking the hip is kind of the next joint up that kinetic chain from the foot to the knee then you get the hip but it's the interface between the back so now if you have hip pain or you have hip pain that's kind of towards the back it actually could be your back that's hurting I met a gentleman at the beach yesterday I was getting some food and I was talking to him about my show and that sort of thing I mentioned it and he said oh I need to talk to you I've got some hip pain or back pain when he said I want to lose 40 pounds I've been trying to walk and my back hurts me so much that now when I bend over to set up for work I don't like it just it just kills me it's like a week and when I walk it hurts it's just really sore so one of the things I found out in his history that he had had a hip replacement on each leg but the side that his back was hurting got complicated it got infected and he had to have it revised and I asked him that after I watched him walk and I could see that he was twisting a little bit when he walked he didn't have hip range of motion on the left side so I want him to be able to walk to lose weight because he's trying to be active to lose the weight like the rest of us are trying to be active now during all this crazy six months of shutdown and everything like that changes so I gave him a couple stretches and let's look at video number seven to see what I told him to do all right to stretch those tight hip flexors because you're doing your walking program to lose weight and you want to get rid of your hip and back pain this is what you do you go to your pretty beach you get in a lunge position try not to get slashed by a wave and you bend you want to make sure you suck your stomach in and you can raise your arms over your head it's like your stomach in and stretch you're going to stretch the right side not this side I shouldn't switch legs try not to fall here so you're going to stretch this leg you bend you keep your tummy in and you stretch you don't extend your back but you want to get this muscle also it challenges your balance so you want to make sure you do that before and after you do your walking program and enjoy sorry about the blur on that one I think there was so much moving going on the background but I think you get the gist so also another example was one of my patients who I was working on her shoulder a couple weeks ago and she said her shoulder was feeling better but what was worse is her her leg and she said she had walked twice and had this terrible pain from the outside of her hip halfway down her thigh and actually bruised but she was walking she never did anything but she said it was torn and she'd had physical therapy before for strengthening but she couldn't even walk from my clinic to her car without hurting so I said okay well let me just take a quick look at you so I had her walk down I said come on up walk down the hallway she walked down the hallway and immediately I could see that her left leg was turned out like that so I said okay any injuries other than this thing and she goes no no foot surgeries no knee pain no no no no just hip pain it's terrible so I had her lay on the table before I started stretching her shoulder and I checked her hip range of motion and I saw that that one leg that was turned out the motion was really impaired on the way in and she had no injury history so I asked her do you just sit on the sofa with your legs off to one side all the time because I don't understand why your hip range of motion is so limited and she said yes I sit like that all the time so I massaged her quad and outside of her thigh similar to I showed you in the knee video I stretched her hip into a little bit of internal rotation showed her how to do a stretch at home and told her to walk with her foot straight and then we worked on her shoulder for 45 minutes she left that day and she came back in like five minutes later to tell me she goes I just walked from here to my car and I had no hip pain for the first time I've had this for year and a half I can't believe how simple that is so I'm just mentioning her story so that you can hammer home to you how simple achieving normal movement even at your foot can impact your hip so let's look at video number eight to learn more hip pain to be pain free right now these are the things that you need to do whether you have hip pain because you started a new walking program and you have barcidus or you have hip pain from arthritis and it's a stiff hip this is how you get started so you're going to lay on your back and you're going to hug one knee up to your opposite chest don't feel bad if you can't go all the way you're going to stretch the night glutes muscles so you could pull it in here knee towards your opposite chest and breathe you want to make sure you do both sides and again if you're here that's okay if it's tight you want to give it time to lengthen another great great way to get hip range of motion when you have hip arthritis is to get hip rotation so you want to spread your legs as far as you can drop one knee in as far as it goes let the other one fall out you can use your hands to help your hip if you need to and then you go the other way drop one knee out the other one in and stretch breathe and then repeat so if you have very bad hip arthritis and you find it difficult to move your leg this is a great way to gain some range of motion you want to get on your hands and knees and sway your back a little pull your belly button in to protect your spine and rock back it's very important not to let your background because when you rock back this way it enables the hip joint ball to get back in the socket where it should be and not where it's riding causing you pain and wear and tear from hip arthritis so after you do these motions it's important to strengthen so you want to use your big glute so you want to lay on the surface and you can lay on your bed if you'd like but this is a nice table for it you're going to put your hips right here put your head down pull your belly button in and lift up just high enough to squeeze the glute you don't want to lift this high and get your back involved you only want to use your glute muscles you do 10 times on one side then you're going to repeat and do 10 times on the other side and because when we walk we alternate our legs and a lot of people are walking right now to get fit during this COVID shutdown we're going to alternate suck your stomach in alternate your legs if you can't go high that's okay you want to be pain-free so those are the things to do to get out of hip pain right now excellent so I hope everybody really tries to work on these exercises to get out of your foot pain out of your knee pain and improve your hip range of motion so that you can save your back it's so important now at this time that you have the tips and the tools to do in your home so that you can get yourself out of pain and enjoy life to the fullest right now during these difficult times so I have a little bonus for you and I bet you never thought that having poor posture could affect your hip or your knee or your foot however it can because if you're very rounded for 30 or 40 years you become more rounded and it alters the position of your spine which alters the position of your pelvis and your hip joint socket and can place more strain on the front of your knee so I'm going to give you a bonus posture stretch in video number nine okay so you just finished your surf session you just finished hunkering down over your laptop and everything in the front of you is tight and you don't want back pain and you don't want hip pain and you want to be able to go and enjoy your day so it's very important I do this every morning and I do it at work to stretch out the stuff in the front that got tight so you're going to stand in a doorway I like to have my arms and what I call it is the T position straight at shoulder height or slightly above you put one foot in front of the other and use your back foot you exhale and then you press forward your back foot and inhale and you stretch you'll feel it get tight right across here then you push back and you inhale now you can exhale from that position when it gets very tight inhale again lift your chest you can also look a little bit to the right breathe in now you stretch more of the left side then you come back look a little bit to the left breathe in and then relax and enjoy better posture the final piece of the puzzle that I gave that gentleman that hurt his left low back after his hip replacement from trying to lose 40 pounds is to suck it in I told him you need to suck it in before you move and engage your deepest abdominal muscles so let's review video number 10 for that let me introduce you to your secret weapon to end lower back pain and get a flatter stomach your transverse abdominis or ta as I call it is your deepest abdominal muscle it's been around since the beginning of time just waiting for you to call on it to help support your back but no one told you it was there if you have back pain you need your ta to form the anatomical girdle with your deep back muscles to support your spine you see the ta contracts just after your brain has the initial thought for motion your brain thinks I want to reach for that glass of milk your ta fires then your arm moves try it pull your belly button in towards your spine go ahead suck it in now that you know it's there use it before you move and enjoy a pain-free lower back excellent so thank you so much for tuning in please try these strategies so you can decrease your pain and get to pain-free and enjoy your life aloha everyone