 Welcome back to Movement Matters. I'm your host, Christine Liddellus, physical therapist and board certified orthopedic clinical specialist. So many people suffer from knee pain. It's one of the most common reasons one seeks physical therapy since this pandemic. And what's important to know is that there are multiple ways you can be creating damage and pain in your knee without being aware of it leading to arthritis. Let's take a quiz. Are your calves tight? Do you have a bunion? Are you flat footed or have fallen arches? Is your hip weak? Do you walk or stand with one foot turned out more than the other? If you are standing right now, go ahead, look down and see if one foot is turned out. If any of the above are true, you will most certainly be creating strain leading to pain and tear on your knee and a painful pain. So what can you do to solve it? Let me introduce Sandy Cavallo, a former patient who despite significant arthritis cured her knee pain with these simple exercises. Welcome, Sandy. Hi. Thank you for coming on Move My Matters. I'm so excited for the show. Well, thanks for inviting me. This is great. So tell everybody, you came to physical therapy with knee pain. What were your symptoms? Almost like I felt 80 waking up in the morning, walking upstairs is when I really would feel it. And hence me going to the orthopedic surgeon who recommended physical therapy. So I'm so happy I had a chance to meet you because the exercises you introduced me to really, really help. I'm so glad. I remember I was thinking back on how you had been walking and we're so excited to be walking. And it was something that I had heard over and over again in the pandemic is people have been walking pre-pandemic but they were really walking a lot more during the pandemic because you could. That's one of the things we could do is walk in our neighborhoods and I was seeing a lot of knee injuries. And so when I first met you, let's pull it up image number one because this is what I saw. Oh, wow. So we, your left foot, this is what I saw as for the viewers. This is one of the things I think about because the knee is stuck between your mobile foot and ankle which adapts the shock on the ground and your hip which helps to adjust those forces, stabilize your pelvis and all those important muscles. And so when I looked at Sandy, I saw, I drew a little sloppy lines on there but I saw her left heel looking relatively straight and her right heel which is on the side of the knee pain looking bent in there. And in the bottom photo, I kind of point to the little bulge on the inside of her ankle because that tells me that the arch has fallen that when you land from walking in order to absorb shock, you need to go from arch up to arch down and with the arch fallen like that it takes the shin bone in and it twists at the knee. Yeah. So years of running on hard pavement and so forth with abnormally flat feet. It, my feet took a beating. So the left foot, I had to get reconstructive surgery. Hence that photo showing it a bit up actually a lot bigger than the right side. But if you notice the right side fell it was falling but I'm hoping, you know and I'm pretty sure with the exercises it's going to help. Oh yeah. Oh for sure. And so I know like when you first came in I was looking at you going, oh my gosh well, your knee range of motion was great but the foot was kind of taking the knee in for a ride and causing like this twisting which leads to it. Yeah. And the tibia the shin bone is following the foot as you land and I remember we were just talking about it a minute ago. I stuffed some, I think you said I stuffed some paper towel up in the arch. And yeah, for that, for that. Like, hey, your foot needs to be in a better position in order to set up what they call like the chain reaction when your foot hits the ground and adapts to forces and all the muscles fire up your leg to stabilize your body. What are you using now? I think you have some orthotics in your shoes now that you got. Oh yeah, let me show you. So what I'm using in my shoe now is a full-size insert. Can you see that? Yeah, yeah, that's great. Okay, and then under this, and this is just for me because I have flat feet is I have this smaller insert that I place right underneath for extra arch support and it goes right into your shoe. So you can get this locally here but I tell you, it just works, it helps. Where did you get that? I got it from the ultimate foot store. I mean, I'm sure people can go online and look forward but you know, if you're gonna be doing things on a regular basis, I just wanted it now. That's perfect. No, that's perfect. I'm glad that you all got to show to people because what we're doing is we're correcting your knee pain from solving the dysfunction in your foot by allowing your foot to have some support in the arch so that the certain muscles could fire so it doesn't increase your knee. So that's one of the things I wanted people to get from the show. So I was so glad when you went in. Oh, and Christine, with the full package with doing the exercises you taught me, then it's a complete resolution for my foot pain. Yeah, I'm really excited, I'm really excited. So let's look at another picture, image number two. Oh, I don't know if Sandy came in. So one of the things that is troublesome for sitting off that chain reaction is if you have a bunion and I tried to draw some lines so you could see on her right foot it's more of a crooked line. And why that becomes a problem is because when you land if your big toe is not there to stabilize, you don't get the right muscles to stabilize your foot as you pass over the foot during walking. And so if the bunion's out of the way, your foot has no stability so it will roll in and the arch will collapse. And again, that takes the tibia with you, the shin bone and twists at the knee. And if you keep doing that 10,000 steps or walking two miles every other day over six months, you're gonna cause that wear and tear in your knee and that is what gives you arthritis, arthritis that happens because you didn't have an injury. Just all of a sudden, oh my gosh, my knee hurts. I don't know what happened. I was saying that a lot and you were one of those people. Yeah, it's unfortunate. You know, I don't run anymore because of the problem with my feet. So during pandemic when it first started, I was doing that power walking every other day but my right foot took a beating on it and then I'm wondering what is this on my toe? Which is what you call a bunion. Yeah, yeah. So with the exercise, with the bunion exercise in the video you have, it's helping. That's great. I know I just showed, that was just yesterday, right? That I showed that to you? Yeah. I'm gonna show that in one second. Let's go to video number three. This is just another example of what we're talking about with this chain reaction and having a foot that's either turned out. As you can see in this video, this person is walking with their foot very turned out and they actually have some knee pain and hip pain as well. And so I wanted to show that because when I gave you the little quiz in the beginning, one of the things was, is if you're standing, look down and see if your foot is turned out because if your foot is turned out, that's gonna create more arched collapsed collapse and the shin bone will roll over the foot. Now if we go to video number four, I asked him to correct it, run it straight and you can see his lip is almost on. He has a little bit of a smoother walk. He's not kind of hitching like that anymore when I asked him to turn that foot straight. And the reason why is because now the certain muscles will fire, you don't even have to think about it when your foot is straight. I can't remember. Was your foot turned out as well when I saw you and I said, turn your foot straight? Yeah, it was slightly turned out. So again, with the exercises that you taught me, I know that all of the exercises will help me fix the problem. Yeah. We don't wanna do an operation if we don't have to. Say that again. That is the last thing you wanna do is have that foot operation. Yeah, well I think the main point that we both want people to hear is that you have the power to correct these little things, whether you're putting inserts in your foot or doing the exercise that you've done that we're gonna go through in a minute to correct your pain and solve your pain. And I think you and I were talking about your husband, he was like, wow, you really have to think about how you hold your foot because I was telling you, you can't stand at the sink like that with your arch collapse. Right. Because I remember you saying like, my knee feels good, but gosh, and I'm just standing and the sink doing dishes, it still hurts. And I was trying to figure out why. And it was just that letting your arch collapse in like that was causing just a constant little twist at the knee. And so the way you're working, and you did such a good job of just correcting your position. And for everybody listening, I know we don't wanna have to think about how we hold our bodies. Like we don't wanna have to think about sitting up straight in minor or posture or the fact that we're standing with one foot turned out. You just kind of wanna be in your life. But if you have pain, those fine details can be something that you can do in seconds to stop pain, right? Right. Yeah, just that little tweak of what you showed me what to do. It just went away. I just have to constantly, but it's gonna become a habit. I know, cause I'm doing it all the time. It's just tweaking that move and my knee, and it works. Yeah. It's great. Where are you walking now? Well, I'm walking, let's see, maybe about 30, 35 minutes. I don't wanna just jump right into it. I wanna get the exercises down, build up that support from my knee, and then I can get back to my schedule. Yeah, that's a good point to tell people. Cause I know when you started walking, we were talking about how you were up to a certain period of time at a slower pace and you wanted to get back to brisk walking. And I said, Yeah, right. Either speed up your walking in the same time that you're doing right now or keep it slow and add time, but don't do both. Don't speed it up and add time at the same time. Right. Christine, so I'm keeping it slow, like what you recommended. And then I speed up maybe five minutes and then, you know, cut it back again. I'm in a rush, but I'm not really, I wanna get those exercises down where, you know, I don't have to worry about my knee. And I know down the road, I can just pick up. Yeah, I think it's great. So let's go to video number five, where we do the initial exercises that Sandy started doing in the beginning of the knee pain. To correct your fallen arch. So say your ankle has fallen in like that and your knee is coming in, you're gonna need to work on moving your foot back into a normal position. Now there's a many different ways you can do that. When the foot rolls in like that, it takes the tibia with it and the femur comes as well. So if you squeeze your butt cheeks together, you'll see how that corrects the position. It takes my foot from in and my femur is from out. So one of the things that's important is just to think about that. When your foot is in, getting it to sit more in the center. So like where these toes are up, this is getting that bunion. Get your foot and shift it so it's straight. So it's not so bowed. It's something that you need to pay attention to throughout your day, whether you're standing at the sink brushing your teeth. Also to help with that, to stabilize the arch, you can do a toe curl. Now you can see with the toe curl, this raises, that works on the intrinsic muscles of the foot. So that is to help strengthen up the arch muscles. But also what's more important when you're standing or walking is that you learn how to shorten your foot or crunch your foot. You can see the arch come up but the big toe stays down. It's like you have a pair of shoes you wanna fit in but they're too short and you scrunch your foot. Scrunch your foot, that helps to stabilize. So you can also work on scrunching your foot to stabilize the arch. Now I know that I'll look familiar and I did forget to do the single legs go out on that half bozu ball. But Sandy, I know you just told me the other day that you're keeping up with the exercises but your favorite is working on the alignment standing on the bozu ball, which is an exercise that I was telling you to crunch your foot, stabilize the arch while you're on it to do the squats. Are you still working on that? I am. You know, the bozu ball for me is a challenge, Christine, but that's what I like about it. If I can get that down, then I know that I'm going in the right direction. So that is my priority and I have the bozu ball so why not make use of it? I think it's great. Are you still doing calf stretches or the toe curls at all? Yep, everything that you taught me that that will help me with my foot problem, yes. And I rotate through the week. I don't do the same things every day. I love that. So that's such a huge message for people watching. I tell people you don't have to make it like a long time commitment of doing your exercises every day. You're doing them to reeducate your body so you can change the pattern to make it more normal. And you do them throughout the week, that's great, because you're giving your body messages. How much time do you think it takes you every day to do some of these little things? Well, you know what, 15 minutes and then I add a couple of the things in there for other parts to work out in. But I don't want it to be fun. You know, it's just a routine for me to go in okay, I need to do this, but it's fun and then move on. So that's how I'm looking at it. Because like I said, the operation is the last thing you wanna do. That's right. And I think that when you can do what you wanna do and do it without or with less pain, then you get your fun back. Yeah, you know, I make it a fun thing because... I'm sorry, these exercises are the ticket to fun. Yeah, yeah, don't worry. Yeah, I was, I'm really happy though that I was able to get you as a physical therapist because you didn't make it where you do this or it's not gonna work, you know, and the exercises are great. So I really appreciate that. Oh, I'm so glad. So let's look at video number six where we show how to get that tendon working that controls the arch muscles. In order to strengthen and exercise this very important posterior tibialis muscle that helps control your arch when you're walking, it helps to raise the arch, but it helps to decelerate the motion while you're pronating and landing during walking. You need to strengthen it. So you wanna put an exercise band around your feet, cross your legs, make sure it's here, and then you're gonna pull your foot inward. Pull it inward. In. And so you're bringing your big toe side inward. Nice and slow, you can see mine shaking a little bit. That's how you wanna do that exercise to strengthen your posterior tib to keep your arch up, to prevent your tibia from rolling in and giving you knee pain and eventual arthritis. These little jabs that I throw in there, little snippets of to get that muscle to fire so that you can stop your tibia from rolling in and prevent yourself from getting knee pain. I think that's key is we're using these little exercises for a purpose, not just to strengthen a muscle, but to help a muscle function better so your leg functions better and you stop your pain. Now that exercise is a little challenging. You kinda gotta cross your leg. You could tie it around a table leg, you can also, I think Sandy, our first time we gave that, you were just taking your foot and sliding it on the floor like that, right? Yes, yes, so if you don't have a band handy, you can do that exercise. Yeah, yeah, that's one of the things I like to do for people is you don't have to have a band for every of these things, it does help, but there's a lot of different ways to exercise a muscle. And so I try to give you things that you'll do too because it's important. Yeah. And the bunion exercise that we were talking about earlier. Let's go to video number seven. Here's your not so quick bunion fix. This toe's normal. This one used to cross underneath this toe here when I bent my foot. And so how I got rid of my bunion, you can still see the knuckle is still arthritic, but I don't have the crossover anymore, but it does look as good as this one. So what you need to do if you're gonna start, if you have a bunion and you're gonna start trying to move your toe out so it can bear the weight like the foot was designed to do, if you can't move it out to the side like I'm doing here, you need to take your finger, pick it up and move it there and then push the toe down into the ground. You'll see this muscle bulge out right here. I'll do it again. No muscle now, put it out, press it down. You see this bulging right here. That's how you start. And then eventually you start to be able to move it like I can straight out to the side, straight out to the side, straight out to the side. That's what you need to do because when you're walking, the toe is designed to contact here, not like this. So you can get a lot of calluses here and a lot of calluses here and a lot of pain here. So you wanna get this working and don't be frustrated if it takes a couple of weeks to figure that out. You can also use a spacer to help restore the normal alignment of your foot when you're walking to save your knee. I just gave you that exercise yesterday. Can you do it on your own? You have to use your finger to move it. Yeah, I have to use my finger. That one, Christine, will be a challenge because my toe is so used to locked inwards. So I'll probably have to put something in between and work on that moving my toe. But the end is to work on being able to move on its own. That's a great exercise. And I'm sure many people have come up with that exercise. Just trying to strengthen a muscle that abducts the toe. But I had an injury when I was in San Diego that I couldn't run. And so I was walking and I developed, I have bunions, my mom has had foot surgery, my grandmother had them. And I developed such severe knuckle, toe knuckle pain on that that I couldn't even walk. I was walking, your arches collapsed. I was going the other way. I was walking on the pinky toe side. I couldn't even bear a weight on the toe of the, the pain in that knuckle was like, it felt like shards of glass rubbing inside of my toe. And so I was working with a friend of mine who's a physical therapist to try to restore the normal mechanics in that toe, which is hard because it was so dysfunctional and it was so inflamed. So I started doing that exercise, but I did put a little spacer there, like those little pedicure things when I was sitting around. I would put those in there to try to stretch it out. I would massage it out. And I even did use some, I didn't show a video of this, but I did do some taping strategy to kind of help with kinesio tape, to help re-educate the muscle, to put it out there. I have to do that for your next time. But at the same time it did, it took me two weeks to get to move that toe, two weeks. And I say, watching grass grow because I literally looked at my toe and said, move and it didn't. And I said, move and it didn't. And then I did this and I held it and I did this and held it. And probably two weeks later I said, move. And I went, and I was so great. I still do this today. This has been probably 15 years. My toe knuckle once in a while will hurt when I kind of get off my exercise. And I play beach volleyball, which is hard on the big toe. But most of the days I walk around and my toe, I don't even know it's there until I look at it and I can see that that knuckle is more swollen. So take the time. It's gonna be a challenge, but take the time to work on that. That will help you tremendously. Okay, thank you. All right, so we did a little video of Sandy yesterday doing the single leg squat. And I wanted everybody to see, since we're talking about the causes of knee pain coming from your bunion, from a tight calf, from your arches collapsing, which is caused by a tight calf in some cases and from weakness in different areas of your body. Let's look at her single leg squat as of yesterday and video number eight. So this is a good side right here. And what I like to look at is like it's relatively straight from her foot to her knee other than balance and her trunk. When she goes onto this side right here, the right side, you can see her arm moving away from her hip because she's leaning over that leg. And it is a little bit harder to put up, but she fixed her position so well at her ankle that if you look at that video again, let's look at it one more time. So you can see it on the left, there's great tibia, other than balance, there's great thigh bone up to her pelvis at level. Now she goes, well, yeah, so we're gonna do it again. Her arm, the space between her hip and her arm, now when you go over to the right, you see the arm moving away from the hip because her body's leaning over it. And that's a good balance because even though she's corrected a lot of these things, she still needs the support of her orthotic to help with that fallen arch that you saw in the video. So that's what Sandy's trying to work on on the Bosu ball, on that half ball is working on stabilizing the arch and the foot position as well as the pelvis on an uneven surface, which will get you to be able to walk fast without thinking about it eventually. Right. Yeah. And it's work. Yeah, it's work, but you know what? The payoff is great. So I'm good with it. The payoff is great. So now this is an exercise that is not only a booty or bun toner, right? A booty boot camp, but it's an exercise I give everyone. And I think it's so important to strengthen the gluteus medius. Gluteus medius is a muscle that's in your hip that helps to stabilize your pelvis here, this thing, your pelvis on your leg. When it is weak, the pelvis can drop or the femur can twist in, which also can hurt your knee. It can also hurt your back. So let's go in video number nine where I show the very basic how to isolate and strengthen the gluteus medius. To strengthen your gluteus medius muscle help get your pelvis to be stable on your leg. When you're on one leg, as we do in walking, running, going up and down stairs, you're gonna put a band around your feet here or around your ankles. You're gonna pull your toes up. You're gonna squeeze your buns tight, press down into the table, slide your legs apart. You're gonna do 10 times at the same time to set your pelvis. Then you're gonna keep your buns extra tight, press them down, hold your left leg stable, then slide your right leg out to the side. Most people wanna lift it. That's wrong. It uses the wrong muscle. You wanna push your buns down, slide your leg out, push your calf into the table. You do 10 times on the right, and then you're gonna do 10 times on the left. Did your slides look familiar? Yeah, I love that exercise actually. Yeah, we did a lot of glute burning on that exercise. Is it something that you still keep in your routine today, or are you just walking sideways? No, well, I do both. I mean, I swap off, I don't do the same thing all the time. But that exercise, it's simple if you have the band and I think as we get older, women have to work on their hips to make them strong because that's one of the first things that goes as we get older, falling on your hip. It's so true. I'm glad you mentioned that because there's one of the things I like to say, and I've said it so much lately, like lateral movement is key. And I wish that I could get everyone to twice a week, sidestep down their hallway or do this exercise because you're right, as we go through life, we're walking forward mostly, right? So the gluteus medius is stabilizing you to keep your pelvis level on your leg. But as it fatigues or as you go through time, walking with your foot out, having a bunion, injuring your knee, all those things that muscle can shut down. If somebody has a back injury and you get sciatica, it can shut down your gluteus. And now you've got that hip drop. So all's we have to do to enhance our balance is work the gluteus medius. Like as you said, as a woman, as we age, we worry about balance. And if we just did some sidestep every week or work this hip muscle once a week, we wouldn't lose the function of it. And so then when we're 80, we won't be like, wow, I really just feel like I'm unstable when I'm on one leg. That's so important, you know? And with these exercises, I just have to keep working on it. When I'm home alone with my, I go in the garage and I take the band and I'm playing with my dog, but I'm also doing that, so. I love it, I love it. So we have about one minute left, Sandy. Is there anything you wanna share with the viewers today? I hope with the information I share today, if I can just help one or two people, I am happy. You know, then that will tell me that all the exercises that you taught me and we went through in therapy is a game changer. No, you're so inspiring. I was inspired by you with how quickly you were attended to turning your foot straight, squeezing your buns to lift your arch and I want that message. So thank you for coming on to Movement Matters. Thanks for inviting me, Christine. You're the best. Oh, thank you. And thank you to Think Tech Hawaii and all our viewers for watching today to wrap up, to solve your knee pain and stop hurting your knee, turn your foot straight, do some toe curls, work your butt muscles. And as always, life is better when you listen to your physical therapist. Aloha, everyone.