 Hi and welcome to Movement Matters. I'm your host, Christy Linders, physical therapist and board certified orthopedic clinical specialist. Movement Matters is designed to bring you not only the most effective physical therapy tips, but also holistic information to help you achieve total body wellness. Since this pandemic, people have been more active in their home environment, doing more gardening, home projects, and outdoor exercise, including regular walking, which is good. However, I'm seeing more back, hip, and knee injuries from this rise or simple change in activity level. I have a value pack show for you today where I, your virtual physical therapist, will be providing you with simple tips and corrective exercises to do in your own home to resolve your back, hip, and knee pain and also help you overcome pain from hip or knee arthritis. First, I want to share with you the secret to ending low back pain in video number one. 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. Here you have it. That's the secret to ending low back pain. I pulled that. I designed that right from an expert from my book that will be out in the next month or two on how to get rid of low back pain. But in addition to pulling your belly button in to engage your anatomical girdle, you want to be sure that you have the proper flexibility in your glutes and your hamstrings which can, when tight, put extra strain on your low back and make you more vulnerable for injury or pain. So if we look at video two, if you are suffering from back pain because you've been bending, cleaning, doing too much gardening, remodeling your home while you've been quarantined and staying at home, these stretches are the go-to. You want to lay on your back, on a bed, on a floor, draw one leg up, clasp your hands in front of your knee, and hug your knee into your chest. And you want to breathe three to five seconds. It's an excellent stretch. Then you want to hug your knee to your opposite shoulder so your foot goes on the other side. You put your outside hand on the outside of your knee and your inside hand somewhere on your shin. And you hug your left knee up towards your opposite shoulder again. Breathe in three to five seconds. Then just stretch your hamstrings. You want to clasp your hands behind your knee, let the knee relax, keep your shoulder blades squeezed in your head on the table, and then gently kick your legs straight to stretch those tight hamstrings. And the last one is to draw both knees into your chest, give them a hug, and breathe three to five seconds. That will do great to relieve all the tension in the big glute muscles, your hamstrings, so take the strain off your low back. Enjoy. Those stretches are excellent, and they can be your first course of action if you have an episode of low back pain, and they can also be your regular course of action. Now I've got a great question that just came in. Is it better to sleep on your back, side, or belly? I often wake up with low back pain if I don't sleep on my back. And so that's a great question because it's something that many of my patients complain of in the morning they have back pain. They catch themselves on their side or on their belly. It is optimal for your spine to sleep on your back with one pillow fit specifically for you for your neck and a pillow under your knees. However, we do roll around on our sides. Sometimes we end up on our stomach. Sometimes we prefer to sleep on our stomach. If you are a side sleeper, it is important to put a pillow between your knees to try to maintain the pelvic relationship with your knees so your spine doesn't strain all night long. And also our shoulders and our hips are wider than our waist. So if you're waking up in pain and you're a narrow waisted person or a wide hip and shoulder person, you might actually need to roll a small towel and put it right in the shallow part of your waist when you're laying on your side to support your spine so your spine doesn't bend like this in the center all day long into your soft bed. So that's a great question. So I also have another exercise that we're going to do right now that is great for alignment. It is great for back pain. It is great for poor posture. It is great for hip pain or hip arthritis. So let's look at video number three. If you have hip pain or hip range of motion limited because of severe arthritis or you have poor posture and having back pain, this is one of my favorites. It's one of those exercises that you're not really sure what it does except for you know it does something and you always feel better afterward. So you're going to want to get on your hands and knees. You could do it on a bed, on a floor, anywhere. You're going to suck your stomach into stabilize your spine always and sway your back like a horse that's been ridden too much and aim your tail bone to the sky and then you're going to move your buns back towards your heels but only as far as you can go as pain will allow in your hip if your hip range of motion is limited or if your back doesn't start to round. So you only want to go back as far as you can keeping your tailbone to the sky and sucking your stomach in without pain. So if you have hip arthritis this is great. You may rock it back and forth here 20 times and then pretty soon you feel that that pinch deep in your hip is going away. So I call it a modified version of quadruped rocking. So enjoy that wonderful stretch. I love that exercise and one thing I love about it is also if you do have knee pain you can do it on your bed. It doesn't have to be on a hard floor or anything like that. Now I want to talk about alignment a little bit for a bit and also the fact that I have a little bit more of an exceptionally swayed low back. Part of that is my anatomy which is why I'm so passionate about teaching people how to suck it in to engage their anatomical girdle and protect or end their lower back pain or their low back injury that they're suffering from. Other people may be more rounded and maybe you've saturdayed us hunched over for 25 years and you've become more rounded and you can't achieve the horse that's been ridden too much position that's okay. Just try to go for as much of a flat back or use the cue that I used which is tailbone to the sky and only move back as far as you can while you're trying to keep that arch. Suck your stomach in stabilize your spine activate your anatomical girdle and aim those sit bones aim that tailbone to the sky so that you will stretch your hamstrings stretch your glutes but more for those people who are suffering from osteoarthritis of their hip or maybe a congenital dysplasia which is a shallow socket that people have or sometimes your structure just isn't formed with a tight ball on a socket fit and it's more loose this way. This is a great exercise because with those conditions the femur the head of the femur I almost said humorous at your shoulder. The head of the femur can migrate forward towards the joint capsule and cause your psoas muscle to tighten up to try to stabilize the joint. So this exercise the quadruped rocking with your spine mildly swayed is to help make space in the posterior capsule of the joint so that that ball can sit further back in the socket and get rid of that groin pain or that front hip pain that you're suffering with every step while on your walk going up and downstairs. So why I mentioned alignment as well with this exercise is so many people tend to lean a little bit off to one side or you stand on one leg or you turn and watch the tv off to one side. Those are our repetitive patterns of comfort our path of least resistance when you do the quadruped rocking your hand should be directly under your shoulders your knees directly under your hips and you're going straight back so any muscle tightness that has happened say on one side because you've been leaning off to one side one side tight in the other side stretched gets stretched out and reeducated so your brain gets that pattern of straight and alignment not lean to one side not twisted to one side and I remember when I was in New York City and I gave this exercise to someone who when they rocked they deviated a little bit off to one side they had hip pain on one side I said I like to say this is for alignment but a lot it feels like you're not really doing anything and so he went and said you know what I'm doing that 20 times a day I do 20 repetitions and that really does something I don't know what it does but I feel so much better afterwards so I wanted to call that to everyone's attention it doesn't feel like you're doing much especially if you don't have hip pain or hip arthritis and you're doing it to align your spine because you've had poor posture or poor sitting habits that you weren't aware of so do it anyway do 20 repetitions it's very very important so on alignment since I'm talking about hip and knee and back pain let's look at video number four where I show some alignment doing a single leg squat hello ha let's talk about the young athlete why are young athletes so at risk for knee injuries for one it's usually because of alignment they're not able to maintain this straight alignment with their shoulders hips knee and ankle when they're running forward or jumping and landing they end up having a collapse where either the hip drops or the knee dives in and that happens from either foot weakness or tight calves that occurs after a recent growth spurt or hip weakness here where the hip muscle is not strong enough to stabilize them in this position so when they go to bend they'll drop here or the knee caves in there's many ways to fix that stretch your calf strengthen your hip muscles and work on proprioceptive training which is balanced training and learning the new alignment until it becomes a motor plan which I'll show you in some images to follow I mentioned hip and knee alignment here with the high school athlete because I've seen too many young athletes coming in probably after a growth spurt I was one of those people that sprained my ankle injured my knee hurt my hip dislocated my shoulders I grew too fast and my muscles and everything hadn't stabilized I was told back then I was 12 so I kept injuring myself and so I bring up the high school athlete because it's one of those things that we go through a growth spurt and we may have been fine two years ago playing soccer high jumping playing volleyball and landing from a jump or running cross country whatever the sport is that is a running or a jumping or a moving sport they may have been landing perfectly last year and now they've grown and one side has that dysfunctional pattern that I'm showing I showed you in that video where the knee dives in or the hip drops because the muscles haven't stabilized that that athlete's body because of the growth spurt and it can happen on one side and I typically do see that so to prevent young athletes from injury we need to stabilize the hip to help support the knee but also for all of us who have been at home maybe walking more bending in the garden going up and down the stairs in our homes tackling sorting projects that we might not have had time before because we were commuting to and from the office it's very important to stabilize your hip to control that abnormal alignment because abnormal alignment leads to wear and tear at our joints which leads to arthritis so if someone like that young athlete is doing a single leg squat with their knee diving in every step their knee isn't bending this way it's bending this way and so over time every time you go up a stair every time you go down a stair your knee is twisting and then that is causing abnormal wear and tear which will lead to arthritis in your knee now if you're that athlete where the hip is dropping and I show the trunk kind of leaning over to the side you see the keep the the the hip dropping down and caving in that is hip weakness that is driving that alignment dysfunction and you need to strengthen the big hip muscles to stabilize your pelvis on your leg like this so we can stay here instead of dropping down over and over again creating abnormal movement of your hip joint in the socket which causes it to wear and wear and can lead you down to arthritis so all that said the hip muscles are what control the rotation of your thigh bone not your quadricep muscles per se it's your hip muscles they're rotators so while we will strengthen your knee and I'll show you later you really need to strengthen your hip muscles for your hip and to control that extra motion at your knee that you may be having when you're going down the stairs so let's look at image number five and I'll talk you through it so you're going to pull your toes up you're going to squeeze your buns tight and press your knees down and you will slide both your legs away from each other the reason why I want you to push down excuse me is I want you to feel the muscle directly behind the the hip ball the bump on the side of your hip that's your gluteus medius muscle and that is what's going to help stabilize your pelvis on your leg when you go up or down your stairs so what I tell people to do is to squeeze pull your toes up press your knees down slide both your legs away from each other at the same time for 10 repetitions then reset lift your toes up squeeze your buns and then you slide one leg out for 10 times so now you're using the opposite leg to stabilize you while you exercise one leg then you reset toes up buns tight press down slide your other leg out for 10 times you will feel a burn most likely doing those 30 if you don't you can do another set of the open that's a great exercise that's my first course of action that really helps to strengthen the gluteus medius muscle to help your knee and help your hip while you're going up and downstairs while you're landing from a jump while you're running which is repetitive jumping and any other activity that we may be doing more of now during this pandemic so now we're going to put the gluteus medius to work in function so we're going to look at image number six where you're going to have a band around your ankles your feet are going to be pointing directly in front of you and your feet are wide you're going to suck it in because now you know that's a secret to ending low back pain and you are going to crab walk is kind of what I've called it all of my career um sidestepping is another word monster walks I've heard and you're going to wide walk step by step to the side never letting your feet come together because you don't want to slack the band that would be too easy so you'll take a little step and then a little step a little step a little step you can go down your hallway back and forth all the way to the right and then you come back to the left so I can your stomach in exercising your gluteus medius and putting it into function because function is being on our feet so I've got another question thank you so much for sending these questions these are these are fantastic I love to be able to provide this show for you to have the right information in the exercise so that you can do it in your own home so what are the best preventative exercises someone can do to avoid or hip or knee replacement and just second part of the question if someone has challenges walking up or downstairs due to knee pain what can they do so to answer the first question I have a series of hip exercises that I call the hip rotator cuff exercise it's a four by four so let's go to video number seven to show those what I have found to be the most effective series for hip strengthening exercises whether you have tendonitis knee pain hip pain hip arthritis is to get the deep hip rotators functioning properly so to do that I do a hip four-way series I call it so you land your side bend your knees and you do a clamshell I do 10 then you hold it open and you tap your foot from horizontal back to your other foot then you bring yourself an alignment so you're in a straight line with your knees bent and then you clamshell again for 10 after that you hold the knee up and tap your foot navigate your gluteus medius you go in a straight line make sure you're not forward but in a straight line and you lift up and down you want to make sure you don't lift up so high that you use this muscle you only want to use this muscle so that's about all you need to do you get a good burn and you'll rescue your lower body enjoy so those are my favorites and I had a very big problem with my hip playing beach volleyball in San Diego I kind of somewhat dislocated it and tore the labrum and I was trying to find a way to do what I was explaining to you in the quad rocking which is to get the head of my femur back up into the socket so it wasn't causing me the groin pain and those exercises that I just showed you were terrific and really were the thing that got me including the quad rocking that got me out of the water and got me back to running and playing volleyball at the time so to answer the second part of the question which is if someone has challenges walking up or downstairs due to knee pain what can they do so there's something that's called a hip strategy that I use on my patients who have hip or knee pain but mostly knee pain walking up and down the stairs so let's play video number eight when you have hip or knee arthritis it's often very painful to go up and down stairs and many of us have stairs in our homes stairs into the doctor's office or stairs into different stores so this is a hip strategy and what this does it puts more load into the muscles of the hip than into the knee muscles and takes less force off the front of the knee so what you want to do is instead of going up and down the stairs straight up and down like this it feels a little funny at first but it works great you want to bend at your hip so you're sticking your buttock back your back is straight and then you step up so you go back it's like a little bit of a crouch and then you step up you'll immediately feel the load going right into your powerful glute muscles and your hamstrings and the same thing for going down let's say I'm up on this small step I don't want to go down like this which puts a ton of force right on the front of the kneecap I want to kick my rear back and then step down you can see when I kick my rear back my knee automatically bends and you feel the load go into that it might take some practice but please try it every time I use that strategy I get the same reaction so now I just preface it with it feels weird it feels like you're crouching down I've had my family members do it my patients do it I young and old everyone says the same thing when I do that my knee doesn't hurt going up and downstairs it just feels strange because you feel like you're very crouched down but you do feel try it you do feel the load in the tensing back in your glute back in your hamstring and it takes the load off your knee so if you've got knee pain you're going up and downstairs multiple times a day where you live in a home like I do that has stairs you want to make sure you use your hip strategy and you don't overuse the compression on your knee and then you can decrease your risk for having knee surgery and a knee replacement by taking that repetitive load off your knee so I love this we have another question I need to do knee exercise on the bed when I do this while pressing my knee to the mattress it hurts one of my knees is there something I can do to help with this exercise this is perfect timing thanks for sending that because I was just going to go into a knee exercise so in the next video I show a knee exercise and in the second part of the video I show me putting my hand underneath the back of my knee to press into and a roll underneath the back of my knee to press into if your knees hurting when you press it down we don't want you to have pain when you do these exercises we want it to be pain free so our job as physical therapists is to try to find a way that you can perform an exercise without pain while you're getting your body healed so let's look at video number nine many patients have come in complaining of knee pain as they've been doing a lot of yard work doing a lot of bending while they've been doing more home projects so I wanted to show you a very simple exercise to help your knee from suffering from pain one of them is called a quad set and so you want to put your legs straight on some surface here and then you just push the back of your knee down so you take the back of your knee and you push down it tightens your thigh muscle you can do 10 or 15 of those should be pain free if it isn't pain free you could put a little folded towel underneath and give your knees something to press and to tense this muscle in the front of your thigh to progress that you put a roll or a beach towel or something behind your knee you can see it better from here and then you lift your lower leg so you're pushing the back of your knee down here and lifting the lower leg do about 10 to 15 of those to really activate that muscle and then you swing over into your chair and then you kick it straight so you're just straightening like this resting on a chair try this so I want you to try that so you can fold a towel underneath your knee or roll a towel and press down however much you need you could bunch up a blanket so that your knee is not hyper extending into the soft surface of your bed because you want to be able to engage the thigh muscle above your knee cap without having knee pain so you may need to adjust the surface that you're doing on it like that using the roll fold the towel so that you don't have knee pain because I'm not really sure if I answered the question earlier about is there exercises or are there exercises you can do to prevent a total hip replacement or a total knee replacement but for the total hip replacement I have many patients that are coming in with severe arthritis in their hips and they're planning on getting one in the future but let's say they want to wait 10 or 15 years until they're older and they just want to make it through so the exercise prescription is is extensive but I do have for the people that are trying to prevent their hip replacement I do have them do quadruped rocking so that I can get them a little bit more range of motion again I want it to be pain-free so if you rock back and you get a pinch that's as far as you rock back and then you just stay before that pinch for 20 repetitions and you do it every day and you will notice that you're going a little bit further and further back as you open up that hip joint when we have arthritis sometimes it's a square peg in a round hole so to speak and you may never get the full range of motion because there's a generation in the joint but you can also achieve full pain pain-free function as you go about your day and that's what we're trying to get the next thing I will have them do is try to stretch out their hip muscles like I showed you in the back stretches but you have to go gently and there's there's other hip stretches I'll have to maybe do that in the next show I didn't have a video for that but also it's important to do my hip rotator cuff where you lay on your side you might not be able to use the band at first because you may have pain so you can do that four-way clam shell that I showed earlier to help engage your deep hip rotators and those exercises are great to help you prevent your hip replacement or get you to pain-free so that you can enjoy what you're doing right now if you're intending to have it in the future also if you're trying to prevent or hold off a knee replacement or just function better because you don't want to have your knee replacement for six months or you can't have it for six months you're waiting and you want to be able to function now because you're in excruciating pain doing those quad sets and the short arc quads where you have the roll underneath you will help you a lot stretching your hamstrings like I showed in the back video will help you tremendously and also which I think you learned when we were talking about alignment strengthening the gluteus medius muscle so you land your back you put the band around your ankles you push down and slide now every now and then I have someone that likes to bend their knee when they slide or lift their leg and why this is a problem if you have knee pain is because it will hurt your knee your knee is no longer stable when it's not locked if you bend your knee a little bit and you slide the knee is going to move and that's going to cause that twisting and you will have pain so you need to make sure you lock the knee press your knees down pull your toes up squeeze your buns and slide apart because you also get a quad set when you press your knee down those are some of my favorite exercises as well as the hip rotation four by four because I mentioned before your hip controls the rotation of your thigh bone so if you're getting that excess rotation on your stairs it's leading you to have knee pain and you're doing the hip strategy well because I know you will be now then you want to exercise your hip to stabilize that thigh bone so it's not twisting so much while you're going downstairs and then your knee won't hurt as much so I hope that as you answered your question so we're about out of time I hope that you enjoyed this I can't wait to hear more questions in two weeks of what you would like me your virtual physical therapist to provide for you you've learned the secret and low back pain so please practice that and two weeks ago virtual physical therapist number one I showed you how to engage that in a video if you would like more information we'll look at image 10 which shows you that I post regularly on instagram which is christine lenders pt and I also do it on facebook which is christine lenders physical therapy and you can go on there and get a wealth of videos and information they're quick they're short they're for a wide range from jaw pain to ankle pain to shoulder pain you name it so thank you so much for joining us thank you so much think tecawaii and all our sponsors and donors for allowing us to bring this to you in your home stay safe everyone and I'll see you in two weeks life is better when you listen to your physical therapist