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Archive for the ‘For Professionals’ Category

Finding a Hamstring Imbalance: Osgood Schlatter Disease continued

Monday, November 1st, 2010 by Karena

zac lowYou’ll see the last post was on Osgood Schlatter as well.  Because of the imbalance in the vastus medialis (see last post) I wanted to check the hamstrings a little more closely today when this client came in.  This is how I did it:

  1. I put Zac (our 15 year old client with Osgood Schlatter) prone on the long box facing the foot of the reformer.
  2. I sprung the reformer with one each of the red, blue and yellow springs.
  3. I put the foot loops over the arches of his feet.
  4. I had Zac bend the knees to pull out most of the slack out of the cords. (about 120-115 degrees)
  5. Zac performed hamstring curls in parallel, external rotation and internal rotation. He did 5 of each with both legs (grooving the motion) and then 5 of each with one leg only (dropped the blue and  yellow springs)
  6. This exercise showed a weakness in the hamstring that creates knee flexion with hip extension in internal rotation.  Or in simpler terms: His right leg was much weaker than the left when the knees were together and feet dropped open while trying to perform a hamstring curl.

Homework: I added to Zac’s homework with the exercise in the pic.  He is in internal rotation and he is pulling against the weight of the theraband.  I am having him do all positions on both legs, double-leg and single leg with the theraband and the help of his very amazing mom.  I am also having him do extra work on the position that is most weak (see #6 above).

Exercises for Relieving Sciatic Pain

Monday, November 1st, 2010 by Karena

When it feels like a gnarly-toothed troll has taken up residence in my tush, then it is obvious that my sciatic pain is back.  Grrr.

I have had my fair share of sciatic pain but it’s been a few years since it has been bad and this week?  VOILA!

Roll out your sciatic pain on a 6" foam roller.  Ahhhh..... relief.....

Roll out your sciatic pain on a 6" foam roller. Ahhhh..... relief.....

Our teaching schedule became a little busier this month and my sciatic is now a cranky little putz.  Here’s what I do for my clients and now, again, for myself when the troll returns.

5 ways to Give the Boot to the Pain in Your Bootie (Sciatic Pain)

  1. Walk 20-30′ briskly on a zero incline. If the pain increases stop. The idea here is to loosen up the spine and therefore loosen up the bootie.
  2. If walking without a limp is impossible, then I would recommend medium-light weight on the Pilates reformer.  Continue for 20-30′. (See why the weight has to be light-ish?) The purpose of this is the same as #1; hence the long time period.
  3. Side-lying leg work. Lie on your side. Bend the bottom leg and straighten the top.  Lift the top leg off the floor just to hip height (10x’s). Follow this exercise be small leg circles. Again no higher than hip height. And again 10 in each direction.
  4. Use a 6″ diameter foam roll to steamroll your tush.  See the pic. This exercise is similar to a deep tissue massage of the area.  I also like to ’steamroll’ the IT Band.  The IT band is on the side of the leg between the knee and the hip. Don’t roll over your hip or knee bones.  They will NOT appreciate it!
  5. A popular stretch for sciatica as mentioned by @MelMajoros on Twitter is the ‘Figure Four’ Stretch.  Lie on your back with knees bent, soles of the feet on the floor.  Place one ankle on the opposite knee. Put your hands under that opposite knee and pull it to your chest.  Ahhhhh… relief!

Exercises for Osgood-Schlatter in Teen Athlete

Thursday, October 28th, 2010 by Karena

This is my second teenage athlete in three weeks that has come to me for knee pain.  This young man is still in

Exercise can change the muscular imbalances that affect Osgood-Schlatter Disease

Exercise can change the muscular imbalances that affect Osgood-Schlatter Disease

high school and has a really busy schedule of basketball practice and conditioning. His chiropractor diagnosed Osgood-Schlatter Disease, often considered a ‘growing pain’,  which is knee pain affecting children where the bony protrusion below the knee (the tibial tuberosity) becomes inflamed. You can usually recognize it by the bump that begins to form on that bone below the knee, a bump that lasts throughout adulthood.  You can see from the photo that that bump has not really protruded very much yet on the right knee that is affected but if you look closely you can almost see it.

So what can be done about Osgood-Schlatter? This young man does not want to stop his busy practice schedule for fear of being side-lined during the season.  So the normal answer of resting to alleviate pain is not an option. Plan B, then, is to find the muscular imbalances and work hard on those and hope for a big change in the pain levels as the muscles become more balanced.

These are the imbalances that I have found so far:

  1. A weak vastus medialis (the muscle that sits above the knee and to the inside) on the right leg. You can see in the pic that the v.m. is not as developed as it is on the left knee.
  2. A tendency for internal rotation of the right hip which leads to improper tracking of the hip, knee. Or in other words when the knee bends it points at the other knee instead of where it should be pointing: right over the big toe.
  3. And this is the big one: very weak gluteal medius and minimus (the muscles at the side of the hip).  VERY weak.

The exercises to fix the imbalances:

  1. Glut Med, Min Stregthener. Side-lying leg series: Lying on one side, bend the bottom leg while keeping the top leg straight.  Lift the top leg to hip height and back down ten times.  Then lift the leg and hold for 10 seconds.  Lastly, circle the leg ten times in each direction. Once this exercise gets easier start adding ankle weights. Build up to 5 pounds.
  2. Tracking of the knee.  While seated, lift the leg off the floor in parallel position (or knee straight to the ceiling). Bend and straighten the knee and watch the tracking. The knee needs to continually point over the big toe.  Small variations not acceptable; this is your chance to really focus the movement and groove a healthy pattern. Do it perfectly.
  3. Strengthening of the Vastus Medialis. Do the same as exercise #2 with this small change: Instead of the knee facing the ceiling, turn the knee to the outside.  Bend and straighten. Continue tracking the knee as well. As you bend and straighten the knee will still be pointing over the toes.

Good luck. Let me know if you have any questions. K
p.s. Yes, I know it would be better if the pic were turned 45 degrees right. I have the picture on my computer vertically and when I upload it turns it. If you happen to know how I can fix that, Please! Let me know!

Is Core Strength a Medical Necessity?

Sunday, October 10th, 2010 by Karena

Core strength has been a buzzword in the fitness world for quite a while but now we

We accept your insurance through our partnership with SCV Therapy Services!

We accept your insurance through our partnership with SCV Therapy Services!

are hearing that same buzz from the medical field.  Clients are being referred to a Pilates program by their medical doctors who know that increased core strength can only mean decreased physical pain. So how do you know if core strengthening is for you?

Will Core Strengthening Help YOU?

  1. Have you experienced muscle spasms?
  2. Have you suffered an injury that has affected your ability to do everyday activities?
  3. Do you find it difficult to maintain excellent posture?
  4. Is it difficult to sit for long periods of time or does doing the same prolonged activity exacerbate your symptoms?

These are just some questions that are strong indicators that core strengthening could help you.  Here’s why:

  1. Muscle spasms happen in the large muscles, turning the small, core muscles off.
  2. Injuries tend to make us rely on our largest muscles because they are the strongest, again, turning the small core muscles off.
  3. If you can maintain excellent posture throughout the day then your core strength is intact.  Excellent posture uses your core muscles all day, every day.
  4. If sitting still hurts, that pain indicates that your spine is collapsing while you sit; pushing bony structure onto nerves or other bony structures instead of being lifted and supported. Pain while pursuing activities indicates that you lack core endurance.

Core strengthening, while beneficial to all, is especially beneficial to anyone who has every suffered an injury. As an interesting side note, core strength is not just about the spine and the stomach muscles.  Every joint has core muscles; all the smallest muscles in charge of the balance and control of the joint are the core muscles. So any injury throughout the body benefits from core strength.  Cool, huh?

At Pilates Teck we are able to accept your health insurance through our partnership with Santa Clarita Valley Therapy Services, a physical therapy clinic that offers the most up-to-date and thorough care in traditional therapy as well as occupational and aquatic therapy. Need to know more? Please call us! 661.260.1609.

Back Hurts When You Sit?

Thursday, September 16th, 2010 by Karena

As far as I can tell that is the best kind of back pain to have.  Lucky you!

In very broad terms, I see two

All our happy hours at our computers can be the worst thing for back pain

Many happy hours sitting at the computer can make for a very sad spine.

types of back pain clients:  The first has increased pain when they are still, especially sitting, and the second group has increased pain when they are moving.  In both scenarios great improvement can be made to pain levels but, generally, the first responds most quickly to therapeutic exercise or pilates exercise.

If you feel pain when you are sitting but feel relief when you get up and walk around the fix is pretty obvious: Move more.   As a rule, even painful joints have pain-free ranges of motion.  Maybe your back hurts when you do ‘X’ but you can still do ‘Y’ and ‘Z’.  That’s very common, so be sure to continue to do ‘Y’ and ‘Z’. The importance of moving, moving, moving is in this short little note. Take a peek if you haven’t seen it already.

I had a frustrated client today. He said: ‘Exercise isn’t going to change the fact that I have a bone spur or how the bone spur pushes on the nerve and hurts like heck.’  I agree on Part I: Your bone spur will not be affected by exercise except that it may not get larger if your alignment is corrected.  I don’t agree with Part II: That exercise won’t change the pain you feel from the bone spur pressing on a nerve.  When did your pain get bad?  Six months or 2 years ago?  And when did you develop that bone spur? Probably long before that.  If we age inactively then the muscles supporting the area around the injury (the bone spur, in this example) become weak and offer less support in a position of great compression (sitting).

Get exercising. Get stronger. Lose the pain. If you can walk without limping, take short walks that don’t flare up your back muscles and then find a few toning exercises to take care of your weak spine muscles and butt muscles.

Use the navigating tabs to the left to go to find free exercises for back pain: Look up Back Pain Series 1-8.  Also, our DVD for exactly the issue of weak spines can be found under the store tab on this site.  Please let me know if you have any questions!

Should you exercise before having surgery?

Tuesday, August 31st, 2010 by Karena

We have been the #1 studio for helping clients/patients prepare for hip surgery this year.

Pre-surgery exercise: The Key to Quick Recovery

Pre-surgery exercise: The Key to Quick Recovery

We’ve helped three women prep for the surgery and now we have a fourth prepping to go in in a few weeks. I am impressed that so many are thinking about getting fit before surgery.  And I think you will be inspired by their results.

I had a client this morning, our third total hip replacement, who was back at Pilates for the first time today, post-surgery.  Her surgery was 8 weeks ago and the stories she shared with me are almost verbatim what our other clients have told us about their speedy recoveries from a quite invasive surgery.  I have listed quotes from their stories here for you. Be prepared to be amazed.

  • “My doctor said he has never seen anyone recover so quickly from a total hip replacement.”
  • “My physical therapist said she would show me how to get out of bed and I had already been back and forth to the bathroom just hours after surgery.”
  • “My physical therapist asked me to wait so she could tie the belt around my waist to keep me falling.  When she saw me maneuver my way to the walker she threw the belt down, saying: Guess we don’t need that!”
  • “My friends are mad because it took them many more months, if not a full year, to get where I am now.”
  • “I can’t believe what exercising has done for me to prepare me for the surgery.”
  • “The pain from the incision is nothing compared to the pain my hip was in before surgery. And with all the work I did pre-surgery I just feel amazing.”
  • “My doctor wants me to use my cane if only to remind me not to do anything crazy.” (4 weeks post hip surgery)

Great stories, huh?  Thought you’d like those.  These are just notes on hip surgery. If you are looking at going in for any type of surgery, I highly recommend working with someone who is familiar with pre-surgery protocols so that you can get back to living as soon as possible. Surgery is traumatic enough; don’t allow the recovery to be anything but a breeze.  Wishing you great health. K

Exercise Tips for Hip (Trochanteric) Bursitis

Sunday, August 29th, 2010 by Karena

As I was lying on the couch, acutely aware of where my trochanter protrudes on my femur. I thought: ‘I should write my little friends (you!) a note about bursitis’.  I have had some flare ups with the ol’ ‘B’ word but I can generally keep the pain pretty short-lived because I know what to stay away from.  And if you have bursitis, I think you should know, too!

Hip burisitis occurs when the cushion between the hip bone and thigh bone gets inflamed

Hip bursitis, and more specifically trochanteric bursitis, occurs when the cushion between the hip bone and muscles of the thigh becomes inflamed,

Acute episodes of bursitis need never become chronic. Just stop pushing on the bursa!  The bursa is a soft little pillow that cushions the connection between a bony point on your thigh bone (the trochanter) and the tissues of the outside of the thigh. And if your thigh bone squishes the bursa, it becomes inflamed; hence the ‘-itis’ that gets suffixed onto the backside of bursa…

How do you squish the bursa? The bursa is easily squished when you externally rotate the thigh or repeatedly rub the trochanter against the bursa once inflamed. External rotation crams the greater trochanter against the bursa squeezing the life out of it. That’s fine when the bursa is happy but when it’s not happy you need to avoid squishing, smushing and otherwise irritating the bursa.

Here are some things you can do to avoid externally rotating the thigh.

  1. Don’t cross your legs with one ankle dropped over the opposite knee.
  2. Do sit with the legs together, knees touching. If you can cross the legs and smush the inner thighs together you will still be avoiding external rotation and you could be internally rotating which will pull the thigh bone away from the bursa–aaahhhh, sweet relief…. (think piriformis stretch for the professionals out there)
  3. Walk with your feet pointed straight ahead: no duck feet. Duck feet externally rotate the hip and smush the bursa
  4. Perform exercises that internally rotate the hip.  Lie on your back, feet hip-width apart and push the knees towards each other.  You can do an isometric push here.
  5. Another exercise: Lie on your side, bottom leg bent, top leg straight. Now lift the top leg to just below hip height.  Then bring the entire inside of the foot back down to touch the floor (heel to big toe knuckle)
  6. Sleep on your back with your ankles crossed and knees rotated inward.  Okay, so you might not last the entire night that way but it is a great way to get off that bursa!
  7. Do not move the leg to the side of your body past the hip bone.  (No hip abduction for the professionals…) You will have to adopt a demur lady-like position in everything you do until the pain subsides.
  8. Do not sit cross-legged.
  9. If you are really flared up you’ll get discomfort with walking for a period of time or otherwise moving the trochanter against the bursa. If you are doing something that hurts, I would recommend not doing that.

Does this make sense? Each and every time you externally rotate the thigh or carry the thigh to the outside of the body you ’smush’ the bursa.  Since the bursa is inflamed that kind of motion is only going to tick it off further.   So…you’ll get relief extremely quickly if you can just remember to STOP SMUSHING THE BURSA.

Good luck and let me know if you have any questions! K