Jessica Bento, Physical Therapist (Creator of DVRT Restoration, Shoulder & Pelvic Control Courses)
The other day I stumbled across an IG “influencer” named top 40 Physical Therapy influencers…I was like what? That’s really a thing? I guess I just don’t get social media and never will…
So this particular “influencer” and yes I use quotations as I don’t really want to admit that its a thing…I could tell did not have a lot of experience in their field just by some of the exercises they were showing to be beneficial for knee pain…and this isn’t the only one I have seen, I can’t tell you how many times I see people give the top ten exercises for low back pain, top movements to prevent knee pain…you name it I see it, and the thing that stands out most to me is that if these people actually treated patients or knew what it was like to have low back pain or to have knee pain they sure wouldn’t be telling people to do a lot of things they show on the “gram”.
Now don’t get me wrong, there is a lot of good stuff out there, but there is also a lot of bad stuff and when people have credentials after their name its hard not to believe what they are saying…and they themselves might believe what they are saying to be true or works but as someone that has treated hundreds of patients over 15 years and still does, as well as being someone that has had their fair share of aches and pains, I know automatically what is going to work and what isn’t. I can look at an exercise and say no way is someone with real knee pain going to tolerate that, or no way is someone with low back pain going to be able to perform that exercise pain free.
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When it comes to the 7 foundational human movement patterns (squat, hinge, lunge, rotate, push, pull, and gait) I find that people really struggle with implementing lunging. While some might write off lunging as not as necessary as squatting or a drill like the deadift, lunging has huge implications in building real world strength and resiliency. From frontal plane strength, hip and core stability/strength, acceleration and deceleration strength WITH direction, lunging is typically overlooked with the immense value it has. One of those reasons is we don’t often give coaches and therapists great progressions and we many times miss the true source of many issues. This #DVRT lunge is a great example! ______________ 💥 At first glance it may seem like A LOT of “stuff” going on, so what is happening and why is this such a great example of how to introduce lunging? First, putting an XL @perform_better mini band around the feet in this manner reminds us that we have to cue the feet first! Many people cue on the knee, but the feet are the drivers of the knees and have HUGE influence over the #glutes . Incorporating a @valslide helps us teach how both feet play a critical role in the lunge and lunging backwards is less deceleration than lunging forwards (having to decelerate less of my body mass). Sliding also helps us build up to stepping and allows us to progress what is often overlooked as a VERY challenging action. _____________ 💥 The rotating press out of the Ultimate #Sandbag plays another big role! We often talk about in DVRT that we can to build core stability from the bottom up (the chain the feet create) and the top down (how the upper body integrates with the core). The ability to “pull apart” the Ultimate Sandbag while engaging our grip builds a better moving #plank helping stability for the trunk while allowing better mobility for the hips. Rotating the Ultimate Sandbag in this manner helps us work on some cross patterning and try to better connect the chain of the shoulder, core, and opposite hip as we move in walking and running. Having the actual load of the Ultimate Sandbag not gives us that irradiation, but strength training … continued in comment
If these types of drills don’t make sense in regards to helping your knee issues, please keep reading!
It’s easy to say do this, do that…but with no real understanding of what it’s like to experience these issues or not treating patients with these pathologies is where a lot are lacking. In this particular blog I wanted to talk a bit about knees as I am currently working on our first installment of DVRT Rx. Which will be based on the knee. DVRT Rx will be going in-depth into not only the knee but the shoulder and low back too!
As I have talked about before, the knee is not that smart, it typically will do exactly what the hip and foot tell it to do and most therapists will look at the hip and foot when it comes to knee pain but very few know what to do or put into action how to get all those parts “talking” and I am finding its because very little do therapists incorporate the core into their rehab of the knee and by leaving this piece out we are forgetting the foundation. This is where I feel most knee rehab exercises are lacking.
While we shared this in regards to training the hamstrings, its relevance to the knee is almost more profound!
I made this mistake early on in my career, in fact I left out the hip and foot initially and focused just on the knee. It wasn’t until I went to a Gary Gray course and had my eyes opened up to how to train movement. Now a days you will rarely see me do any form of rehab without acknowledging the core, that also goes for shoulders, hips, low backs and so forth. So when I look at the knee I am actually looking at about 100 muscles in that chain. You might be saying to your self, WHAT?! 100 Muscles? Think about it though, there really isn’t anything in our bodies that are not connected, our muscles all communicate with one another to produce movement, they don’t work alone.
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Turn up the 🔈🔈🔈fix those knees… Getting people to train for strength is something we all want to achieve with people, even in a #physicaltherapy setting. Strength can be the way we live better, become more injury resilient, and be healthier, especially women and bone density. However, it isn’t always as easy as telling people to JUST workout. For example, we know #squats are great for building lower body strength, but people struggle with not having pain in their knees and low backs. _________________ 1️⃣ While there are many methods of trying to correct improper movement, it can be something as simple as giving more feedback to people to learn how to use their body smarter. One of my favorite methods is to use @perform_better bands both around the feet and the thighs. This feedback helps people learn to use their feet and #glutes correctly to avoid most common issues like knees collapsing inwards. _________________ 2️⃣ Many people will coach knees and hips, but they rarely coach the feet. Since EVERYTHING comes from the ground up we have to help people learn how to use their feet and that by itself can correct so many issues in performing a proper #squat . Solutions can be simple if we understand what the body wants to do in movement! ________________ 3️⃣ When we put the band around the knee area we don’t want a band to just hang out there, but we want to BREAK the band apart which really engages our glutes and combined with the feet transforms our squats. Not only do we see the knees not collapsing, but we see the trunk become more upright and better range of motion. That’s why I love simple strategies that think about #functionalfitness and get people successful.
When it comes to the knee it is key to give that knee some cues so it knows what it’s supposed to do. What do I mean? Well, take for instance, an online client of mine that literally has bone on bone in both her knees due to osteoarthritis, her goal has been to put off total knee replacements. Guess what? She has squats in her program but I make sure to give her knee a feedback through the type of squat I program for her. It allows for her knee to know how to move.
You are probably like what the heck are you talking about? Well, we cue the foot like we have talked about so often with the use of bands or simply cuing gripping the ground with our feet. We also cue the core to react by the way she holds the weight, wether there is counterbalance in the load with bands such as front hold squat with the USB attached to the core step and bands providing more feedback or by creating counterbalance with a press out squat. She is able to squat pain free by providing her knee knowledge of where to go in space but the cues we give at the foot and the core. Pretty awesome right?
So today Im breaking down what I do for my own rehab and taking a squat, lunge and hinge movement pattern to show you what it means to give that knee some feedback. I can honestly tell you if I don’t use these cues or the right tools I will have pain in both my knees.
This is why progression and cuing are so important to what we do at DVRT. Don’t forget, if you want to delve deeper into our system, ALL our DVRT Online Education is 30% off as well as our great functional training tools with code “holiday2020” HERE
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The way I would have treated knee issues is VERY different than I look at knees now. As young physical therapist, I admit, I looked at the body in terms of parts. However, as I continued to look for better solutions for my patients, I started to learn how incomplete and misdirected a lot of my efforts actually were in getting results. ______________ Knees are a great example of most of us think if a knee is giving us issues, we look at the knee. I’m not suggesting we don’t look at the knee at all, but looking at the knee ONLY gives us a very incomplete story. That is because all our joints are impacted what is happening above and below the joint. For the knee, that means we have to put a lot of energy in looking at what is happening at the feet and hips. ______________ These 3 #DVRT drills that I show place heavy emphasis on not just treating the feet or hips individually either, but connecting them in a way they work together. For example, the split squat lift/chop I perform on a @perform_better balance pad to make my foot work harder to create stability while pulling apart the Ultimate Sandbag during the lift/chop ties in the core/hip complex to the movement. In other words, a much more effective way of building stability. ______________ The half kneeling Around the World on this small balance beam places me in an inline position where again, my feet, hip, and core have to work synergistically to keep me stable. The Around the World is like a lift/chop with a plank, working more reactive stability of the core. Finally, a Front Loaded rear slide good morning with @valslide and XL mini Perform Better mini band gives me feedback to “grab the ground” with my feet, use both feet, and by pulling the Ultimate Sandbag apart, I get a great tie in with the core/pelvis. Try these drills to help your or those you are trying to help knees be healthy and strong! Find out more with our DVRT online education that is 30% and functional training tools with code “holiday2020” at DVRTFitness.com