The Real Reason Your Knee Hurts and Who to See About It

Our bodies often send us pain signals that we just don’t understand.

Much like when we watch an episode of Lassie, all we really hear from an injured joint is barking.  “What’s that, knee joint?  My arch has fallen down a well and cant get out?  Ok, lets go to the old johnsons place and get a rope!”

When Lassie barks, people listen.

Wouldn’t it be great if were were able to sit down and have a nice cup of tea with the ankle, knee and hip and ask them what is really going on?  Who caused this and what other instigators are involved?  What would they tell us? What if we included some other major players into the conversation like the low back or the shoulders? Some might just show up and have nothing to say but be happy for the free tea… but some might tell us things we wouldn’t have known unless we asked…

If we are to listen, watch and learn, we might actually understand better what is happening.

Let me give you an example of one of my clients.  Her real name is Joan, but lets call her ‘Marion’ to preserve her identity 😉

Marion says ‘my knee hurts’. I resist all instincts to immediately take out any exercise that might affect Marions knee, but first ask a few questions.

Turns out Marion wore high heels all this week (fashion diva that she is). Her knees now hurt. That information is crucial to me if I understand two things:

THE ANKLE IS A SHOCK ABSORBER:

Shock absorbers make for a softer ride

By placing her foot in a high heel she reduced the range of movement of the ankle significantly (at the price of a nice looking calf of course a small price to pay for beauty – I mean, they hobble women in China to give them pretty folded over feet, right?).

WALKING ON SUNSHINE

The four trapped youngsters failed to realize the jumping at once would fail to launch them free of the von trapp bouncy castle.

Each time you step, your ankles, knees and hips act together to absorb shock. Take away your ankles ability to bend and absorb shock, you increase the load on the hips and knees (someones gotta take the load, right?).

HIPPY HIPPY SHAKE

If you happen to be wearing high heels, your heels are lifted, which means your hips will likely tilt forward to help your lower back to arch forward and your mid back to lean back to preserve your center of gravity.

If that didnt make sense, just know that wearing high heels will create a chain reaction that tilts your hips forward. If you have ever worn high heels then I dont need to tell you that you are putting more pressure on your low back.

PHYSICAL THERAPY FASHION WEEK

If you have experienced this phenomenon, but are not sure that your local physical therapist/doctor understands how the ankles can connect to the hips, then I suggest you take a pair of heels down to their office and have your doctor/therapist walk around in them for a while – of course, if it is a male doctor/therapist they might need a larger size heel (and get it in black so it looks more businesslike around the office).

I'm not sure which aspect of this picture makes me feel more uncomfortable. The awkward posture from high heels or the vinyl leather outfit. Either way, it's just plain wrong.

The theory of a strong connection between knee pain and heels is because wearing them can place a whole extra load on the kneecaps.

Sound ridiculous? Hopefully not after you have read this post.

If you have experienced pain then I would urge you to see help from a professional that understands how to read your ‘body language’.  Of my knowledge, the group that are best qualified to do that are the graduates of a special program – the GIFT program (put together by the GRAY institute, run by Gary Gray, a world renowned physical therapist and an amazing human being).

If you have ever been to see a physical therapist and found it a negative experience, I would beg of you to consider seeing a GIFT graduate.   Having completed the course, I can tell you the finest quality of therapist (and highest quality people) attend these courses and are fully committed to helping others but also taking the time to understand them.  In short, they “get it”.

What makes a GIFT graduate different than other professionals in the health professions?  They GET IT!

These people represent some of the sharpest and most progressive minds in the country – and can sometimes be hard to find if you dont know what or who you are looking for.  I am just lucky enough to know some of them.

These fine people are known as GIFT Graduates – they will likely also be qualified as “Functional Manual Release” Therapists (one of the certifications offered within the course).

These graduates will also have a secret handshake that they use to connect with other GIFT graduates.  Just kidding, they don’t (or do they?…..)

If you are a physical therapist looking for more information on the GIFT program and why it breeds the sharpest functionally aware physical therapists and personal trainers in this country, you can click here:

http://www.grayinstitute.com/about.aspx

To find a GIFT graduate in your area who can help you, use the email below:

info@grayinstitute.com

Best of health to you all,

Jamie Atlas

Physical Therapist vs Personal Trainer pt 4: Building a bridge

The past few posts I have been writing about physical therapists and personal trainers quite loosely and have ruffled some feathers, it would seem.

I have received about 500 hits in the past 24 hours on just this post alone:

https://jamieatlas.wordpress.com/2009/05/07/the-ugly-truth-about-personal-trainers-and-physical-therapists

It got some people rather outraged – enough to write some pretty strong criticism of my non-physical therapist perspective.  But I welcome this.  I appreciate any comments people make.. just leave my mother out of it next time, ok?  😉

Here’s how I see the roles of physical therapist and the personal trainer

Right now there is a problem (and you can’t blame it on me – phew!)

I (as a personal trainer) have people asking for help with problems a physical therapist should be dealing with and physical therapists I refer out to who are dealing with clients that should be seeing a personal trainer instead (a qualified one, not some dumbbell jockey with a weekend cert).

It’s a problem because personal trainers and physical therapists are getting annoyed with each other…  Like ‘egg your house at halloween’ kind of annoyed (yep, that bad).  So rather than put myself under the microscope again, let me ask for help from YOU.

We need to connect the two worlds so they can know and trust when to pass off people and to who.

But I want you to help me (and any others) to build a bridge between the therapists and the trainers (and others perhaps).

I need your opinion on:

What personal trainers / physical therapists need to do to improve their communication with each other.

The two groups don’t really talk with each other, but rather tend to talk at each other.   If there is to be a smooth transition back and forth (which means more business and better outcomes for us all) then we must have communication.  Let’s talk in a way that helps us connect and improve rather than criticizes and encourages hostility between the two.

Let me open the batting and say this:

Any physical therapist in the Denver area is more than welcome to one of my personal training sessions for free & I will take you through a workout while we discuss theory, technique and all matters physical & personal,then have a nice cup of tea afterwards.

Who else wants to tell us what personal trainers and physical therapists need to know about ourselves (and each other!)
Bring it!  We need to know these things!

Personal Trainer vs Physical Therapist pt 3: the Deathmatch

So in the philosophical debate between physical therapists and personal trainers, it would seem that there are either two choices:  a Deathmatch or a team hug.  Personally, I prefer hugs.  But for the sake of healthy argument lets have a few swings before we buy each other a beer and call it evens…

One of my readers ‘Selena’ wrote an excellent response to my last post (see my responses in blue below)

There isn’t an “ugly” truth between physical therapists and personal trainers.

Truth #1: Physical therapists are licensed providers of care.

Very true!  Physical Therapist are licensed providers of care and also jolly good fellows (which nobody can deny).  But aren’t personal trainers licensed at some level of care?  Even if it is just checking to see if they can touch their toes or if they have any history of heart disease?

Truth #2: The educational background for physical therapists has evolved to the point where physical therapists graduate with a doctorate in physical therapy.

100% agreed – a huge issue is that personal trainers nowadays can have a degree or a weekend cert and the public does not know the difference.  Point to you Selena, well said!

Truth #3: Fellowships and residencies are now post-graduate options for physical therapists.

Ok so this is an extension of #2, so let me ask if these physical therapists are going to actually make their money back on their education or just become professional students.

I mean, any physical therapist will tell you that if they accept insurance then they live according to what scraps the measly, scrooge-like insurance company will begrudgingly toss their way after treating the client with all their heart and soul.

So I will give you a point, yes – they can be very very educated.  But is that to a point where they become so specialized that they become true experts at one very small range and not necessarily what their true market might need?  Educational point to Selena, Philosophical point to be further discussed I think.

Truth #4: Literature indicates that physical therapists are just as well-versed and qualified at evaluating patients with orthopaedic complaints as orthopaedic surgeons.

Ok so I dont want to sling mud at anyone, but are you trying to say that PT’s are as good as Orthopaedic surgeons?  Or are you saying that orthopaedic surgeons are not very good at evaluating patients?  I know the surgeon that wanted to operate on my back after three visits wasnt really helping me feel the love.  Especially since on his desk he had magazines of luxury cars..  I still swear I heard him say ‘I think we need to get you into leather upholstery.. I mean surgery!’

Besides which I am not trying to say that injured people should use personal trainers, but that physical therapists generally are not taught how to get a person to peak fitness – just to ‘not in pain anymore’ fitness.  There is a difference, right?
Truth #5: Physical therapists are knowledgeable about the impact various co-morbidities have on pain and function (i.e. diabetes, congestive heart failure, multiple sclerosis, dialysis, osteoporosis, balance deficits, cerebrovascular accidents, post-operative healing, pharmacological side effects, osteoarthritis, central versus peripheral pain mechanisms, depression anxiety, fear…)

Ok I gotta contest this one.  I can agree that they study it, but I would argue that they dont use it to help people get to their healthiest.

Now I agree that personal trainers should know all of the above.  I think the industry is moving towards that.   So although physical therapists may know more, they dont necessarily get to use that knowledge nor do they use it to help people achieve peak fitness.
Truth #6: Exercise is easy… the skill is in knowing what exercise, when, at what intensity, at what duration, how often, in what manner and the effect the exercise will have on the sometimes multiple co-morbidities.

Now come on.  Exercise is easy?  Have you been to a gym recently?  Did you know that only 16% of the population belongs to a gym?  That we have never had more opportunities to exercise but have record obesity across the globe?

I say that the skill is not in the mechanics you outlay, but in the application to the person behind the flesh and bones and finding the motivation within them to rise to a level greater than they had previously acheived. But I recognize your point in regards to multiple co-morbidities (nice word by the way!  I am totally going to use that one if you don’t mind) however for people with no ‘morbidities’, does a personal trainer become the right option?  (ahh, the moment of zen, where we can consider things in a different light, if ever so briefly).

Truth #7: Physical therapists also aim at educating patients to such a degree that patients can be safe and can independently exercise within their abilities taking into consideration any co-morbidities.

Nup.  You lost me.  When I work with personal training clients I often ask what they do and they show me an old photocopy of some textbook exercises that the therapist gave them to do… 6 months ago.  Now, you may be an exception Selena (and I am sure you are, with all the excellent points and arguments you are making) but I think we can both agree that Physical therapists educate as much as their budget will allow and that they dont necessarily teach them that they need to keep progressing their exercises past whatever black and white rotator cuff handout they have slipped into their workout folder.

In my opinion, public safety is at risk with the lack of regulations on personal trainers – no substantial education and the lack of consistency in certification. Personal trainers can spew out “optimum health” but reality is personal trainers don’t measure “optimum health.” How does a personal trainer measure “optimum health” to ensure clients are optimally healthy? They don’t.

Selena, with all our back and forth – well, all my back and forth 🙂 I agree 100% with the statement of “public safety being at risk with the lack of regulations on personal trainers”.   We need trainers to be better organized in their knowledge and to have standards of care that we all meet and agree on – we dont necessarily have to agree on those standards, but there must be standards nonetheless.

But let me ask you this:

If the physical therapist is not going to ensure the client moves past a level of ‘pain free’ and into ‘optimal health’, then who will?  Are physical therapists taught about exercise periodization?  Do they know the different systems that burn fat?  Do they understand which machine will help with which movement pattern and which wont?  Do they know the difference between the cardio machines and are they willing to train people for free while they build up their business?

Personal trainers are not the best choice for consumers.

I agree that personal trainers are not the best choice for injured consumers.. But I also feel that personal trainers are currently the best choice for those that dont show ‘co-morbidities’ and want to get to a new level of health.

But as I have said in the past, this is changing.  The lines between personal trainer and physical therapist are starting to cross and soon both will have similar skillsets and interests.  And then all we need a marraige between the two and lots of drinkies to realize that we aren’t that different after all (awwwww).

Selena

Thanks Selena for your comment on my post!  I truly appreciate where you are coming from and am truly grateful for your thoughts.  If anyone else would like to comment lets keep it civil and work towards a new understanding of each other, not a division of doctrines, ok? (wow, division of doctrines!  That one sounds awesome!  Selena, I get the co-morbidities and you get the division of doctrines, ok?  Deal!)

The ugly truth about Personal Trainers and Physical Therapists

Sometimes I am retarded.

I don’t mean retarded in the ‘I am Sam’ kind of way (although my friends might argue that point) but more retarded in the ‘what were you thinking when you said that’ way.

I have one of my blog readers (thanks, Marm217!) in particular to thank for pointing out my error in judgment in regards to the plight of the physical therapist and the personal trainer.

You see, I wrote this blog post a while back about physical therapists and how they were different to personal trainers.

Read it here if you haven’t already:

Physical therapy vs personal training faceoff

Well, Marm217 read the above post and had the following well deserved and constructive comment to make about my short-sightedness in that article:

It’s great to base your statement on the shortcomings of the “average” physical therapist on one client of yours…. I’m sorry you feel that way. I think PT’s and personal trainers would do best working together, but all of the personal trainers I’ve come into contact with seem to resent physical therapists…

This reminds me of being at a presentation by Gary Gray (an amazing physical therapist) that was filled with physical therapists and personal trainers.  It might as well have been a cheesy fight scene from ‘west side story’.  The two could not seem to get along well at all.  I will admit that I was one of those trainers that was resentful of physical therapists, but that I no longer feel that angst – I do agree 100% with the ‘co-resentment’ that seems to happen between the two groups.  of course, Gary Gray had everyone hugging and smiling by the end of the day (I think he slipped something in the water).

Truth be told, why wouldn’t the two dislike each other?

The Trainers envy the therapists for their fancy book smarts, degrees and cushy insurance clients.

The thunderdome revisited: two fitness professionals enter, one fitness professional leaves!

Therapists on the other hand get annoyed that the trainer can be allowed to work  with people after having done a 3 week certification instead of a 4 year degree – not to mention that the trainers sometimes make just as much as the therapists (which is neither the trainers nor the therapists fault, it is more the system that is to blame for that one)

One person said that being a PT is really like being an over-priced personal trainer, that he “rehabs people all the time” and another personal trainer would not hire my friend who has her personal trainer certification because she’s in PT school and is “not going to make a career out of personal training”.

I think that is a shame that people will make judgments on others without having seen what they can do or how much they might be able to help.  Truth be told, there are horrible and great professionals  in any industry and there are great careers to be had as either a therapist or a personal trainer.

I honestly feel that the most important thing both occupations could do would be to put aside our egos and work together instead of squabbling with each others collective industries while the client sits patiently waiting to be helped with the best care possible.  By weighing down each other we hurt and confuse the client.

My truth is this:

The therapists role has traditionally been to get the person pain free and functional.  The trainers role has been to get the client to the point of optimal health.

For better or worse, the roles & responsibilities of these two professions are slowly moving towards each other

There is a significant difference between the two, but that difference is changing every day.  Therapists must get better at prescribing exercise, trainers must get better at counting to 12.

PT’s and personal trainers both have valuable knowledge about the body and can offer something different to each client or patient. It’s really a shame because there could be potential there, if more personal trainers were open to it.

I agree with Marm217 and I apologize 100% if my post came across as putting down physical therapists.

My intent was to spark conversation about the human body and how it was more complicated than what ‘the system’ would have people think.

So to rephrase.  We are extremely complicated beings – more complicated than probably a lot of personal trainers (and certainly some physical therapists) will ever care to understand.

But we must ask ‘why’.

so maybe we shouldn't ask 'why' ALL the time... just most of the time.

So next time you have a personal training session or need to go to physical therapy and are handed a dumbbell or a band or are given an exercise to do.. ask ‘why’.  You might be surprised by the answer (but probably not as surprised as your trainer/therapist who is probably used to gleeful subservience and will probably give you extra reps/pain for talking back).

Thanks again for your comment, Marm217!  I appreciate your input thoroughly!
Any other thoughts out there about personal trainers or physical therapists?

May I should just break into song ans sing that musical scene from ‘Oklahoma’ where ‘the farmers and the cowboys should be friends’?

Dont know it?  Here is a video below that sums up this whole blog (maybe I should have just posted the video and left it at that):

So remember – territory folk should stick together!

Yours in health,

Jamie Atlas

PS  I have since written a followup article to this post.  See it by clicking below:

Physical Therapist vs Personal Trainer pt 4: Building a bridge

PPS Are you a physical therapist?  Want something that shows my attempt at being more than just a weekend cert dumbbell jockey?

https://jamieatlas.wordpress.com/2009/03/02/knee-pain-often-comes-from-foot-problems-an-explanation/

Click on the above post to read about how knee pain can be attributed to the actions of the foot.

If you want to see why I think the bench press should be outlawed, click on the link below:

The Bench Press is a Useless Measure of your Strength pt2 (the juicy stuff)

PSSSST…Want to try something really different?

I WANT TO USE YOU.

Well, I mean use you as a guinea pig for some testing of a new method of training I just launched.  Read THIS POST to find out more or click on the link below:

https://jamieatlas.wordpress.com/2009/05/06/personal-trainer-needs-volunteers-for-innovative-online-fitness-training-method/

Functional Training: Why Your Body Needs It

Many people in the fitness industry struggle with the ‘F’ word. They know how to say it – but they dont know how to use it in their workouts.  We’re talking about Functional Training (no, not that other ‘F’ word, you sicko).  But why should YOU care about functional training?  Here;s an explanation:

If your motivation for exercising extends beyond your desire to improve your swimsuit figure, then chances are you have been trying to get more of the ‘f’ word into your workouts.

I am speaking specifically to how functional your workouts may (or may not) be.

Many of us want to integrate ‘real world’ movements into our workouts, yet most of the exercises we do in todays gym are anything but functional.

Your average person sits for 14 hours a day – and stands for less than 2 hours!

Here is a great example: How many hours a day do you sit? Really think about it? Chances are, you only get a few chances to stand throughout the day. And yet, when we go to the gym, what do we see? A range of exercise machines that will work you out while you sit!

Over 90% of the gym machines in your facility will have you sit to do an exercise.

If you wanted to be strong from a standing position, would it make sense to train standing? Would you use more muscles? Would you use more core if you were standing while you did an exercise? Would that mean you burned more calories and therefore more fat?

If you wanted to be strong from a sitting position, then by all means train from a sitting position. Just remember that your muscles will react completely differently when you try to use them from a standing position – you know which it is that you need most to play your sport, mr/miss weekend warrior.

Unless you are a wheelchair basketball fanatic, I am going to guess that standing/running/moving in multiple directions will play a major role in whatever you do out there in the real world.

So we have established that your body needs to be standing to be truly operating in a functional sense.

Chances are, even your warmup is failing to warm you up.

Watch the video I made below that explains an 8 minute full body functional warmup. It can also be used as part of a workout if you add dumbbells to these movements.

It is if you are remotely interested in any of the following activities, you might want to start thinking about what you can do.

Activities that are mostly rotational in nature that your average gym cannot train you for:

• The Tennis swing
• The Golf swing
• Tossing a Frisbee
• Swinging a Baseball bat

But also…

• Any throwing sport
• Any running sport
• Anything that requires you to rotate your body (care to see behind you? try looking without rotating or a rear view mirror)

And let’s not forget – sports or activities that require you to CONTROL rotation:

• Horse-riding (ever tried to stay still while a horse gallops underneath you?  It ain’t no merry-go-round ride, that’s for sure)
• Wrestling
• A basketball jump-shot

Any of the above apply to you?

Most machines have no concern for rotation. But is our ability to rotate important? Hopefully the list above convinces you that it is.

In simple terms, we move in front to back, side to side and rotation movement pattern in almost any functional movement pattern. Your workouts need to embrace true function if they are to deliver true results.

Your body moves in more than a front to back pattern. If you look around the gym you will see quite quickly that the majority of exercise equipment either pushes or pulls you back or forward, up or down. But rarely does it ask you to rotate your core. Or to move side to side.

Still dont believe me? Lets take a look at the old faithful bench press. A staple of any good workout, right?

When was the last time you laid down on a flat surface and pushed a metal rod off your chest?

I don’t really watch a lot of football, so I don’t know the rules. But I am pretty sure they play football standing – not lying down on a bench. I am also pretty sure they don’t get to carry metal bars onto the field (Not that it would matter with the amount of equipment NFL players wear – sometimes it seems they wear more padding than the Korean Riot Police!)

"Hey, you need me to spot this set for you? Oh it's totally cool lady, I'm glad to help out."

Although the above may be an excellent exercise for building a big strong chest, does the bench press qualify as ‘functional’? It would surely be functional if you used the same ‘function’ of the bench press in real life…

I’m not convinced that the bench press actually qualifies as ‘functional’.

Football is a sport that hails praise to the sacred bench press. In dusty gyms everywhere you can hear the sound of manhood being challenged: “Hey dude – how much do you bench?”

If my goal is either fat loss or functional muscles, does it make sense to work the chest standing, since it would work more muscles (and be more functional)?

"Hey man, you have something on your helmet - let me rub that off that for you"

If an exercise is to provide “real world” results – be it strength, flexibility or sporting prowess, it should match (or at least come close to) our real world needs.

If we take a look at the picture of a typical football tackle, you will notice four major differences that stand out immediately compared to the bench pressing picture:

The football player trying to make the tackle is:

1. Standing
2. Not holding a bar
3. Using more than just his chest muscles
4. Wearing more clothes than the woman doing the bench press (maybe it’s just really warm in that particular gym.. I mean like, really warm)

How about your workout? Is it functional? Or do you think functional workouts are just for fancypants pilates instructors? Does it make sense that working more muscle at the same time would burn more fat?

All great questions to ponder.  You may love your workout, but when it comes down to it, shouldn’t your workout serve not only your aesthetic goals, but also your life goals?  This article attempts to look at just a few ways you might consider ‘tweaking’ things to suit you better.

Yours in health,

Jamie Atlas