Get Moving For Life Blog
Wellness | Lifestyle | Disability & Injury Management | Injury Rehabilitation
Lifemoves Health and Rehabilitation's team of health care professionals share their knowledge with you so that you enjoy an enhanced quality of life. We post articles about wellness, disease and injury prevention, exercise for chronic diseases, injury rehabilitation and disability management.
Knee injuries can be complicated to rehabilitate from for several
reasons: there are a many different structures in the knee itself which can be
damaged; knees are in between two joints (hip and ankle); we need our knees to walk
so they are constantly loaded instead of resting when appropriate; there are two main types of knee injuries: 1) traumatic like twisting during a fall, 2) degenerative due to osteoarthritis and years of overload. Traumatic injuries are caused many mechanisms including a cleat getting stuck on the soccer pitch while pivoting. The rehabilitation process is also often made more
challenging because people gain weight from being inactive, the stress of
rehabilitation and their resulting poor eating habits.
Clients have told me in the past that their Physiotherapists
often focus on the site of injury, which is the knee without paying attention
to the hip, ankle or upper-body changes. They are an important part of the rehabilitation process. Physiotherapists help diagnose the injured structures as well as restore joint range of motion and reduce swelling after the initial injury or surgery, while we focus on discovering the root cause of the injury and resolving the resulting movement compensations to keep clients active.
Successful Rehabilitation from a Knee Injury
If, all the leg extension
and leg curls in the world aren’t providing any relief maybe there is another
How Movement Changes after a Knee Injury
While there are many variations to knee injuries, there are
some common and discernible movement patterns that change due to the pain. Due the pain the quadriceps and glutes
(buttocks) may become weak forcing other muscles in the hips, calves and knees
to take over to help accomplish daily activities.
- During a squat a foot turns out, a knee drops on the squat
isn’t as deep on the painful side
- When standing with the feet together a simple push to the
elicits a side-step to regain balance
- Single leg squats are not deep at all, painful and often
- There will knee pain and difficulty balancing during a forward luge
- Changes in walking again - hip shifts, uneven stride
- Keeping the back straight and using the hips hinge forward
and lift up for the straight deadlift will be difficult
Our muscles have different relationships to each other
depending on the movement. The hip joint
is meant to be fairly mobile, much like shoulder, the knee joint is meant to be
stable and the ankle is meant to be fairly mobile. Knee injuries make that joint unstable,
therefore it is often the hip, low-back and/or the ankle (sometimes on the opposite side) that take up the stability slack.
Figuring Out Individual Compensation Patterns
The first step is a comprehensive review of health and movement
history, followed by posture and movement assessments. Each assessment provides further clues into
how the injury has affected current abilities.
Knee injuries seem to have fairly similar compensation
patterns. Investigating relationships
between each muscle provides clues to how these relationships have
changed. Neurokinetic Therapy™ is an
assessment method used at Lifemoves® to figure out this puzzle.
How does Neurokinetic Therapy Work™ (NKT)?
It works by altering the brain. Injuries, especially chronic injuries alter
the brian’s motor control centre. By
testing each muscle in a systematic way to see if it is inhibited (weak) or
facilitated (strong) in relationship to others we can solve the puzzle. An example of this found in a knee surgically
repaired knee in Level I NKT™ is that popliteus, a small muscle at the back the
knee can be compensating for six or more other lower-leg muscles. Another one is that the fibers of rectus
femoris (thigh muscle) that cross the knee joint are weakened by deep hip
stabilizers. The fascinating thing is
that other structures such as scars and areas in the upper body can play a role
One the relationships have been figured out the facilitated
are with stretching, trigger point release, soft-tissue release, fascial stretch thearapy and then strengthen the inhibited structure. Repeat this at home
two to three times per day to really change the motor control center.
Changing Movement Patterns
Now that muscle recruitment is back online movement habits
need to be changed to lock it in. Kinesiologists look at the whole body and how
it interacts within the environment. Start with the basic unload or body weight
only activities and sometimes in small ranges motion, small with proper technique and minimal pain (if
any). If these are unfamiliar consult a Kinesiolgist.
Progressively Load the Movements
Continue with the stretches and myofascial release. Once the general movement patterns such as lunges, step-ups,
step-downs, deadlifts, straight leg deadlifts are being performed well it is
time to add more resistance in a gradual and progressive manner. Continue to ice the injured knee if it is sore, red, warm or slightly swollen after activity with a wrap or cryo cuff.
Getting Back to Sport
Begin with straight line running for small periods of
time. If that is successful add, slow deliberate agility and sport drills. If
these produce no pain (during or the day after) speed up the running and cutting drills over several
Losing Weight During Rehabilitation
A common complaint is weight gain because even walking is difficult. There are alternatives
to stay active, such as deep water running.
Not a big fan of the water? Try an elliptical trainer, a rower with the
arms only or an arm ergometer. To keep
up the cardiovascular system in shape another alternative is upper-body resistance
training circuits with repetitions from 15 – 50 reps, built up
Nutrition habits fall to the way side as well. Perhaps these habits need rehab of their own?
We are working on aligning ourselves with a Holistic Nutritionist, Leigh-Ann
Franklin in Vancouver to assist clients with this part of their recovery.
Have you had a
knee injury before? What were some of your challenges?
Labels: chronic pain, osteoarthritis, total knee replacement
Muscle, bone and joint diseases (musculoskeletal) are a group of over 200 conditions that affect quality of life and have a big economic impact. They are also aleading cause of pain and disability. Our clients seek the guidance of a Kinesiologist to help them select appropriate
exercises to manage pain and improve physical function. An encouraging recent review of several
studies continues to support exercise therapy for the treatment of many of these conditions and diseases including “fibromyalagia (FM), low
back pain (LBP), neck pain (NP), and shoulder pain (SP), and four specific
musculoskeletal diseases: osteoarthritis (OA), rheumatoid arthritis (RA),
ankylosing spondylitis (AS), and osteoporosis (OP)” (Hagen et al, 2012).
Impact of Musculoskeletal
Conditions on Society
“About one in five consultations in primary care are for
musculoskeletal conditions,” (Hagen et al, 2012) those patients are often
referred other health care professionals including Kinesiologists. These
conditions are so prevalent that the United Nations declared 2000 – 2010 the
decade of Bone and Joint. This mandate has been extended another 10
years. The World Health Organization is focused on “achieving
the global objective of gaining recognition of the importance of musculoskeletal
conditions globally, regionally, and nationally” (Conference Board of Canada,
In an Ontario health survey these conditions were associated
with 54% of all long-term disabilities and 24% of all restricted activities. Persistent chronic pain from musculoskeletal conditions
is estimated to affect 20 – 30% of adults
in Canada and Europe. In Sweden these conditions were responsible for 25% of
the costs for all illnesses (Hagen et al, 2012); in 2000, musckoskeletal
conditions were the most costly condition in Canada with an estimated cost of $22.3 billion.
Three quarters of these costs are attributed to decreases in economic productivity due to long-term short-term disability and premature death (Conference Board of Canada, 2012).
The impact of bone,
muscle and joint diseases increases with age. These diseases account for half
of all chronic disease for those over 65 (Conference Board of Canada, 2012). Risk factors include smoking, inactivity and
obesity. The pain and physical
disability due to these diseases and conditions affects social function and
mental health which diminishes quality of life (Woolf, 2003).
Hope with Exercise Therapy
for Muscle, Bone and Joint Diseases
The tide has shifted from doctors prescribing medications, inactivity and rest when managing
these conditions to the prescription of more physical approaches. In over 224 trials dating back to 2007 with
24,059 patients the reviewers found solid evidence that supports exercise
therapy in the management of musculoskeletal conditions. What did they find?
- Exercise therapy is very beneficial for
improving function and reducing pain for osteoarthritis, low-back pain,
fibromyalgia and shoulder pain.
- Little evidence that exercise therapy influences
disease pathogenesis, except for osteoporosis. There is support that exercise
therapy can influence bone density in postmenopausal women.
- Benefits of treatment increases with the number
of exercises sessions for low back pain and osteoarthritis (Hagen et al, 2012).
Manage Muscle, Bone and Joint Diseases with Exercise Therapy
Kinesiology is the study of human movement and how our environment
and actions influence our health. Exercise therapy is a planned and structured
program that involves the deliberate prescription of physical activity. Kinesiologists develop an exercise therapy
program that includes strength and conditioning as well as lifestyle changes after an assessment and discussion about goals.
conditioning programs are designed to support clients’ lifestyle goals. Examples
of client goals:
- A 50 year old client achieving a Masters 60 min
track cycling World Record
- A 70 year old client being able to lead an
independent life which includes gardening, snowshoeing, hiking, painting and playing with her grandchildren well into her
80s and beyond.
- A 50 year old highly skilled and passionate
Registered Massage Therapist who wants to keep playing hockey and practicing
Whatever your goals are a Kinesiologist can help you maintain
an active and productive life.
- Woolf, Anthony D & Bruce Pfleger. Burden of major musculoskeletalconditions. Bulletin of the World Health Organization 2003;8646-656
Labels: active aging, active rehabilitation, chronic disease, chronic pain, osteoarthritis
Many clients come to us complaining of neck, shoulder, or back pain which can usually be traced back to occupational hazards of a desk job.
There are numerous studies stating that prolonged sitting can increase our risk of developing chronic diseases, never mind chronic pain from prolonged static postures.
so much of our lives now in front of a computer or desk, it
isn't surprising that many people have neck, shoulder and back pain that
originates from prolonged sitting and poor office station set-up. When performing a postural assessment, I often see clients with kyphotic postures that includes
rounded shoulders, a forward sitting head, an extended neck and an
excessive curve in their lower back (lordosis). Most of these clients
spend large amounts of their time seated at a desk (at work and/or
home), driving, or sitting watching television or playing on the
computer, tablet or smart phone.
1. Correct Ergonomic Office Desk Set-Up
At home or at work it is essential that your workstation set-up
to enable you to achieve a suitable posture while working. WorkSafeBC
has a fantastic step-by-step resource that will help you set up a
computer workstation correctly. View it here Workstation Setup.
sitting at a station that is not desk-based (e.g. on a sofa or in the
car) it is also important to think about how you can achieve some of
these recommendations especially if you are going to be in that position for longer
than 60 minutes.
2. Be Aware of Body Position and Posture
aware of your body's position is a key to good posture. To
achieve good alignment ensure you are weight bearing through your
'sitting bones', that you are sitting up tall with a lengthened spine, that your shoulders are
slightly back and down (not in you ears) and that your head is above
your hips (not in front of them) with your ears slightly in slightly in front of your shoulders.
- Lean back once in awhile to use the back support.
- Complete a posture check every 15 min- are you starting lean in your head in? Try zooming your work to see it better.
3. Develop Good Office Stretching Habits
A office stretching routine
can help prevent and alleviate aches and pains. An achy upper-back often means that those muscles are over working and not in an efficient functional position. Try opening the chest and pulling the back head back over the shoulders - this is counter intuitive but effective!
following stretches throughout your day as required:
If you need something to remind you, Stretch Prompter is a tool that you can download from WorkSafeBC here.
- Neck: Slowly flex your head down and up, rotate left and right, and flex side to side.
Shoulder: roll your shoulders gently up, back, down and forwards 5 – 10 times.
Chest: open up your chest area by extending your arms straight out to your sides with the thumbs up or stand up to find a doorway to the classic doorway chest stretch.
Hips: Shift your hips so that you are sitting on the edge of the chair with one leg off. Place that leg back like a seated lunge with your knees bent to 90 degrees one. Reach your arms overhead to get a get a stretch on the side which is off the side.
- Spine: Sit-up tall. Take a nice breath in; turn to one side while focusing on making sure that the rotation comes from the thoracic spine. Breathing properly helps the ribs rotate. Also, periodically tilt your head side to side or look left and right.
4. Move Every Hour
helps to improve your circulation and it can help keep your muscles
long and strong. Break up your day by trying the following: stand up
and walk around for a few minutes, refill your water, deliver a message
in person, take the stairs, stretch and go for a 20 min walk with your colleagues as part of your lunch
5. Get a Sitting Desk that Converts to a Standing Desk
Yes, you can get a desk with treadmill attached to it. It might might not fit in your office. However, there are other options. An adjustable height desk gives the user the option of sitting or standing as needed. Chairlines in Vancouver has options to convert a regular desk into a standing desk. Also, I just discovered a very cool high tech desk designed by former Apple employees. It remembers your positions and reminds you to stand! The Stir Kinetic Desk
will start shipping in early 2014 (it is on my wish list).
Sitting for Long Periods of Time Increases Risks for Chronic Disease
Chairlines Ergonomic Solutions
- in Vancouver, BC
Labels: chronic disease, chronic pain, office ergonomics, office stretches
October 21st is the start of National Kinesiology Week in Canada so, it is appropriate that I explore and share the deeper reasons of why I became a Kinesiologist.
Firstly, I was curious about how exercise
physiology, strength and conditioning and injury management could influence human performance. This interest was piqued by an active childhood
cross-country skiing, playing soccer, hiking and fooling around outside.
Secondly, I began my Human Kinetics degree because I knew it was a solid foundation for many medical professions. I was also interested in health care because one side of my family has a legacy of outstanding doctors.
While the above shaped my educational decisions the way I practice and my choice to
specialize in chronic disease and disability management developed on more subconscious level starting in 1988.
That year, with great protest from myself, my family moved
from Regina, Saskatchewan to Vancouver, British Columbia. I was twelve years
old and had formed strong bonds with all my friends since kindergarten. Faced
with forming new friendships in a new school at the end of elementary proved to
be extremely difficult. There were only
two kids who become my best friends in Grade 7. The rest of class ridiculed me
for my last name and where I came from and the sport I was passionate about,
I tried to participate in the local soccer programs. However,
even there I wasn’t accepted or given the opportunity to shine. With the ski and soccer seasons overlapping I
retreated to cross-country skiing because it was something I enjoyed doing with
my father and I was with a community who cherished each other – many I still
My mother is a compassionate woman who always tried to
comfort me on the days that I came home from a day of bullying. The bullying
lasted through high-school and led to decades of depression. Although when I
was younger I thought he didn’t accept me, my father showed me that he loved
and accepted me by challenging me to rise above mediocrity. He consistently
asked “why didn’t I….” or “why couldn’t I …” when I showed him a completed
project. They both continue to support
me in my dreams and business.
The summer after graduating from the University of Guelph, I
worked at a group home for people with mental disabilities. This opportunity really showed me how
difficult it was for the public to accept the residents as human beings, just
like you and me. Shortly after in
January 2000 I had the opportunity to volunteer as a Personal Trainer for a
client with a cervical spine injury.
During this time I discovered that the opportunities and facilities for
people with disabilities to fully participate in physical activity were
It wasn’t until 2002 when I found someone other than my
family who accepts me for who I am, who challenges me be to greater and shows
me unconditional love. We married in 2012.
While each session is educational and fun clients are also accepted for who they are and what they are capable of. With compassion and unconditional love clients will also be challenged to move differently and move more so that they can get
back to what they were doing if injured, continue to do what they enjoy or be able to take on new
Labels: choosing a kinesiologist, chronic disease