Teenage boy with anterior knee pain
At age 13, I remember going up to my dad and complain about anterior knee pain. It had been pretty intense for a while and I was starting to worry a little bit about it. I was playing a lot of soccer and even though it did not stop me, there were times the intense pain would slow me down. As I was mentioning the location of the pain, he barely tapped the upper part of my tibia. The resulting scream and seeing me holding back some tears landed me in front of our family doctor. Osgood who? I was diagnosed with a condition called Osgood Schlatter and was given some anti-inflammatories and the advice to ice my knee down after practices for 10 to 15 minutes. I was lucky to be able to go on without any further visits and the pain ended up subsiding after a few months.
What is Osgood Schlatter? It is a condition that usually affects 12 to 15 year old children who are active and engage in sporting activities involving a lot of jumping and running. It is more common amongst boys although girls are not spared. The tibial tuberosity, a site located on the upper tibia is injured through overuse and intense pull of the patellar tendon at the attachment of the quadriceps muscles (anterior thigh muscles). The child may experience pain, swelling and increased sensitivity in the area. It is often unilateral but may affect both knees. The condition is usually self-limiting and the nsaids and ice treatment coupled with a break from intense jumping routines is often enough to handle this condition. There are however a few other measures one can take to speed the healing process up and decrease the pain.
Treatment: a conservative approach should help the child regain normal activities in a short period of time. The following actions are recommended to speed up the recovery.
- Special attention should be placed on managing the inflammation. Applying the RICE (Rest, Ice, Compress and Elevate) concept after each practices is paramount.
- The hamstrings should be stretched
- The quadriceps muscles should be stretched and strengthened
- The calves muscles (gastrocnemius and soleus) should be stretched
- Strategically applied Kinesio tape can be used to decrease the pull on the tibial tuberosity
- A Patellar tendon strap can also be worn to dissipate the forces applied on the tibial tuberosity
In case you are wondering what happened to my knee? I did not stop playing soccer and all that is left to remind me of this condition is a slightly enlarged tibial tuberosity and a memory of my dad’s startled reaction after he tapped my tibia…
If your child has been complaining of knee pains, you can contact us at (650)858-1213 and schedule a consultation.
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by Adin on September 24, 2010
Low back stiffness can be caused by a role reversal between the outer unit and inner unit muscles.
What are outer unit and inner unit muscles?
Outer unit muscles (also referred to as global muscles) are superficial to the deep inner unit muscles. A few examples of global muscles are, the quads, lats and external obliques. Global muscles are gross stabilizers of the spine and function properly by responding proportionately to a given amount of stimulus. Back pain often arises when global muscles are constantly turned on (medically known as being in a facilitated state) while the inner unit muscles are inhibited. For example, many people hold tension in their neck (upper trapezius) and experience upper neck discomfort from the muscle responding excessively disproportionate to the given stimulus.
To give you an example in my studio, many people come to me for the first time and when I show then a pulling exercise they feel the neck activate instead of the rhomboids or lats. It takes time to retrain my client to recruit the proper muscles and learn to relax the facilitated upper neck musculature.
The inner unit muscles need to be activated at all times to serve their function properly. The medical term for these inner unit muscles are called tonic muscles. Deep/tonic muscles play a larger role in stabilization of the spine for light to moderate loads. In low back stability, the multifidus plays a crucial role. According to (Hides et al 1994, Danneels et al 2000, O’sullivan 2000, Hungerford 2002, Moseley et al 2002) noticed a high correlation to low back pain and pelvic pain patients and the multifidus muscle fibers becoming shut off (or inhibited) alongside muscle atrophy.
Why should you do more multifidus training?
As stated above, the multifidus is a stabilizing muscle of the spine. Many people with low back pain have a lumbar spine that is excessively mobile and not stable. For example, one reason why golfers (or many rotation sports for that matter) have higher incidences of low back pain is due to a lack of strength in the stabilizers and and increased/disproportionate strength in the global muscles that drive the golf club.
Example of the Lower Back and Pelvic Stability – The Sprinter
If you look at a professional sprinter from behind, you’ll notice very little movement in the low back and pelvis and a lot of movement in the extremities (the legs and arms are moving like crazy!) A sprinter with good pelvic stability must have great core strength and proper inner unit activation to stabilize the legs and upper body.
Which exercises are best for conditioning the multifidus for low back injury prevention or treatment?
Below are a couple great exercises for conditioning the multifidus muscle.
The Prone Cobra – Beginner
Simply lie face down on an exercise mat and lift your torso up from the mat while externally rotating your arms so the thumbs are facing the ceiling. Hold your neck in a neutral position (do not look up or tuck your chin). Retract your shoulder blades together to activate the rhomboids (strengthening the rhomboids is a great way to improve posture).
The Prone Cobra Intermediate – see images below. Lie face down on an exercise mat and position yourself exactly like you would in the beginner cobra. Advance the exercise by placing your arms at a 45 degree angle towards your head and hold the thumbs up toward the ceiling. The prone cobra intermediate will work your multifidus and your thoracic extensors as well as your mid traps (all great postural muscles to work).
Prone Cobra – Advanced (see image at very top of this post)
Have a personal trainer or a workout partner stabilize your ankles and roll out onto the ball until your hips are close to the apex of the ball. The further your workout partner rolls you out onto the ball the more difficult the exercise becomes. At some point you can roll out too far, which will recruit more of the hamstrings and glutes. To keep the exercise in the back/multifidus converse with your partner and let them know which muscles you feel being worked.
Basic Protocols:
This important exercise for back injury prevention can be done anywhere! Start out by performing 10 sets of 10 seconds on 10 seconds off. When ready gradually progress to holding prone cobra exercise for up to 1-4 minutes (depending upon the demands of your work, sport or life environment).
Are you within driving distance to us and wish to start up a personal training program? Contact us today for a free 20 minute consultation.
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If you think that personal training is geared for athletic kids only, think again. Although the number of children participating in sports at an early age is growing, too many of our kids are becoming sedentary. Time that was spent running around, riding bikes or catching polliwogs has been replaced by watching too much television or playing video games. I understand that personal safety is much more of a concern than it used to be but there is a great need for children to move and reach their necessary physical milestones. Yes, training is as essential to the couch potatoes and the boy or girl with special needs than it is for the young athlete.
We have a chance to send our children on the right path by teaching them how to move correctly, eat and stay healthy! A few hours at the gym may create a life long passion for movement and exercise. Most kids will not become pro athletes… but preparing their bodies and minds will benefit them their entire life regardless of their athletic abilities.
It is very important not to lose sight of the fact that we are dealing with kids, back talk and all… so keep it fun and train them applying sound, age appropriate exercises and games. It takes 300 to 500 repetitions to develop a new motor pattern but it takes about 3000 to 5000 repetitions to correct a bad motor pattern. Learning to move and lift the right way from the very beginning will prevent future problems. A purposeful strength and conditioning program can not only be safe and effective, it will also promote motor development and help prevent injuries.
Organized strength and conditioning programs improve self-confidence, mental discipline, performance or coordination.
I recently joined the International Youth Fitness Association and got my first certification as a Youth Fitness Specialist, Level 1. As a long time soccer coach and assistant baseball coach, I wanted to add more specific training to complement my physical education and chiropractic degrees. I look forward to applying these principles and develop as many young kids and athletes into well rounded, active young men and women.
Premier Personal Training: Expert Personal Trainers serving Palo Alto,Los Altos, Mountain View, Menlo Park, Atherton & vicinity.
Weight Loss, Rehabilitation, Nutrition and Fitness Services.
by Adin on September 18, 2010
If you have a “full plate” and feel overwhelmed, it will be benificial to identify all current drains in your life on a sheet of paper. Below is an example of a recent client of Premier Personal Training, Inc. who identified her “drains” and with our help, was able to come up with a strategy to reduce or eliminate those drains.
Drains:
1. Skipping breakfast
2. Not getting enough sleep (due to having 2 babies to care for intermittently at night and in early mornings)
3. Watching the news
4. Addicted to social media platforms (such as Facebook)
5. Too many gadgets (having to constantly modify, upgrade and fix software or hardware)
My Suggestions for Plugging those Drains:
1. I taught her how to make a 1 minute protein shake including:
- Protein Powder (if sensitive to whey – try rice or pea protein instead)
- Powdered Greens (ground up vegetables providing over 10+ servings of antioxidants)
- Mixed Frozen Berries (raspberries, blueberries, blackberries) – Berries provide a “smoothie feel/texture” plus low glycemic carbohydrates.
- 5 grams of fiber (helps slow down the semi high glycemic load of protein powder)
- Fish Oil (Ideally you’ll want some carbs, fats and protein with every meal)
- Glutamine (helps improve gut function and is a fantastic amino acid)
- A few taps of powdered cinnamon (helps counter the high glycemic load of the protein powder)
Please Note: It is best to eat “real food” in the morning such as eggs, steamed vegetables and brown rice for example – however, shakes serve as a great transition step for those who have gone without eating breakfast for years. Sometimes I myself do not have time or make time for a “real breakfast” and therefore whip up a shake occasionally.
2. This client was lucky to be able to afford it – I recommended she hire a nanny to take care of the kids 3x per week in the mornings so she could sleep in. This made a huge difference in her energy and how she felt!
3. I had her explain to her husband she needed to stop watching the news with him because it was contributing to her negative thoughts and creating more anxiety in the evening hours. He understood and helped her make the change by accepting her decision and banning her from the news!
4. She was wasting so much time looking at the online social lives of others (about 2 hours a day!). I suggested she try deactivating the account for 2 weeks and replacing it with meeting her friends in person for walks, coffee or going out to dinner.
5. This client had 2 ipads, 3 ipods, 3 laptops, 1 desktop, calorie counting software, numerous iphone applications and other gadgets that were running her life. This is not an anti Apple, Inc. campaign, but using this much technology (or not being able to manage it) can create a huge waste of time. I had her hire someone to help teach more efficient use the devices as well as consolidate and eliminate. Email also was eating away her time, so I had sent her some links on how to be more effective at cutting down on non essential email and came up with an email archiving and management system (I highly recommend using GMAIL – you’ll never go back after you get used to it)
Adin’s final comments:
If you are attempting to lose weight and get the most out of your personal training program – you will need to also work on the psychological/emotional health component. Your psychological and emotional health affects hormones, and hormones influence your results you will get from our fitness regimen.
Click Here to Contact Us to Get a Fitness Regimen Going With Us!
Premier Personal Training: Expert Personal Trainers serving Palo Alto,Los Altos, Mountain View, Menlo Park, Atherton & vicinity.
Weight Loss, Rehabilitation, Nutrition and Fitness Services.
by Adin on September 13, 2010
If you have not yet read my previous posts on the adrenals/protocols for adrenal exhaustion, please review the below posts to get the most out of this article:
In stage 2 or 3 adrenal exhaustion, your cortisol levels are below normal on more than one time window (see test below), have low DHEA levels, and a poor cortisol to DHEA ratio.
The above adrenal stress profile shows depressed cortisol levels in the morning, noon and afternoon. The DHEA-S average is on the low side of normal – pushing the cortisol to DHEA ratio out of normal.
What are the symptoms of the client above? [click to continue…]
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