Over 200,000 people a month search google for information on knee pain. Needless to to say, it’s a common problem. You may be surprised, however, to learn that the knees are seldom to blame for the discomfort experienced. I’ve outlined 5 of the most common sources of knee pain below, and some ideas to correct the root causes.

1) Far too much sitting

How does this affect your knees? You may wonder. I’ll explain. Your gluteus maximus is the antagonist to your hip flexors, the muscles that lift your knees upward toward your torso. As you sit on your glutes, they relax and lose tone, much like pressure point massage therapy. The hip flexors, on the other hand, get extremely short and tight with long periods of sitting, because of the 90* angle between your femurs (upper leg bones) and torso. This creates unnatural pulling and twisting forces when you do try to stand up, walk, jog, run, squat, or jump. Please note, I didn’t say they are too strong, just too short. They should be at least strong enough to do a full set of sit-ups or knee raises. But they need to be worked and/or stretched through a full range of motion, which includes hip extension. Walking is tremendous for accomplishing this, as one femur extends behind the torso as the other reaches forward for the next step. Strengthening the glute maximus muscles with exercises like lunges, hip bridges, and donkey kicks will help create tone in the glutes that will produce a constant gentle lengthening of the hip flexors.

2) No lateral hip strength

This is a big one, and it’s very common. When we were younger, we did jumping jacks, played foursquare and hopscotch, roller skated and swam, among other sports and activities. We actually moved our legs side to side! That strengthened a group of muscles called our abductors, which connect the outside of our hips to our upper legs. When we were younger, strong hip abductors kept our femurs (upper leg bones) from caving in toward each other. These days though, too many of us have lost that lateral hip strength, and therefore suffer knee pain due to misalignment of the bottom of our femurs with the top of our tibias (shin bones.) What was supposed to be a smooth-operating hinge joint has now become an uncomfortable mess of clicking, grinding, catching, and pinching. It’s not simply bad cartilage, old age, or too much weight. Those may be small contributing factors, but they don’t excuse a legitimate postural dysfunction. I promise you – the path that returns you to pain-free days with be filled with lateral strengthening movements like lying and standing side leg raises, hip hikes, single leg stands, side planks, and resistance band side steps. Keep in mind – if you let the foot rotate outward during these exercises, you will severely limit he effectiveness of the movements and fail to help yourself. So be sure to keep the angle of your feet parallel to each other throughout every exercise.

3) Shoes are too small

This is an all-too common mistake. People often decide whether or not a shoe fits based on the amount of room left in the toe while standing. That’s actually the least important aspect. It’s much more vital to make sure you match your arch length, and have enough room in the forefoot to move and splay your toes, including that neglected little toe. If you are going to use the foot-measuring device, make sure you measure both feet, and use the inside slide to measure your arch length as opposed to looking at total foot length. Many of us have lost some of the arch over time, resulting in a longer foot – but we are still trying to wear the size we wore 15 years ago! Give those toes room – lateral room. They help balance you and keep your knee aligned properly.

4) Externally rotated femurs

If we allow ourselves to become less coordinated and less athletic year after year, we will start to compensate for our lack of strength and balance with an altered gait. What do I mean? Visit a mall and just watch people walk for a while. You will see that we are starting look more like waddling penguins than gliding humans. Our legs and toes are turned out. Instead of simply moving forward, we end up fighting the other half of our body. The right side takes a step toward the right. The left side takes a step toward the left. Yet our goal is straight ahead! What a waste of time and energy. More concerning, however, is that this puts added stress on the knees. Both the toes and the knees should be pointed in the direction we are trying to move. Sometimes, just one femur is rotated. This can actually be caused by “toe-out” driving for long periods, where the heel stays under the brake but the toes are out over the gas pedal. This can add up if you spend a lot of time behind the wheel. If you are going to be on the gas for a while anyway, try moving your heel over underneath the toes. You’ll feel your femur internally rotate back towards normal, and your knee may be better for it. It’s a good idea to check yourself for symmetry e wry now and then, especially on road trips.

5) An unlevel pelvis

Perhaps you sleep on the same side every single night. Maybe when driving, you always lean into the center console. Or it could be you always carry a heavy briefcase or purse on the same shoulder. Any and all of these could add up over time to shorten the distance between your lower ribs and your hip bone on one side versus the other. We have 2 quadratus lumborum muscles that complete this connection – one on each side. If the right muscle is much shorter and tighter than the left muscle, the hips will be unlevel, often resulting in a short leg. (fyi, sometimes the shoulders and neck take the hit instead) This will add stress to the knees – sometimes the one on the “short” leg, sometimes the one on the “long” leg. Remember though, the problem is really in the core. The knees are just displaying the symptoms. Try sleeping on the other side, carrying your bag on the other shoulder, and/or leaning the other direction in your car for a while. Be sure to incorporate core exercises in your workouts, and challenge both sides with equal force. Stretching both sides with equal distance is another good idea. With equal force and distance, the weak side will eventually catch up to the strong side. Furthermore, total strength, balance, and flexibility will increase, making you less likely to develop the postural dysfunction again when doing necessary daily activities like sleeping in bed, carrying items, or driving your car.

So don’t be disheartened if you’ve been led to believe that irreversible damage in your knee joint is the cause of your problems and pain. The often thrown around “bone on bone” idea is VERY seldom true. If you can bend or extend your knee at all, you are likely not “bone on bone,” no matter what you’ve been told. And even if you’ve experienced some cartilage damage, your body can regenerate it given healthy alignment, exercise, and nutrition. You have cells called chondrocytes, and the pumping action that MOVEMENT and pressure creates actually stimulates the production of cartilage. As you can see, sitting around because you have knee pain only makes things worse. Take action, but take safe and smart action to begin your healing and strengthening journey. Contact us if you need or want help making it happen!

As health, fitness, and nutrition coaches, we hear “the time excuse” all the time :) And some people have gotten so good at selling it to themselves, that we almost start buying it.

But if we all take a step back and give this idea of “time” some thought, some powerful facts emerge that can give us a fresh … and better … perspective.

Author Michael Fortino recently gathered some data of the time spent in the average American’s lifespan. Brace yourself. It’s amusing, but also disturbing and disappointing.

That’s 0.9 … less than 1% of your time … that we propose you invest in the house of your soul, the only framework you have with which to live this life.

Indeed, science says 1.8% is even better. The American College of Sports Medicine has confirmed that you should exercise MOST days of the week, which = 4 in a 7 day week … so we aren’t even aiming “high” … at HALF the final goal!

Look, if you are an average American, here’s what’s going to happen TODAY, according to the research:

• you will get interrupted 73 times
• you will take an hour of work home
• you will read less than 5 minutes
• you will talk to your spouse for 4 minutes
• you will exercise less than 3 minutes
• and play with your kids for 2 minutes

I don’t know about you, but I HATE AVERAGE. I’ve spent my whole life trying to avoid it like the plague.

Not that I’ve always been successful at escaping it’s ugly grasp, but I will always continue to try to run away from it. If I trip and fall, I’ll get back up and keep running.

It’s often 2 steps forward, 1 step backward … but anything is better than sitting in the middle of the bell curve.

Speaking of the bell curve, you really only have 3 options:

1) Be below average
2) Be average
3) Be above average

I don’t write to try to change convince you that you SHOULD want to be above average. You wouldn’t even be a recipient of this email if you didn’t already desire an above-average life.

I write to ask you … if you resonate with the 3rd option, the desire to be above average … are you treating your body in a way that is congruent with that philosophy?

If you aren’t investing at least a LITTLE time into it every week (.9 – 1.8%), the short answer is “no.”

Maybe you feel like you are above average due your academic accomplishments, your business success, or your relationships with family and friends.

While being above average in the mental, spiritual, financial, and emotional categories is notable, you will still lose your mind, lose your independence, and become an unnecessary burden to your family and friends if you don’t TAKE CARE of YOUR BODY.

That’s just “average” played out.

So I challenge you to rethink this idea of “time.” We all have 24 hours in a day, 168 hours in a week, and a full 8,736 hours in year.

What will you do for yourself, for your body, for your health, and for your life THIS year, THIS week, and THIS day?

Take your time, and make the most of it. Take care of yourself so you can make the most of it!

Pain often gets equated with bouts of physical exertion, but did you realize that most of our pain is caused by our more sedentary activities? We hear a lot about bad posture these days, but most of us don’t realize the severity of the consequences. Muscle imbalances and the resulting abnormal length/tension relationships can really deform us.

The asymmetry caused by muscular imbalances causes a wide array of dysfunction, compromising joint integrity. Then we find ourselves in chronic pain, and often unfortunately unwilling to do the very thing we need to do to fix it – exercise. After all, it’s hard to feel like working out when getting in and out of your car, or standing up and sitting down, or bending over … already feels like a workout! I’m not saying that random intense exercise is the answer. You need a more intelligent approach in these situations. Meaning, you must work the RIGHT muscles to start to eliminate the dysfunction. This is most often best combined with stretching the proper opposing muscles. But make no mistake – exercise is actually the answer, not the problem. Some people can find it difficult to exercise to reduce the pain though. This can be due to muscle dysfunction or muscle knots.

Though proper corrective exercise is the answer to our pain, we must understand that we WILL lose the energy and drive to perform it when we aren’t feeling right. You see, pain signals our nervous system to “dial back” the power we can produce. Picture your car with a tire blowout. If your vehicle’s computer was programmed to minimize the damage this blowout would cause, it may limit your horsepower output to control your speed. Our bodies are very intelligently designed to survive what happens to them – including what WE do to ourselves. But why do we choose to injure ourselves, and force our body to focus on preservation instead of performance? I contend that being unaware of what we are doing is a big contributor. So with that in mind, here’s 11 bad posture habits that many of us make daily. Avoiding chronic pain involves avoiding these mistakes.

1. Sitting at the computer with your head in front of your torso

Did you just pull your head way back after reading that? What is it about our computer screen that draws our face in like a magnet? For some, it may be eyesight issues that need to be addressed with glasses, contacts, LASIK, nutrition, or exercise. (Yes, you can actually nourish and exercise your eye muscles for better sight). For most, however, it’s just a natural “focus” response. The good news is that you can still think about what you are reading or typing with your head atop your torso instead of in front of it. You will feel strange at first when you pull your noggin back, but your neck and upper back will thank you profusely later in the day. Hanging your head out in front of your body forces your upper trap muscles to hang onto it for dear life, lest it fall down into your lap. So remember to slide your head back above your torso, and gently tuck the chin. Now, if you feel too far away from your computer once you pull head rearward, there may be room to move your torso forward instead. Meaning, pull your chair in. Think about it like this: don’t just commit your head to your work. Commit your heart as well.

2. Operating your car’s pedals with your hips instead of your ankles

What in the world am I talking about here? Think about how you drive. Do you leave your heels on the ground and rotate your foot back and forth from the gas and brake pedal? Or do you lift your knee and entire leg with your hip flexors to get your foot on top of the brake? For many, it’s the latter. And here’s the problem. We already have tight hip flexors (the muscles raise your knee to your chest) from sitting all day at the office. It’s unfortunate we have to sit on the way there and on the way home as well. What we should probably be doing is stretching the hip flexors before and after work instead. The last thing we should do is work them in a narrow peak range of motion (seated) by doing knee lifts in the car. Furthermore, if you drive an automatic like the vast majority (sad face), you are only working your right hip flexor. This could lead to hip asymmetry that can compromise your low back, knees, and feet.

3. Walking with your lower back muscles instead of your glutes

Try this. Stand up straight with your feet together and arms at your side. Now raise your right arm above your head while you step backwards with your right foot. We’ll come back here, but do that before reading any further so you don’t bias the test and get inaccurate information. Seriously, stand up and try this first. Ok, fine, some of you will have to do it later, already knowing what we are looking for, but hopefully you can still get a good picture of what’s happening. Does your back arch to get your right leg behind you? It shouldn’t. The glutes should accomplish this task with extension from the hip joint, without the need for the pelvis to tilt or rotate from the lumbar-pelvic connection. You might be trying to take strides longer than your tight hip flexors truly allow. Next time you walk, try to do so with perfectly still hips. No rocking the hips side to side, no twisting or tilting them forward and backward; instead, make everything happen from the top of your femur (your upper leg bone). It’s a win-win. Your back will feel better and your butt will be tighter.

4. Driving with your hand on top of wheel, or even at 10:00 and 2:00, instead of 9:00 and 3:00

Your driver’s ed teacher was not a bad person, just a little wrong. (could likely be a bad person, too, based on my personal encounters) Before I even talk about the the postural dysfunction implications, allow me as an autocrosser and track-day enthusiast to be the first (more like the 1,000th) to say that the 10 and 2 hand position limits your car control. You can make far more tight turns with both hands staying on the wheel at 9 and 3. Not to mention, if you start to slide, you have many more degrees of rotation to catch it with a countersteer, without ever removing your hands from the wheel. Why do you think Formula One steering wheels have become horizontal rectangles instead of circles, and certainly NOT some Y-shaped nonsense? So the 9 and 3 position can make you a better driver, but why is it better for your body? (By the way, one hand on top is probably the worst, it results in a combination of issues.) It’s all about your shoulder joints. Let’s do another test. Stand up, relaxed with your hands hanging at your sides. Go ahead and do this before reading further. If you removed your hips from the picture, would your palms face each other in parallel? Or do they instead angle backward toward the glutes? Maybe they even face the wall behind you! If so, that is extreme internal rotation of your upper arm bone – the humerus. This can result in a pinched acromioclavicular joint, improper axis of movement, pain, and decreased range of motion in the shoulder. In some cases, it can proceed all the way to “frozen shoulder,” where you can’t get the elbow up to even your ear. The more we can externally rotate the arms, or at the least, limit the internal rotation, the better off our shoulders will be. Think about it, we already spend a ton of time typing at work with the palms down. (Kudos to me for writing this on my iPhone, right?) Let’s at least drive with them facing each other. And if you really want to get crazy with the correction, try driving with your hands at 8 and 4 and your shoulders pulled back. But be careful, such departure from the norm has been known to send your car spinning out of control!

5. Walking with your feet pointed outward instead of forward

This a pet peeve of mine. Honestly, I have a family full of people who can’t decide which direction they are going. As they walk, it’s a step to the right, then a step to the left, followed by a step to the right … You get the picture. It’s one of extreme inefficiency, and something I’ve been working for years to consciously prevent myself. (we can often overcome genetics with a bit of focus and work) To be fair, one of the best athletes in the world (though I can’t stand him for some reason), Lebron James, has a similar issue. His feet point outward. But to be fair yet again, he requires some serious insoles in those overpriced Nike-hyped shoes of his. Imagine how fast he could really be if his feet and knees were running in the same direction as he was! I’m guessing years of wide-stance-only heavy squats with feet 45* outward contributed to his foot orientation. For most others though, it’s a lack of stability that causes the “run-away toes.” As we move less and less, and sit more and more, our hip and feet muscles get weaker and weaker. Then as we get bigger and heavier, we search for much-needed stability with a wider stance. Try having someone attempt to knock you off balance with your feet together compared to your feet apart. When we should be asking our hips, feet, and ankles to do the work of balance, we just turn our legs and feet outward – problem solved. Or is it? Hint – it’s not. Your problems have just begun. Enter pronation of the foot, collapsing arches, knee misalignment, and all the soft tissue pains that come with those conditions. Next time you walk, make sure your knees and feet are headed the same direction you are. You’ll get along better with your body when all your members are on the same page.

6. Standing primarily on one leg instead of evenly on both

I admit. I did this for years. I was recently tagged on Facebook in a photo from high school and when I clicked through to look at it, sure enough, I was standing there with about 80% of my weight on one leg. Surprise surprise, my other hip shows today for comparative weakness and I’m in the process of correcting a lateral pelvic tilt to save my knees. Same-leg-always-forward mountain bike descending and same-one-legged-landing fadeaway jump shots in weekend basketball don’t help my issue either. But at least that is just a necessary (for a short 6′ player like me anyway) part of bigger whole – fun exercise. But when I am just standing around, there is no reason to not be equally balanced with level hips. Same for you. Take it from me, you don’t want to develop a lateral pelvic tilt. It limits the amount of force you can produce without pain and complication during athletic movements. In fact, it can limit the amount of time you can stand perfectly still, as the compensating muscles on one side of your back will fatigue early. Fortunately, corrective exercise can (and has) make things much better, and eventually fix them. But why get messed up in the first place? Stand strong, stand equal!

7. Crossing your legs while sitting

For us guys, the manly thing to do is to put our ankle on our opposite thigh, and torque our elevated knee nicely against the natural hinge joint that was never meant to bend that way. Right? For you girls, the feminine thing to do is to set the back of one knee on the top of the other knee so the pelvis will tilt and rotate, resulting in one leg’s blood flow being restricted, and the lower back being nice and unevenly weighted. Right? Outside of social convention, crossing your legs for long periods of time is a postural bad idea. Now, if we were to evenly divide the time between our right and left legs – giving equal opportunity for one to be on top of the other, it may not be as bad. But the reality is – we aren’t that fair. We tend to have a preferred “leg up” if you will. And the resulting assymetries can wreak havoc on our bodies. Try to sit as squarely as possible, especially if sitting for long periods of time.

9. Cradling your phone between your head and shoulder

This one is quite the obvious no-no. And though we’ve left big cord-laden phones behind, the concept of cradling between the side of our head and the top of our shoulder, even with our smartphones, has unfortunately not yet totally disappeared. There is something a little too transparent with putting our friends, family, and co-workers on speaker phone around other people. You can never quite predict what they are going to say. On the other side of the line (pun intended), there is something of a betrayal felt when you find out that your own words have been broadcast to not only the person with whom you are speaking, but also everyone in the office, church, coffee shop, or family gathering, wherever they happen to be. So in our need for multitasking during the conversation, we often resort to phone cradling over the speaker option. We all have a “strong side” when we talk. Ever try to win a heated argument with your phone on your “weak phone side?” You probably won’t. This is why you see people switch the phone to their more coordinated side before solving a problem or giving an answer. (sometimes even while a business call is ringing) The result is that the more phone conversations of consequence that you have, the more likely you are to favor a single side. So if the work that your family depends on includes many phone calls, you are probably a strong-side caller. Furthermore, if it’s work related, you’ll likely be shuffling papers or typing while talking. It’s the perfect storm for strong-side phone cradling. Consider Bluetooth, or … Challenge yourself to have effective conversations on the other ear. It will be good for your brain anyway, and you might find more creative and potentially better solutions.

10. Wearing shoes with too much heel lift

I’m not just referring to “high heels” in the typical sense of the word. Many of us actually wear high-heeled dress shoes and even tennis shoes, in the practical sense. I covered this in a previous article, but when you look at today’s men’s dress shoes, as well as men and women’s athletic shoes, you notice an over-powering trend of heel lift. Everybody seems to want to feel taller in dress shoes and everybody seems to want a tennis shoe that sets them in motion, before a single muscle contracts. (You are sort of falling forward in a high heel tennis shoe) Here’s the problem. To keep you balanced in a higher heel shoe of any kind, you have to arch your lower vertebrate and lean backwards. This tilts the top of you pelvis forward, shortening tight hip flexors even more, and compressing already intervertebral discs in already over-arched lower backs even more. The nail in the coffin is the fact that the heel bone gets jammed up and rotated away from the ball of the foot, overstretching the plantar fascia on the bottom of the foot. Since the shin/foot angle never even sees 90 degrees, say nothing about less than 90 degrees, the calf muscle and Achilles’ tendon gets tight because it never has to (or should I say gets to) work through a full range of motion. The lesson? Slowly reduce the heel-toe offset in your shoes. Don’t go from high heels everyday to zero drop running shoes tomorrow. You may overstretch and injure tight tendons/tissue. But do begin a slow step/down in offset to regain ankle and foot range of motion, while loosening your hip flexors and decompressing your back.

11. Lifting things with your spine instead of your hips

Your parents may have often told you (like they did me) “lift with your legs,” but did we listen? Probably not, we were indestructible kids, right? Too bad those poor technique habits often remain in our much more easily destructible older bodies. It’s funny how we often trade a little effort now, only to encounter a lot of pain later. Shouldn’t we do the opposite? Let’s go through the “pain” of picking stuff up properly today so we don’t have to endure the pain of pulled muscles and slipped discs in the future! The muscles of your spine are primarily stabilizers. They were not designed to hoist massive loads as the primary mover. Fortunately, the muscles of your hips were. The way to do it right is to get as close as possible to the object you need to lift. Bend your legs at the knees and lower your hips (don’t bend your spine), to get your hands down to the object. Keep the natural strong arch of your back and a stable base with your feet, equally dispersing the force through both the balls of your feet and your heels. Stay symmetrical side to side – both legs doing the same thing, and keep your core strong and tight. Breath in on the descent, holding your breath for a split second during the initial exertion to further stabilize the spine (valsaga maneuver), and exhaling as you drive upward through your legs. Do not let your back round out as you stand back up. That defeats the whole purpose of the proper setup. Your spine should rather ride on top of the elevator of your hips. It does no bending of its own. It might have to tilt forward a bit depending on your balance and flexibility, but it doesn’t round out or loosen. A good way to think about a tight strong spine is to picture your head and hips as “bookends” for all the individual vertebrae that make up your spine. If you were to remove the bottom of the shelf, would the book ends be pulled tight enough and straight enough to not allow a book to fall? A falling book in this analogy would be akin to a slipped disc. Keep your bookends strong and straight – “use your legs!”

I hope you found this list helpful. Maybe you saw yourself in some of the examples. If so, indeed your head, neck, back, and knees have the potential to feel much better. Wouldn’t that be awesome? Begin to fix the imbalances with better posture exercise designed to correct your unique issues. Your energy will improve, as will the intensity of your workouts. You’ll get truly healthier, and in so doing, become stronger as your body gives you “full power.” Stay aware of your posture during all of life’s repetitive actives, and if you need help with corrective exercise so you can enjoy a fuller, pain-free life, contact us today. Our in home personal trainers are happy to help!