Knee Pain and Patello-femoral Pain Injury Rehabilitation Seminar | Feat. Tim Keeley | FILEX

okay guys swimmers will start I think there's a few more people coming in just a minute remember my name is Tim Kelly I'll be presenting patellofemoral turn pain today hands up you who in my lecture just this morning okay call same sort of format this afternoon you look so familiar with different pictures different words but we're going to go through again getting you guys understanding what patellofemoral pain is what it means what it does to your clients how to rehab how to keep in their program how to keep them better and how to basically get it right anyone the class today that has patellofemoral pain okay great out of you people if you got pain when you go on one leg and squat if you got that so that you want anything like that yeah have you got a creaky knee as well it sort of makes a noise who said yep would you mind later coming up here and showing us your creaky knee would that work do we'll get you in a second we'll get you in a sec I'll put you on the mic we'll do a little trick okay we might use you later and that I've got again I've got some videos I've got a lot of stuff to show you a lot of stuff explained to get your heads around it welcome heaps of questions just fire them up here as long as we've got time we'll go through them one by one all right so same format today work on with patella femoral knee pain what is it and what's going wrong let's work out exactly why people getting us and what the structures are there to get affected so you guys understand the basis of it what to look for in a client who has got patellofemoral pain or is going to get it so you can spot it early all right so things we look for things you guys need to look for a little touch on what we're doing physio treatment the rehab side of things the goal and the focus of what we're trying to achieve and what we need to do and then plowing through all the rehab exercises that you - no - get patellofemoral pain right based on what is going wrong that's the hard stuff you get that right you're winning then we work on same format progress that's normal training how do we get these people back squatting back running back playing sport and how to get them sticking to it how do we get this person doing these boring physio exercises doing their rehab progressing the through and then not let them fall off the wagon and stop in their homework and give me a problem about so let's start at the top patella femoral knee pain because there's lots of different types of knee pain we're just talking about patella femoral patella meaning kneecap femoral being femur so it's the patellofemoral joint so the pain arising from problems in the joint and and the region of the patella femoral joint so when you will see a diagnosis from a doctor of visiting and it's got patellofemoral pain we're blanketing a little bit because there's lots of different problems going to cause it and lots of maybe structures that cause it and the pain does change sometimes it's just it's - there's different pain like an ITV Center there's a swollen bursa at is that okay but a lot of time they'll come with that and in the neck it's better the next week they've got potato paint under here they all got all of this new paint got a whole thing as patella from pain because it does shift and change depending on what structures are affected and what is what alignment is getting affected so try not to put it down to one injury it's like the rotator cuff and pinch it's not just one injury per se its pain in that region because of something okay so think of the structures around the patellofemoral joint right you've got beat up patella cartilage both services femur right you've got the groove of patella sets on the lateral side you've got lateral neck much the holds a patella on the outside you've got the VMO coming in on the medial side hooking into the side of the knee cap helps stabilize patella tendon quads tendons ITB coming in the side hamstrings in the back carbs a lot of stuff that can affect the biomechanics of how the knee joint works alright the other thing I want you to think about is the movement of the kneecap on the female a lot of your clients you haven't studied Anatomy don't understand what happens when they've been in straight their need don't we know what their knee cap does okay so they think I just you know bends and straightens remember when you be in Australia the knee your tibia slides under your femur and then the patella slides in the groove of the femur okay knee cap doesn't go on the tibia yeah so things to think about hip and knee alignment when you are running or squatting or standing on one leg you need good hip and knee alignment if you're going to recover from patella femoral or not get patellofemoral pain alright so when you are standing on one leg I can't have money rolling in I can't have my hip dropping down right so when you're thinking about this pain you got to think about what are the structures that are holding my knee in alignment and what exercises do I need to do to get those muscles working to hold my knee and alignment and because a lot of time it's the knee and patellofemoral joint coming out of alignment is the cause of the problems hips stabilizes so thinking about Glu meat and men thinking about lateral rotators of the hip what today - how they influence the angle of the knee the angle of the patella femoral joint what are their role when they're open chain you know if I do abduction my glue meet them in doing this for me but that's open chain when it's closed chain they're doing this for me okay same muscle looks like a completely different position and a lot of people train open chain expecting that the brain will then know how to do it closed chain okay and if they're not working being able to spot it okay so if my glute means not working that means what happens going to do that okay and seeing that in people trying to dispel a few myths of the VMO vastus medialis oblique is the bleakest meaning going in obliquely into the kneecap remember the VMO does not stop knee rolling in okay so if you see a person here I can't use an easel in we do some VMO stuff that is not because the VMO is wreak that's up here okay remember the VMO is a knee extensor along with all the other three quad muscles but it's little neesh role as to try and pull that knee cap medially and provide a meal force to keep it in the groove when I bend straighten my knee and balance with more aeration acumen my lateral quad and ITB okay and it's most important role is between 0 and 30 degrees so it's from here to there when my kneecap goes into the groove I need it stabilized as it goes into the groove of the femur when I bend my name and the load goes on I need that working so it works mostly from there to there so we're to be trained it there to there okay so if I'm trying to train it down here is no point trying to do it down there because its major functions from here to here I talked about foot pronation right so a lot of lecture today is about VMO hip stabilization ones up there footballs are other things you've got to think about and assess you know if their foot is prorating on one side maybe that's the primary cause of why their knees rolling and rather than how strength strong they are here we get people in our clinic who come and go I've got this terrible VMO I mean terrible tell the femoral paint and every mi was huge you know that's not a problem and it glutes are working really well and I only get it when I run about sort of 12 K 15 K I get this knee pain and they've thrown out in one leg so even the office working perfect apart from that so there's other things to think about not just muscle control and muscle stability so the kneecap needs to sit in the groove bottom line okay if it's sitting out of the groove let's pull one way even by a few millimeters four or five millimeters it's enough to cause problems so we need that balance we need to keep that back and sometimes very very hard so you're going to think telefilm pain is coming from positional fold of the patellofemoral joint don't just think i for kneecaps gone laterally okay it can be the femurs gone medially rotate in okay don't you think it's a kneecaps fault it's the joints fault all right it's what's happening with the joint and you've got to work out which structure is causing what what's rolling in all right and its effect on their structure so is it the fat pad that's getting impingement i straighten the knee is the vs. around the ITB versus sitting underneath captain Taylor versus is it my patellar tendon is getting loaded on an angle I'm getting a patellar tendonitis is my calf is getting worn away on one side because I'm just doing too much loading on the lateral side is it getting too weak on the medial side because I'm not loading it all those sort of things and you know is it soft tissue is it ITB work there's ITV problems is that the plike of a thickening of the tissue on the outside as it just is a just cartilage pain I'm getting or bone pain that I'm getting okay let's have a look at a video I want to show you just so what I just talked about sort of resonates with you about what's happening with a patellar groove so there's your knee now all Anatomy videos like a few on the last ones they're not quite perfect so when you see the VMO on this it'll look like a tendon if you look at your VMO if you've got good [ __ ] if you look at your VMO the muscle goes right into there okay so it's a it's a muscle blends into the tendon so my must that is not tenon that's muscle okay so the muscle blended a very short tendon right into the bone okay on this one you'll see serve a very long tin erm which is a poor representation the best video I could find I'm sorry I searched a lot so what happens when you bend your name is when you go explain to patients see how that patella move down and to the groove if their patella is sitting wrong it's going to cause positional fault and you overload that it's going to cause problems alright and when it comes up again back on the groove so keep going think about that that's what happens you put some muscles over top they should come in in a minute and wait one more time is to be in his name all the time there that's now this is the incorrect drawing that's supposed to be your VMO okay but it's no very good representation see it over there not a very good representation but think of it as a bigger muscle than that okay but you can see how those muscles and tendons help glide their patella through the groove so again what are those marks the muscles systems that are affecting what that kneecap does but it also if they're working fine but I move the femur underneath because the joint that can slip and slide we can all move our kneecap left and right okay so if I my knee kept sitting out and I do that let's go to ride up and correctly okay there might be a muscle fault got the idea now I'll come to that when I'm and so when you're talking to clients about you know patellofemoral pain and might be a tracking issue and you've got to try to explain that to them with the knee cap so primary cause incorrect position of the patella femoral joints plus your overload that's what's going to give you problems and symptoms so it can be joint pain okay we can physically if you just get muscles stronger and then keep the alignment their pain goes away they haven't actually really injured inflamed anything they're getting a little bit of loading pain in their neck that can beat telephone or pain they can get full-blown soft tissue pain bursitis and ITB problems from a lot of excessive holding in and ITB moving whipping over that Bursa okay and they can be really really tight to it which causes them pain underneath it really tight glutes can be the problem and causing that sort of tissue damage so those sort of things can turn you know give you pain give you problems and turn into things like tendinopathy so if you're getting weakness and pain for a long period of time around that joint things started generating things start getting worse and you can start over at any office so three months ago they had this you know decide cv problem and sort of went away I stopped running but now doing squats again this pain on here might really sort ended under here because what's happened is they've got the original problem they rest it so the information went down but meanwhile that pain and that lack of exercise was made some of the other tissues weaker and now they are causing pain when they try and do exercise so you can develop secondary problems the other ones Carthage where so you can get ruffling and wear and tear on the lateral surface of the cartilage because then it gets shifted over it usually moves laterally but also if you do that you'll see on a video in a second when that moves over college needs to be used okay and a lot of time you'll hear surgeons talk about arthritis starting in the non-weight-bearing side of the joint and you're going how's that possible you know what was that because Carthage is a structure that needs compression force by synovial third to push through it to keep a healthy okay if you're not keeping those color surfaces pushed together that fluid squeeze in between them okay they get no nutrition and they start softening and then you start losing their structure that's how you start getting arthritis and in the knee when that starts happening you Simmons on the medial side of the knee cap and on the themeing what they call chondromalacia patellae now softening of that cartilage because they're not using it you know once I they're using it too much once I've been not using it and it's turning above a nightmare but if you correct their positional fault and you take away the weight loading on one side and you increase it back on the other side very carefully you'll find their pain shifts and changes and starts getting better despite the level of wear and tear that God so a lot of people come in they've got creaky grinding kneecaps and this one you move it you know oh my god that's also but they you get the right exercise in the right alignment and they fine so a lot of people can if the kneecap is sitting perfectly sometimes it doesn't matter how much wear and tear they've got how much raw Arthritis they've got because I've got the muscle strings they've got the balance you may find that they're patellofemoral pain goes away because the patellofemoral pain is from poor alignment not necessarily from oh it's worn and torn there okay you take those the worn torn serves away and you increase the pressure of the soft service and that strengthens up bingo and you'll see on this video but if you guys muscle weighs as soon as you get pain the need within the first week or so that vastus medialis oblique estar falling asleep and if any of you had surgery or major knee joint you'll know that happens especially serious day one that just muscle just and just goes asleep it depends on the level of pain you know you go into surgery and come out and you're on morphine that's a high level of pain that VMO and it's around that knee that they're most kind of go to sleep okay when the VMO shuts off then you've got no hope of keeping that knee in the groove you've got no hope of doing knee bending work therefore you're going to lose this as well so you get pain messaging here okay can't bend your knee can't stabilize on my leg you don't stabilize I'm we get lean on the other one this one doesn't work you start losing hip stability and then that vicious circle starts happening if I don't a hip stability then my knee is going to roll in where Nero's and I can't keep alignment I can't can you look my BMI so how am I going to get right it's a bit of a hard one so try and remember that it's not just about the tracking it's about what happens to the muscle systems as well and how are we going to get those muscle systems balancing up together very carefully to get them out of pain and then get them stronger give them so strong and so much endurance and control that they can run again or play sport or squat or whatever they want to do other things your thing about some people have super big kneecaps and small patellofemoral groups and you're going one we're going to a fat all right some people have congenital dislocations you go that rich super soba listen they have desiccated they're three times when they're a kid and they've torn all the natural all the natural structure are the metal structures away and it all tied in their lateral structures okay they have a really hard work the recaps really sloppy you may find the no amount of ver Mon glued work is going to keep it stable enough to be able to do any run sort of running some people have very very wide hips in a very big queue angle it's going to play havoc with trying to keep good and need liner they're always going to do this sort of thing because of the wider the hips are the more the angle too hard it is for these muscles to stabilize or hold that angle therefore they're not as strong so they go on my leg and start doing this sort of thing so they get problems with their knee which usually happens from there China do a lot of fitness because they're beyond fit and they get injured but they've got this massive problem before that they've got to try and fix to try and get that problem right meanwhile they trying to keep fit and trying to lose weight can be very difficult for those sort of people things to think about so for you guys again if you can understand the patella way the patellofemoral pain works way the injuries work gear be able to send yourself then you'll be able to help those clients a lot more right because you can explain it to them say this is why what's going on see your knee it's rolling in we go to work on you hip stuff if you don't explain they won't do the exercise okay can we just do squats and get more carnage do leg extensions giving quads better because that's what I read in the book you know can we do that if you explain it to them well enough you'll get it right and keep them on board all right second video now what I mean is when you look at this video I'll show you the color tracking one and then I'll show you what a purpose one-legged squat looks like we know when you're looking at one-legged squat what you go look for is the hip height okay you really want to keep at least level I prefer you view like this because when you walk we've got a built-in program in here brain says when I stand one leg and do that I've got my stabilizer on this side to lift my hips so my foot clears the ground if I don't I'll catch it okay that's what it's for I want to stand on one leg I need all these muscles here going lift and not lift here had lift here to clear that ground through there and stabilize and push through all right what that then does is keep when I left here I've got normal alignment here which allows me to keep normal alignment of the knee and my VMO is working my kneecap stays in the groove and I'm fine as soon as I lose that my femur is going to angle in and roll in because remember you're gluten mean and many left rotators okay help add dot and externally rotate okay so if they don't working I'm going to add duct and in turn I rotate I know if they're not working so that's something I've got to work on so at least keep you're literate you're looking for keeping a hip level at least level are higher and you're looking at making sure that knee doesn't roll inwards and like you know with the foot probation sometimes it's harder and if you can do it in bare feet okay it means you're doing really well most people doing the shoes they hide the fact they're pronating because their shoes go to the cathodic in there oopsie okay so let's have a look at us now this first one again best one I could find total it's sponsored by a knee brace and I'm not endorsing the hypnosis because we're doing an exercise session today so hopefully I'll stop it before the knee bro thing comes in hopefully like a little ad in front of that queue lock is the company so with this one again it's going to give you a bit of an idea of you're looking at your right knee here what I want if you look at this as that kneecap setting the groove like that okay and keeping an even force through that imagine that line they've just drawn as cartilage and fluid okay there's a gap in there it's all full of fluid and what you're not seeing is the cost of the thin card service nice white service on each side okay so if that pressures even my quads because when I extend my leg line pulls my kneecap into the groove okay a compression it's really nice the joint loves that loves compression like that right keeps in the groove all the muscles working nicely balanced perfect if my BMI was weak what tends to happen there's this emmalin there's a VM oh well Buzzard long and over at Mike vampires week it can do two things the actual blight and lateral tilt and you can see this on people you can feel it on some people they can give me your finger right underneath that media side you can't even get it on the lateral side and you can see it's just sitting like this okay because the structures on one side are so tight instructions on one side of so weak now you can imagine what's going to happen if I put all the force that I need to do that through one area yeah it's going to load up this area here on the outside here all right and this here is not getting used as much all right my force is wrong my alignment of my telephone was wrong so whether it's a tilt lateral Glide where the femurs moved inwards because I rolled in its so if you think this is my name if my instructions of time pulls my kneecap outwards and this is weak and it's a go that's fine but if I I can ever pretty good [ __ ] but very royal in words my electro structures are going to angle that way most force line is here okay going through there so I have a great vm / if I've got weak buttock here because I've had back pain before hip surgery then I can still get patellofemoral pain with a good VMI because it's not a lot about is about the VMO this is just an occasion so imagine you've got a week there Moe it shifts there's a very much a medical diagram of it it does that just to give you some an idea of what I mean and then it's slow video this one at that force that you want that was like that then does that okay you can start getting changes in the binding changes in the cartilage and then the other two areas I mean that's a very gross exaggeration of how far it can go will get softened okay which gives you secondary problems and creaking and groaning and cracking and all that sort of thing okay so let's look at someone who's really really really really really really good and this is a try fleet and I got this from the gate guys so really good now what he's going to do you can see the VMI on that on that person that's pretty awesome right you want to give us some lights again just a little bit just so you can see that not all of them just the front ones okay so there's your VMO looks pretty good isn't it you'd expect that in a triathlete right they've got to run how many caves and cycle right they need they cannot afford have any out of alignment at all this person knows has got really good control just to show you what it what it what happens when you see good control is the back door so there's they're showing you back even though they don't have that control this is good so far see the height of that left hook above the right okay and nicely through the middle of that now what's going to happen is Eska that's as she's going to roll and words poorly there it is there see that she's purposely rolling an end here she's good though but see there Lyman now there's the middle of it if I draw a straight line down to there you wonder why people get knee pain here okay because my force is out okay so my femurs rolled and she's got an awesome VMI but if femur is rolled in all right and it hips chopped so what she does he's like actually workouts HIV and I'm pretty sure to shoot and she corrects it so she's corrected an airline now that's great you see how that vemos fired up a little bit more now but this isn't right so she needs to correct that so she's going to lift that up there and then create that knee and then push up in that position there will be great if we could all squat like that uh-huh that's what you're looking for for a good squat if you're not getting that a lot in there you're knocking at knee and love it something needs to be worked on she's so good she can actually just tell her brain to do it and she's been cured lift your hip do all that a lot of people can't do that they have to practice the exercise lights please they have to practice the exercise that the practice will strengthening so the brain at least does a little bit automatic and then practice good alignment so that automatic function becomes even better all right okay so that's what you're looking for again I'll go through each exercise I'll show you what you need to look for on each exercise as well so a few things just to recap on what to look for constant them into pain so constant pain if they're constantly painful constantly they're just on there all the time then it's usually constant inflammation something is damaged badly there's enough that's given permanent pain yes yep remember we all pronouns using bare feet and she's approached she might be in really good shoes and orthotics she might need that but it shows yeah she's compensating a little bit in bare feet she's not running in bare feet so there's a but we said about maybe her shoes are helping that part we talked about her maybe if she did run on bare feet you know maybe barefoot running is not so good I'm constantly wounded pain so in a minute pain is usually there you go yeah hurt so it's there it's could have gone hits the air again it's almost like shoulder impingement okay so if that kneecap moves over either poor services like sore surfaces okay in an out of the groove or there's a certain angle where the kneecap doesn't get pulled in the groove well enough and it hurts all other structures okay there's a loading position pain sometimes the pain is only after a certain amount of time running okay or cycling and that's a buildup of irritation you'll see the change in tracking of some people so B when I squeeze it quad the kneecap moves up and far too out it's supposed to move up and a little bit out okay but not so much there goes excess we saw those compared to the other side crackling and cracking uric and you've got a crackling kneecap really loud if you want to come up here and have it we'll have a little listen some of you guys pray a lot ahem boat by crackly and cracking so this is what I call crepitus in the world of physio uitv hurts today to do that okay okay stand in one we can't hear anything nevermind that's right did you see how she struggled Oh to try and notice them okay so cracking you're that sort of movement okay now you can hypothesize all you like that what that is you know it's something to do with the cartilage surface okay with us Fisher in cracking condemnation patella doesn't really matter the problem is you've got a problem then yeah yours cracked you want to hear that maybe come to you in a minute yeah have job classic okay so they stand on one leg and do that so that's a weakness there it's got to be here sometimes they even do it on a squat on two legs so they might squat down and go like that it's a bit excessive okay or they squat away one side now if I'm not perfect and I squat why not drop a hip but if I rotate here my force changes on both there's no okay there might be a weakness through here I'm not quite that great with my core my trunk my thoracic control into notation of femur so they just naturally stand they stand normal bit of FEMA's role in or kneecaps role in the weakness here some people compensate for that and they do the opposite and their foot out here then they naturally stand there just walk on the spot and one foots poking out and it's usually doing that due to weakness of the same muscles that extend rotating why is that because if I put that if the kneecaps they're doing that to keep their knee in a line if I put their foot line then he'll be in so they go rather than strengthen up this muscle the brain goes I'll just shorten it and I'll do that and they usually really tight on that site because the shortened muscles got that sort of relative increase in strength and control when it's shorter and it's longer it's more difficult to activate the muscle okay so you boys natural instinct is to do that you may find they might squat like this to make it easier on their knees then those much hip control it gets much harder to squat like that isn't it okay then it is like that not because you have to use your Blue Shield stabilizing your lateral hip stabilizers in a mid-range position which is how in a short and means you position and the itvbe type did glue to be tight their quads will be tight on that leg you know and sometimes we get people in they've got a little bit of pain here little bit up on you we can't find anything wrong with them but their time the itv of time their quads on time their glutes and they stretch them out the pain goes away you know is that pain just from the kids mechanical pain so again telephone they may not be physically tissue damaged enough to cause them any inflammation anything like that but they still got pain and that leads to VMO weakness and hip stabilisation witness but if you catch it early and getting stretched out it might be foam rolling their idea be loosing the glutes off get it soon as the other side can they come right but why is it tight maybe is because they've got a weakness underline there so give it a Titus and then really when you test them actually you are weak they're in there because they usually do the stretching for a bit I'm great it was good stop the stretching because they fix it and it slowly creeps back again and it's getting tighter usually due to weakness right maybe it's their non-dominant side it's so good that their brain over the years since they were three learning how to kick a ball understand one I think just like left and right-handed people left and right foot it where it's not as different on left and right foot because we use them all the time weight-bearing and doing lots of stuff so the difference is less than hands okay but it's the same Intel is trying to throw a ball with your weekend it's just impossible right and when you if you kick with a the other person can't kick them it foot I'd kick but I'm not as good so if you think about all the problems and all the muscle control issues and all the strength that involves and not be able to kick a ball then what happens when you go running and lift the right foot and you expect to be exactly the same you're not going to be exactly the same and this is where these problems come back and is it just because they are just genetically like that and we're all humans we've got left and right sides okay we if we do and we're going to something bilateral then we need to make sure we're straightening at one side okay to keep that nice little even us and the thing is again I'll come to it later people ask about why how long do I need to do is exercise for why does it keep doing forever and I say well it's like if I teach you if you're a tennis player I teach you how to say your right hand tennis bow and you're so good at it right I teach you for a year how to become a tennis player in your left hand but your tennis player in your right hand for 30 years and I teach you for a year in your left hand and you are absolutely perfectly lifters right after that year you're so good if you stop for a year and you go back to tennis which one that's going to be better right so you stop fitness you stop exercising for that period of time what's going to be better the right because your pathways are set well apart from you can talk to the neoplastic people but most of them are set and so you you you lose you don't learn you keep everything in that memory back okay you can't rewire yourself completely you still rely on something that's been wide forever and sometimes that's that's the major problem you guys will face it's keeping those people on board if their injury happened from being left or right handed or left or right foot it so we've gone to that one physio treatment what are we going to do with these people well first thing if you get people that you see hepa chopping they've got pain the malalignment of that niqab that you can't because their foot pronating they've got a big different system right you think they've got a bit under get it assessed get exactly work out what the problem is their foot the designing of products okay is it do they need lots of glute stretching or glute exercises if he might actually fine okay get a physio assessing that and working with you guys and if you're a physio out there working with the personal trainer to try and make sure that that rehab goes all the way through from start to finish most time people will be near a fox stay in them yep yeah so I would it's thinking about orthotics okay you say you let you've got problems left and right and your glutes in your VMO you've got probably a week on one side and you're strengthening up because of a deficit okay now if you've got pronation that's permanent on one side you're not really going to change that much if you just put on a [ __ ] up a little bit and take it out that's like stopping doing exercises for so you know and you can do it all the arch lifting and all that stuff your life but when you want to run 21 KS you need something that you control that if you're pronating that much that it causes knee pain so we do a lot of stuff physio as you guys probably know the big thing that I think that you'll find when you get a good physio working with the China is the advice that the physio will give about the injury to keep that person on board to do the exercises for long enough and to progress and for long enough to get back training and then keep them there program to get it hundred percent and like I said this morning as a lot of people will find that they'll do the exercises and see if there's that comes it down yes feeling good we can I run again and the physio even only pain I try running but they haven't tested them out and put them through their paces and see how strongly they can get in or out so they can fix the problem right sleep have about three or four weeks off running or whatever sport they're doing pain goes away and they go back to running let's talk the physio well they go back to their squats what are they doing in pain turns back and then I go since I haven't really worked at it the pains back it's just they didn't give it enough exercise or didn't stand Bork along with it in enough sessions whatever they didn't do to make sure that and they didn't carry it through and they're running he can't do rehab and then go expect to go sport and running without keeping your rehab going your ribs just got you out of pain you've even tested it yet so your job is to make sure that you take these people and get them through their rehab and keep it in their program in progress like a now you got a little bit of sport now gonna be two guys running but a little knee press we're doing the listening and keeping that rehab and that program all the way through until they are doing exactly hundred percent and then try and work out how much you need to keep in there to keep them at that level and stop them dropping down otherwise again they're going to say those rehab exercise and work because I felt good but now I'm back more did you stop doing exercises here but I thought I'd need to do them because I'll throw the pain so it's their perception of what the exercises do for them and how long they need to do them for and that's a communication thing with us we need to address that we need to be confident that this is what you've got to do and I want you to do it for the smell of the time and trust me it's going to work always you'll be back in here so we need to restore hips so the hip stabilizes a week or that controllers weak we need to get that back we need to get back the patellofemoral joint we need to get that knee working in a vertical plane it gets a hinge joint here is rotation it because it's a bit of goo when you're doing this sort of thing of course there is but when you're doing running or squats you want to be in a lot because it squats is load running is load from the ground up okay you can't afford to have that need rolling in like this four or three thousand times you know basketballs fine miss you're Kobe Bryant everday okay but you don't want to be doing heavy loaded positions one leg guarding it okay so you've got to creep that alignment we've got to build their strength build injury as you start with the boring physio exercises you get them on board you show them and get out of pain and then you progress them and you put not just weight on you put difficulty on okay make the exercise more difficult not necessary to stack on the way and load up the leg press okay you start adding on getting more muscles working more core working because this is more of a postural problem than it is a power problem put that into your gym routine getting them on board like I said physios I find in our practices if you don't see a client enough they don't get a good outcome that sounds like I just making money but what's better for the client getting better faster and keeping them on board and then raving about you because you know he's awesome he got me better or you're not competent enough to treat them enough times to get there fast enough so they believe in you and then what happens is they go and I'm not really better yet it's not really working though he's no good because you only see once a week you can't get better once a week okay so make sure they're having enough personal training sessions and enough physio sessions to get this problem sword to wait six months to get better they want to get better now so you're going to work hard and get these people coming in and up so you can make a difference and make a change early so then they trust you to when you say this is going to take you three months and you've got a kid eating soy sauce are you good because these ones worked you know you're doing mm-hm because though you I think pain is gone it's fixed but in saying that sometimes tell the femoral pain is that bad that they need to have a specialist looked out okay then he might need a scan they might need a scan to say this is how bad your injury is you have to do these exercises for the rest of the year okay give them a scan to show see what I mean alright so sometimes that is needed for these people as well and for your sake all right so second part of what we're going to go through rehab stuff so I've split this into two like I did with the shoulder we've got hip stabilization we're going to focus on and the amount cords we're going to focus on because those are two areas we're working on to keep the alignment I'm going to talk too much about core today I expect you guys know what you're doing there have stabilization exercise so we're thinking about glute med glute men lateral rotators everything that was keeping my pelvis level the most and my hip and knee and aligned the most and when you think about glute max that's are really good now we need glute max but glute max fires very complex muscle at fires on demand and it fires mostly from flexion to extension okay so from the more flexion you get the more it's going to work okay hoping here and bang it's going to work more right see if you get deeper into flexion with some of the things like lunges and squats it's going to help assist give you some more power and some more strength to do your exercises able when you think about glutes so I've got to work my food is here I'm going to work on my glutes it's not necessarily max we want to fire but if it is really weak okay maybe that's why they're not there getting problems they still have to work on engaging in but the biggest primary focus is actually gloomy tamenund the latter rotators which you sort of don't feel that much glute meeting men you feel when they're sore because you're digging here it's really saw at the top okay glute max is not usually soreness you've done a thousand squats okay you get put a Dom's there but that pain that's not Dom's you know [ __ ] what's that that's usually neither men being tight or weak and they're sore when you go down to V M own quads exercises because I don't think [ __ ] and maybe their quads are really weak as well okay you've got to know whether [ __ ] rollers and closed chambers open chain we try and stay closed chamber as long as we can before we go over chain NEMA closed meaning four foot my foot is planted my body moves relative to my foot I've been chained my foot moves relative to my body this gets a lot more stabilization going this requires stabilization ok so once you've got your stabilization then you move to open chain because open chain is part of daily life and it is a lot of very functional activity especially when you're playing sport and running and you'll find that something exercises every time you're doing hip stability work you're firing [ __ ] all right so you're actually working on V myself so you could be some of us a little bit careful about how much the load you're putting through the knee if it's really saw to try and hip stuff and the way it works we're because we're weight-bearing is minimal need to do or I must work on the VMO Isolators ok it's more about trying to get integrated with civilization the brain the motor control is a better outcome scenario for you so don't try and think I've just got to do your leg extensions I have got leg extensions in there and I'll show you why I ladder isometric isokinetic remember trying to isometric is a lot easier to start with I can build up some endurance and get a muscle firing and then move to isokinetic so I think close chain isometric moving to isokinetic over channel is connected meaning moving alright gotta work with your knee you've got to work like a shoulder in the pain free range if you're creating your injury pain you're creating negative messaging going up it's going to affect the ability for the brain to run that program of squatting or neelam and what it's trying to do effectively so you can't push through the payment injury pain is different to pain from on doing heavy squats it's really burning in the quads ok good pain you know so make sure you're training pain free range fa fa f squatting and they're doing I heard stairwell don't go down there only work in the range they got well it feels like I'm not do anything well you're doing something you know you can't expect you're better if you go into that pain all the time because it just doesn't work I've seen anyone that goes through pain and gets better with this sort of thing reps and sets seems something rehab for sets on the weak side fifteen reps when you're doing isokinetic two sets on the good side every day when you're doing isometric ten-second holds ten reps if you can do two sets of that great some people don't enough time and working on your left and right differences is a priority okay right here we go so in order what you should be trying to work on is this prone glutes boob ridges clams so I'll only raises for point of extension boy a possession physio knees and step downs I've got a star there because they are great VMO exercises and sometimes if the patients could know they're the first exercise I give them because they're my glutes might be working and I want to move a straightener VMO work but I want to combine on some good stuff so I go there straightener physio lunges straightener step downs I'll explain what the difference been step-down and a single leg squat enough is Yolanda normal lunges alright but that's why you should be trying to look for with your prone glutes isometric hold ten seconds make sure they don't arch their back at that point they're okay why your combined knees bending hamstrings firing over my glutes yep it's very hard me to keep a straight leg but also very tight now Amy's - okay I can't get the length and wants to shorten once that my motor pattern says no I've been you've been everything anything I've done it very hard to straighten my leg should be straight my floors lower work on the lower okay they start bending the knee like that they're farther hamster enough to help they're glued out okay my position my glutes work okay but my core stability is not as good so mine the body type where I go hamstrings and back okay they try and make up for because I'm of course stability is no good to go tame strings I like to try and get that pattern of movement going I need to work on my core yeah see these people say these are some things you need to pick up all right very very awesome exercise to activate glute max going get some stability back and by mean when you're using that you are fine glutamine glute men letter o toes you're firing everything okay they all work the bison glute max is a very good way of getting things working because especially when you've got problems of gloomy terminal a rotators but they're glute max is poor it's just Flemish it's not doing anything and some of you get knee pain because they've just got no bummer it's not doing a great one get it firing but you've got to do ten second hold you go to at least ten them try and do two sets and they go do it every day again it's a lot but needs to be fought with you get it going people just don't do it's boring what am i doing but it makes a big difference all the sudden their tone comes back and that tone and that positive michigan ability i can feel it working then relays into their partner movement when they squat and it fires better in their squat and then that control your pelvis bear and things feel better and they can strengthen better you can't really get a good knee without good bone yeah great one to do bridges who hasn't done bridges these are glute bridges though so when you're doing Pilates bridges you do back extension okay so you come up and fall back extension full hip extension okay but if I promote back extension open glutes when you've got some got weak glutes and that's not promoting the right thing so only one person to go up as high as they can go to keep a neutral spine alright and their glutes are going to be doing most of the work to trick with us and write this one down well I got it air sorry push through your heels and you can try this at home or in the break when you do this you've got to push your heels down through the floor imagine though you're pushing arrows down onto the floor and that fires your glute max a little better and all you have to stabilize a little bit better put a band around your knees and you fire your glute made and that rotated even more before you even lifted you've got everything switching on so you've got isometric work on there all loaded up with the band and pushing the heels down everything's switch ting and switching on so your pre Moto's looking before you even lift your bum and then with this position from there as the squat isn't it that's a squat movement let's go from there to there you're just doing it unloaded what people don't realize that this is the end of the squat position end of deadlift that position air as a bridge so you can give that right then your movement and Dennis is going to be bit it and squats is going to be better okay so put a band on one legged you've got to make sure that that doesn't drop so if I'm doing a bridge here oh I come up when I raise my leg I can't drop down on that side because then listen to switching on so they've really got to push down on one side a little bit more than the other and a little trick to one if you want to fire the VMO isometrically is when you push your heel down push it forward don't move it forward but push it for I push your force down and forward into the floor and that will switch on because you're technically doing isometric knee extension yeah on one leg which means you'll get one side working which is the side you want if you're on two legs you don't really feel the difference because you're stabilized through the pelvis on to the other leg you take one leg away all you've got is that one side some people can't go to one big bridges because they just don't have the control it cannot keep the hip stable they stay on - digger bridges and what they do is then you take off maybe 40 percent load off one side put it you know more on six fifty on this side and 80% in 20 and annoy you've seen and ten then finally lift it off yep awesome exercise so under your life that one sonar you lost claims classic yeah but again it's about the cueing you not allowed to let that hip roll what you got to try and do is push those heels together and the muscle I want working if you'll go greater trochanter here always say just the bone you point in the hip everyone's got a bone your point now you go to right behind it into the soft Park the dip there before you glute max almost right there is where you want to be firing now when you push your heel assess if you say push your heels together squeeze your bum we're plumbers they'll usually get something then you've got to cue them don't just lift your knee I want you to use a squeezer muscle and use their muscle to lift your knee and they'll get that sort of idea it at least gets something once they can feel that guy now use that one all right and it'll burn it'll be great and that's helping your lateral rotation all right but you're trying to a closed chamber because your foots down you'll get better activation with that put a band on one band double band all right awesome exercise great tripping exercises you know we talked about how am I going to get them during these exercises long term in my gym program ok warm up we'll go do some clams before you do some squats pretty easy right rather than getting just on a bike get them doing their rehab as their warmup yes that's the progression yeah Pilates progressions yep even harder yeah and a lot of time you know these things you if you ve done Pilates but it's hard and sometimes it's harder than what their level is and like I've go to Pilates to injured you know so you wanna make sure that they're ready for it but it's peláez as an awesome way to keep rehab in their gym program okay if they could well we do with blog field back pain is give them up to the level where they can handle parties they're pain-free and they're into it and they know how to Jordan they're cool and they stay constant do it ladies class once a week because then you know you're going to lose them because they're out of pain and haven't got a personal trainer they need to be in Pilates doing something to keep the same principles going keeping that motivation going get another Pilates thing cycling right now this is open chain okay open chain they have to be good at the closed chain start first really but this is open chain for glute med glutamine abduction make sure they're not rolling backwards and using their TfL again get their thumb and that's all part of their bum and make that muscle work this is definitely I want a really good warm-up exercise for when you're doing clothes chain work it's just firing that must luck don't put any load on it it's just activating activating activating activating alright better to throw this in before all the other hard stuff or the compound movements get there must at least alive get it firing get it warmed up okay awesome exercise but don't use it as a form of your primary muscle exercise to fix hip stability okay doing these doesn't fix this it helps warm it up to get the muscle firing show you then you can do the next exercise and the next exercise the next exercise for point of extension this isn't now being way more complex because you've gotten a lot of core okay they have to keep their lumbar spine and you too unstable so they can fire their glute max okay and get all those muscles working keep them in a line don't even Eve fall out to the side or anything like that before them and given the work on how to control that knee so all the muscles are working together keep that knee in the line all right push your heel up to the ceiling it's a trick and they'll get to the point where that legs are too tight they want to actually back okay so don't go beyond that point all right triggers like when they when they start arching their back when they push they start think about okay hold a plank and they like it and they learn how to do that I come to say a little bit with the obliques but at least they're not going to that sort of pattern okay so don't give them trying too hard definitely add a band on once they got that stability good or they've already got really good core stability add that band I get some resistance going get that muscle really fine because it's quite hard to feel your glute in that range it's quite hard to get it going less you really get a fine so these people haven't got good to the farm very well it's actually quite difficult if you've got some sort of resistance to push against you get a little bit activation it's like doing squats with no bars look you know but soon as you put some Twinkies iy you are not to do now yeah you got a bit of force to react against alright so give that there about a shot now this sexercise is just a different form of doing glute bridges yep just a little bit better range all right make sure and this teaches you how to deadlift at the top and squat top at the top security now is people who you sometimes see they dead left the arch their back and then come up and do that all right so this teaches them to get back into neutral so when I'm going from I'll show you on here when I'm going from this position I'm an extension okay I'm resting that's gone what I want you to make sure OHS and we know here remember shoulders weight bearing heads not just resting you've got to then push it think about what you did with a glute push through your heels okay push forward if you need to a little bit and then fire glutes but at this point because I'm an extensional I have to bring myself into neutral now when I extend when I come up the top I'll get the point where I'm too tight here and I want to extend my back and on the back the motor program says back to take over but I want to stay no no no no I want to do hip extension you've really got to tell them to shorten up between their glutes and your hammies and lengthen up and their lower back and shorten up in the front so they go from long hair to shorter the back here and they get really maximal moving here but they're good enough one legged all right so they get that stability going on as well all right it's all just firing those glutes up get through these next two exercises which you'll be great you can put a band around their knees what they're going to do include me let rotate us getting them in the program you should remind the brain when I do hip extension I want everything working and I want to be lazy because we need to hip extension on my leg like that okay I don't want to be like this I don't to be dropping down and causing problems awesome exercise now they're at home give them do it on a couch and this exercise bodybuilders used to get massive glutes so there's something in that yeah girls love this exercise great bum toner awesome here's your number one this is my fav exercise just about of out of all the exercises that we do physio lunges not lunges busier long years I don't know if I point it 4-0 I'm just back in the day but I like to think so the difference is you might call it front foot lunges that's the thing I call physiology is just the way we do it now things that take home with us up I won that angle before to about 30 degrees okay so standing lunge straight down straight up with people with a telefilm or pain on the back knee they're going to hate that they got one with Jesus can't do that now why is that why do you think that is what is happening biomechanically the back of my knee when I do that the shearing force going through my knee okay I'm not compressing through my name like that the other thing too is there's a shearing force going through this knee as well and there's simply the fact my bodyweight is not over my kneecap okay and then when I go down like this okay it's really hard for here because all the tissues tighten up like that and if I got really tight quads is going to pull that knee cap into the groove and it's not sitting in the groove prop it it's going to hurt sometimes people get it go miss when they get mahadji's that's on the front right because then they're doing a shearing force there and when I been here I'm not getting enough glute movement flexion to get my glutes going while I'm dropping down and I'm not firing my vni VMO enough right the same rule price and people say how far forward do I go I see Arthur Ford am I can go as far forward as I want if it's pain-free and my heel stays on the ground and my angle of my shin well I can see a shadow looks a bit funny with that show but my back and my back thigh and my share need to be equal pain free sometimes people do that they still get pain so I go from here the guy yeah great great great ah now saw if I do that okay so those people are allowed to do this so they don't travel forward here but they're getting a bit of done the other leg so you can Austin see so instead of going forward and down both even okay they go to a point where they don't need a knee cap go for it's a path your toes nothing it's not a it's not a written rule but then then they drop here so I'm getting my hip flexion I'm getting more and more gluten eat more more glute max you and then I'm driving through that leg so if I shift my weight into the front foot it's going to load up my kneecap if I shift my way into my heel that's going to load in the mid lead joint get it nice compressive force hammies and quads working together and I get a really good activation then they'll go I feel that my bum they're perfect so they're not fitting in the knee but they are paying their bum they're doing the right thing so very very crucial and it takes a lot of practice to get this right because you try and change your pattern the movement that there may be used to and you try to completely change it like give them to focus on consciously activating muscles and using cues and you push down through here and you what what what am I supposed to do at the same time when they're doing this I do this way this hips got to stay up so when they're lunge down they can't do this okay so they've got to keep it there and keep an alignment which is very hard you go to be behind them having a look in correcting them and then they need there's not allowed to do this and go out of alignment it's got to be there over their second or third toe middle of the foot between the second and third toe okay so going through they're keeping that hip and alignment all right and when they get enough moving there and there and through the hill and 80% of their weight on the front leg not 20 I mean not 50 80 percent and then when they push up they've got to think about pushing through the floor to come up so again that same principle of pushing your heels down so when you drop down 80% goes onto the front heel down them back into the hill all right and when you push up push the heel down to come back and you'll get better glute activation let me get a bit of glute work your knee stays in the line if your knee stays in line and you're doing the extension your quads are going to work and your VMO is going to work better and that's how you get your VMO yep in a closed chain position with your hip stabilization talking to your brain and gain that motor control back so yeah you have to do it some people it's not about how far for the knee goes it's just the fact they're bending so they might get a point where they go down and go or not that's saw and then I can't do that well you can just get in here and just work there and tell them that's what they've got to work on so they get enough strength here and so you build up their strength and they'll eventually get lower and I think it'd better body weight changes and can afford and back to get it down through the heel to get better okay get their back foot a bit better and way they go awesome exercise okay put that in your program but make sure it's not a split squat lunge with their foots floor and they push their knee forward okay it's not a normal lunch now and things like pump class they can't teach it like that you know it took me five minutes to teach they don't know T so everybody make it perfect go any V person single person the class and make sure it's actually perfect they can't do that so they have to do straight up and down lunges so a lot of people go to pump class with patellofemoral pain have to change their lunges so get them to change their lunges and I give them an out in the Platinum we say just got construct instructors love it yeah come to stroke and say I'm just doing physio lunges because I've got this neat pan acid cool because otherwise they say hey you're not doing lunges right because I've been told a lot that so make sure you you explain why you're changing it any questions on that yes so much education I give when doing these ones yeah if you can I think I think that better the thing about a functionally allonge like this teaches me how to get strength from this position and push up so does strengthen in a different position that's fine okay you might need that in certain sports you know if you're getting back and you have to push up so that there is warranty for that yeah but on tennis players or every players they might need it and but for rehab stick to that sick yes four sets of 15 yep this one you can add on weight so obviously dumbbells and things like this that's the heart of it dumbbells what I'll talk about that is yet is that with my button the Arab and okay Jeff's just a favor this one putting the fear of and around here that way which is putting their knee and they fight it so the resistance directly for here so rather than stacking weights on me how do I get this fired up from the resistance that way okay so putting a thera-band on much more effective then the weights alright but they'll find those exercises hard enough but weeks before you put on any weight and sometimes it's not about the size it's about the activation second favorite of all the time beyond the part on the one arm only grades I showed them this morning step downs now this is not a one-legged squat as you probably know it it's not a pistol squat okay it's not a step-up and it's not you'll see a lot of literature in a lot of videos and they do step downs like this the league forward okay that's pilot people really good control you're teaching some of the back and shop with their leg back so a step down but step back and down right now again have a look at my angles to be are upper body doesn't really matter about the back leg because it's not planted okay but tibia and upper body will to be in spine same angle but you can change it depending on the pain again this is much this is like the physiologic Sampson principles but we know stand on one leg and the weight streamer heel wore them a toe so I keep my weight through the mid part of a joint I've got to make sure my knee doesn't roll in this is really hard for some people because as soon as I sell my leg go do that I calculate an airline if they drop here so they've got touch up here but as soon as I go on deflection here I'm lengthening all these muscles and the muscles want to switch off when they start in the point and they just roll so a lot of people go yep and good here and then it goes was that okay we'll just rolls on the bottom why is it rolling in the bottom because they're just losing strength a lot of the deeper they go this is why you've been doing all those bridges and that's or things to teach them how to get that position perfect so when they go on one leg they've at least got that okay and again being on one leg will give you way more work here and here alright making control working on getting that front of line and trying to keep this hip on the line going as far as they can go far as they can go when it starts rolling then driving back up and staying on one leg it's about endurance alright again watch that hip shot you know I don't want them going down if they get to this point and do that okay they have to have to maintain alignment some people there's a video on our website of this one to show the differences some people will get the point where they go or hurts at that point so what you might do and I'll show you this way as if they you get pain past 30 degrees because they've been it's not that's when the goes in the groove and it hurts so if I get the pond they go now that hurts okay don't in the met they've been they need too much so they do that they're still doing knee flexion they're just not travelling it forward and loading up the patellofemoral joint yeah so you got a thing of what the angle if you look at the angle of my knee okay there's an infection but also there's the same knee flexion okay so it's different mechanics more good activation but some people can't do that I can't get back you're like I can't do that because they haven't got the control and the confidence to do that alright the other thing you don't watch too is making sure they don't initiate it with okay deal wanting a squatting they go bang first thing I do is that because that's what they're used to that's what they're confident in as me but they don't know what to do here so they've got to make sure the knee and hip go together okay sometimes people go okay a bang knee and in hip okay but by then they've already lost the control because they haven't been ever got the hip control going okay so it's it's really pedantic but you have to be with this stuff and this is the difference between you doing hard doing a few step downs if your lunges are not getting better and doing them and getting better because if you didn't is poorly or teach them poorly they'll think they don't work they hurt hey what do knows if you teach them right and teach them the low level and really do work okay so only the people really really bad bad knees there may have to stay away for us for a while but they should be seeing the physio from anyway I shouldn't yeah it might have been in your cute kid there about now that gets really hard put a fair value knee like the lunge tight that way it'll pull them in okay they've got to be really good at that then we'll be good for people who involve change directions sports especially with the ACL rehab people get them on one of these okay doing the same thing get their foot in the middle of the BOSU first okay when they stand on us and first time they'll do this and that's their brain you're logically trying to work it out you just put their foot on the back and get them stabilizing but then a week they'll be like okay that's cool then they've got to try and do a step down on that and then you've got to put a band around it so rather than putting on weight this make things more and more more difficult for your stabilization which builds and builds and builds and builds their strength yep keep it level yeah some people will try and roll it out for the fake a bit of alignment okay try and keep it level most people will stand on this and put it sideways because they try and keep it level the neros it yep all right now VMO quads the first two for this section are physiologist and sit down okay so there why my favorite because they were both together every knee patient comes in outdoors gets these sometimes variations of them even if they've done them before even if we're done before we get them make sure they did absolutely perfect and they sort of go oh you're not doing actually that's great this is harder longer I can't get doing it perfect you can't lose with the stuff and sometimes that's all it takes is just those two exercises some people turn these exercise their fintax I didn't every time before a run feel great right so knows that's what takes because it does work a lot of things together it works on a lot of alignment a lot of postural control and if they've got good core things like that it's just a matter of doing exercises and get them correct and get a few muscles working and all sudden their pain goes away other people have to work harder and the gym change from a normal leg press which is open chain pushing away hold your hands to your feet you know the one where you stuck with the weights on okay great for when you don't have knee pain awesome use it but when you've got knee pain you're trying to let rehab one leg you're better to keep it closed chain on a one leg rehab press salute me three and I'll show that picture you've got in your notes yeah that's what I mean by a rehab press I coined it rehab processes leg press on it but when I say leg press two people they jump on the other machine so I mean rehab press can't put a sticker on a movie rehab press like closed chain and see what's closed chain bodies moving right when you push through that foot push through the heel and imagine you're pushing the plate away from you not pushing your body back same principle about pushing your heels through the floor see that theme rolling through better glute activation bit in the alignment better VMO better chords okay make sure you're not going solo that you curve your lower back that's what happens on that other leg press they go too low and it curves the lower back up puts a lot of pressure through the discs so we don't get people who've got disc problems doing that open chain link press all right and single leg this won't give you too much functional my word functional stability being able to do this that will give you a lot of strength and the components of those muscles that need strength to be able to keep that position and practice that position okay so this is not a substitute for anything else you don't go I'll just make personal ID by by those lunges its third on the list if you've got a gym if you've got this okay so said what can I do if I don't hear nothing good that is what you want to do and it's just working on strength control difference you can write you're probably fine people to step down lunges they don't notice the strength difference but they notice their balance their functional difference in the control and their balance all right begin on this there's a massive difference in strength because that's all you need is strength for this really because you're locked in that machine it's stabilized you're feeling good and they do left and right and then one side is to go all I don't know how weak I was now if you weren't working on that because you know the physio lunges let's get others more activation and endurance and control not necessary just straight brute strength then you're missing out on something so this is sort of essential in a way now there's a different way of doing a step down this is where your one-legged squat comes in but you've got to do one thing to squat against the wall let's start with against the ball you're pushing out against the ball on the right leg to evacuate glute meat and men and external rotators on the right leg and it forces you to work on the left leg as well so the pressure you're doing two legs at once for one's loading the pressure pushing out forcing the other leg holy crap is it's got to push back okay so that's great but it's not single leg balance by itself you've got some stability and control with the ball it's like when you do a squat and you've got the other leg so this one you've got the other leg so again don't use it as your primary it's an addition okay it's something to add on to get more strength for more control and yeah okay I see a lot of people going for this let's work on your VMO but it's technically not completely single leg of it all right you've got some sort of your leg is connected through the wall and they're through the ground via the ball okay so that one's steak the medicine balls dynamic okay it's hard to control that medicine ball dynamically it's very hard to keep in one position to use a lot of posture control so it's again it's adding to your regime all right again make sure you can change the knee and the change-up angle all that sort of thing pushing through the heel with that exercise any questions with that one static yeah just here getting the squat push into the wall when you push them all your national after work you get all my lord pushing the head whereas the board medicine ball on now this is easier to do a Scottie disappear visible when you've gotta miss the ball it's small you know my god you have to try and really get your angles correct and perfectly you can just as a muck around with this one okay so I like using that isometric and have burns get the isometric control going I like using that one as a nicer kinetic whatever you do when you're Google start from gun YouTube and you say best fear mo exercise ever and they friggin got a medicine ball here ah it's just like a it's always in America the medicine ball there what is it doing when you push the Mitsuba that's a best VMO exercises because it's squeezing your push against that what's it doing up here if I push it yeah switching all these off right so how is that going to teach me how to do that I think it's the pressure on the ball or something Ivan whatever you do don't put a bits in between your legs doing squats put a band around your legs and pull outwards because we don't suffer from knee pain because their knee rolls outwards because it can't roll out once okay you don't sit there and go jeez look at my knee it's rolling out words well squat it rolls in we're doing your squat okay so there's no need to worry about here you naturally get adductor control from doing this okay you're doctors along okay for a reason because they control just the sort of movement here okay they don't have this huge big rotation movement out here you've got six muscles out here and two gloomy can't got lots of stuff to do that right member you your glute meet them and help rotate in open chain so they're already working okay so it's not about adductors trying to control it if you squat okay when you start getting advanced this is adding in more abduction when I move my leg out I'm making my leg do that it's harder okay so I'm taking one leg let's step down and I'm trying to control that way very functional for sport great for these athletes who need that stepping ability and off center ability it's a lot harder to get to this point the guy what am i doing okay so trying to get that control in trying to stop that knee rolling inwards and outwards alright progressions right how do we then get all this three head stuff is Rossum rehab stuff and get them closer to doing their normal stuff in the gym their squats and their deadlifts and they're walking lunges and all that stuff how do you get them doing that again you'll not the stabilizers get them functioning choose some exercises warm everything up all right and get that patellofemoral joint working try and work on all those principles you just learn pushing through your heel and the alignment happen I want something okay pull those little cues and use them and your next set of exercises add the BOSU into everything you're doing squats deadlifts similarly dealer's step down so the bands on okay make it harder for them but more interesting maybe they'll stay on board for longer when it's a little more interesting side steps and side jumps so you can actually add in loading now because sometimes the patellofemoral joint needs loading it needs that ability to load and compress and move to strengthen okay so don't be afraid to start getting them jumping on and off BOCES let's have a look at this so what I mean is add on a band we talked about that if you step down and going to BOSU in a band on a dinner yeah really hold up it sometimes you don't think about doing but it's what's what's missing for these people before they jump from rehab to just doing deadlifts okay so doing similar dealers is great but can I do it on a BOSU right to get more or more head stabilization more and more control going sighs didn't especially very important for people going back from surgery or back from recibir knee pain where they've lost a lot of stability and and fear of loading it to actually give them loading that knee better because all the time they don't do that they'll just do squats and then they go and try and play sport there's a big gap in between is where you guys can come in and help when they're doing squats deadlifts put a band on now I'm putting a band on you can do 100 kilo squats of the band on you'll just get way more let rotator work done and way more stability that teaches them to keep their near yeah this one where it starts yep now the first thing they got to learn is how to squat on squat off okay they've got to get that right first but when they're landing on it they're trying to land on land on the jump like that yep one-legged stuff you can even use a band when they're home I know it sounds silly sounds pretty basic okay but this is great stuff for them teach them a lot of alignment lot of hip control pistol squats really hard that's actually a really hard exercise they have to have a really good glute and quad control a lot of people cheat in common so domestic sitting there and they're using it when they're not good enough and a lot of this sort of stuff is used at entry-level by some people to do one negative work and they missed all the other stuff beforehand because for this you need good glute control you need good quad strength you need no pain in your kneecap you need good alignment to better do this but then this build strength which is what you want hard exercise to do step-ups how many people do step ups as one of their primary things we're just doing step ups with bad alignment you know and you see people do step ups and this weapon in step class because they do step up since their class as they start from here in a dropped position okay with us all off and then come up through there and then finally when they get to the top then they left but on the way through what's happened if they're down here and they drive through that knee then knee can't stay in a line when it's dropped here it's on an angle yeah so they need to be in that position there when they step up so you've got to get them being out of step up with the level pelvis all the way up and all the way down some people come up a really high box and then they'll step down and they'll get to this point and then they'll go like that and during that point is the crucial part of we may need that VMO control and if the knee is rolling in they probably won't get it so work on the alignment of that one and maybe that's a hard exercise so when you next look at that exercise and you see people doing weights with it you think have they got the control foot are they going to cause a metallic femoral joint problem because they don't have hip stability to do this exercise and they overload is this exercise going to cause them a problem it's also really good exercise to build strength but you've got to do it correctly yeah II think unique oh I'm going to finish on this one before we wrap up this one is a touchy subject okay people with really bad patellofemoral joint where shouldn't really be doing this unless they've got really good alignment so when the knee caps back in that nice compressive force you measure it out on the side I try and get them doing the extension it's got to hurt that good alignment will actually promote some strength fit but you're good so you've got to do it essentially on the way down always to up hold one take one away on the way down I would only do this under guidance from a physio to make sure absolutely sure they are allowed to do it is a very small population of people so I put it in there it's great for VMO when the VMO is weak if they've got everything else working in alignment and they're under safe conditions okay it will help them and if you're going to choose it then you got to choose it wisely I've been nine times out of ten you probably won't use this remember the VMO is only controlling the kneecap so turn the foot out is not really going to make a difference for people okay they should have found it with all the other exercises yep yep not chavalla i would old rather you had this person in your sitting first and under your control and your care before you give this to person just randomly yep okay thanks ba our quads Tyler cept honest work on those things ITB rollers for those guys with ITB tightness all right massage treating sometimes that's all it takes like I said with the shoulder you just might find the all you need to do is loosen that ITB stretch the quads out physically it's out there pain goes away the remember there's probably some underlying weakness and of why it's tightening up maybe it's their foot that's pronating okay so sometimes change the symptoms isn't the best thing to do long term quick fix but you've got to look underneath that the most of us we again causes hamstring sometimes do we have really poor hamstrings and overdeveloped quads you see this huge big vm over there su got a knee pain when they do running maybe it's their hamstrings cue angle we talked about wide cueing or pronation maybe a need for better shoes orthotics things to be aware of always core stability is always in there and think when things are harder cartage we intend off these really need to be professionally assessed okay and see are they really allowed to go back and doing 20k marathons if they've got too much wear in their knee cap choose your rehab press over your leg press yeah in single leg work over double leg work because you know now what it does for you all right cool any questions so far yes ah well you can get knee pain from not having a Sartorius working but it's pretty rare that's pretty well we've had people come in with Sartorius tears and their pain isn't like a line like this and they do it usually from a twisting injury in sport but it's really rare really rare okay see she may need to work out why they're excessively tight so you got to work out why that is yeah physio lunges have normal lunges so we showed you before maybe limit their running distances but then progress their running distances up you've got to get the endurance back lifting and just because they can do 2k great but then you've got to build the strength that they can do what they want to do begin mainly as a limit on what they can do and just make sure you change the routine if they're in pain so think about this on one to two weeks they've got to be pain-free at least okay it's what we aim for just at rest pain-free single squat is going to take them two to three weeks usually to get that pain free and they've got to do their rehab exercises at least the first four weeks just to get some sort of changed you've got to keep them on board for that amount of time then you've got to keep them going so going back to doing normal squats and lunges the others may be at the four week mark maybe at the six week mark because that's how long it's going to take them to correct everything just enough to get them their pain down so they can do that because but then they've got to keep those exercising because of therefore we mark and nowhere near perfect I still got to keep going in sport six to eight so you some ideas of use those exercises once they're fine use those exercises in their warm-up to keep them in their program or you just devote a whole day to that that warm-up that's their rehab and make sure they keep back in touch with the physio make sure they're going okay an education on you know just because you've done those exercises and you're feeling better mean that they're going to stay that way now you've got to keep pumping up the ties and making sure that that you know always retesting that how they still got it do we still need to keep doing those exercises so and just to finish off guys so any of you personal trainers or videos anyone who wants to see me or my colleague my colleagues at West I'm in the East we also do we do normal consultations for you guys but also anything on the phone if you want to bring clients in that's something we also do that as well so you've got a client I sure get doesn't come to our gym you can bring the money of a consult together with us and we give you a we give you a cheaper rate for that and normal all our news feeds all our our exercise we release their articles everything our labels on our Facebook so if you want to catch the up that information get all our articles stuff they get released jump on that and those those handouts you've got or on our website but if you want the extra exercise sheets we give to our patients jump on the website there's a library page there click on that you can download that exercise sheet it's got all the cues and how to do everything which is really good for your clients and those videos that I showed you today on our YouTube account right thanks very much

Channel: Physio Fitness | Physio REHAB | Tim Keeley

Views: 939,783

Rating: 4.0447044 out of 5

Keywords: patello-femoral pain, knee pain, knee exercises, exercises for knee pain, knee rehab, knee rehabilitation, physio for knee pain, physio, vmo strengthening, glute strengthening, vmo rehab, exercises for vmo, gluteus medius, hip muscle strengthening, exercises for knee injuries, itb syndrome, patella maltracking, VMO weakness, quadricep strenthening, knee injury rehab, glute exercises, hip exercises, itb pain, Tim Keeley, Physiotherapist (Profession), yt:stretch=16:9

Id: x5UbLJApR58

Length: 94min 1sec (5641 seconds)

Published: Tue Jun 04 2013