Knee Stability Exercises – Level 2

**Do not start this program without first being examined and prescribed a beginner program. This is NOT a beginner program.

Stabilizing the knee via exercises is an important injury prevention technique that most people do not incorporate enough into their routine. Many sports place strain on the knee and therefore can cause injury. You cannot strengthen ligaments or joint cartilage. It simply is what it is. However you can strengthen tendons and muscles and improve flexibility and co-ordination. There is no better injury prevention for the knee than a 2 to 3 times per week stability program.

Here are the goals with knee stability programs:

Increased flexibility of:
1. Hips (internal, external rotation)
2. Quadriceps
3. Hamstrings
4. Inner thigh muscles
5. Calves

Increased co-ordination of:
1. Ankles
2. Core
3. Hip & knee movements

Increased strength of:
1. inner thighs
2. hip muscles
3. hamstrings

 

We cannot ignore any aspect of the leg structure, from the core down to the ankles, as they all have an impact on the efficacy of knee movement. Please do these exercises after a proper warm up (e.g.: 5 minutes on the eliptical).

 

1. Foam Airplanes
– stand on foam board (without shoes)
– arms out in “T” formation (do not let arms drop throughout exercise)
– lift one leg off
– keeping chest over hips (straight back), bend one “wing tip” down to ground by moving hips NOT arms
– then reverse movement and bring other “wing tip” towards ground
2 sets of 8 on both sides

 

 

2. Balance & Pass Medicine Ball
– balance on an exercise ball with your knees (feet OFF ground)
– stand erect, chest over hips, arms out, one hand holding med ball
– pass ball back and forth (see video below)
2 sets of 10 passes (5 to each hand)

 

3. Face-the-wall Squats
face wall, feet wide apart
have chair behind you to catch you if you fall
– toes turned outward 45 degrees and toes one inch from the wall
– pull chest “back” by pinching shoulder blades together and keeping ears over shoulders (head back)
– hands between your legs (finger tips against wall)
– squat down as low as possible while maintaining proper technique

2 sets of 15

 

 

4. Hamstring “pops” on exercise ball
– lay on back, feet on ball
– arms at your sides, palms down for support
– lift buttocks off floor and lift on leg up in air
– simultaneously roll the ball towards your buttocks and elevate the leg towards ceiling (see video below)
2 sets of 8 each leg

Nurse performing body-hamstring proprioceptive strength rehab

A post shared by Dr Emmanuel Parenteau (@drparenteau) on

 

5. One-legged Quarter Squat with Ball and Foam Board
– pin ball between wall and buttocks (NOT low back)

– place both feet on foam board (NO shoes)
– chest out, arms out (do NOT lean forward)
– lift one leg in the air
– drop into a controlled, quarter squat (NO further, too much pressure on PCL)
– press back up and repeat (see video below)
– make sure foam pad is far enough away so that at bottom of quarter squat your knee is not shifting forward

2 sets of 8 each leg

Knee Stability Squats – only quarter squats or less (otherwise hard on PCL and knee in general) 2 sets of 8 each leg

A post shared by Dr Emmanuel Parenteau (@drparenteau) on

 

6. Hip Circles
– Lie on your side.
– Bend bottom knee.
– Point toe of top leg.
– “Draw” as large a circle as you can by moving leg in a circle.
– Go as far UP and BACK as possible.
– reach forward lay forearm flat on ground to keep pelvis from leaning back during exercise
Do 2 sets of 10 on each side

 

 

7.  Single Leg Pot Stirs on Exercise Ball
– lay on ground
– one leg on ball
– lift pelvis slightly off floor
– palms down on floor for support
– “stir the pot” with foot on ball
2 sets of 8 “stirs” for each leg

 

Self Questionnaire Flow Chart for Future Care

Patients often ask me “when should I come back to see you?”

This is a difficult question to answer. In order to help patients self evaluate for their needs of future care, I have developed the following flow chart. Feel free to use it for your own purpose.

please review this Pain Sensation Chart before using the flow chart.

CLICK TO CALL:
1-250-589-6325

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Sciatic Nerve Pain

Many patients who have pain in the hip will immediately claim “I have sciatica!” Often this is not the case. This blog entry will help you differentiate between hip pain and true sciatica.

The sciatic nerve is made up of the peripheral nerves L4, L5, S1, S2 and S3. Somewhere near the buttocks these 5 nerves combine into one “hose” of nerves and we call this bundle the Sciatic Nerve.

The sciatic nerve then weaves its way through the muscles of the back of the hip (buttocks region) in order to run down the leg. One of the big muscles that can put pressure on the sciatic is the piriformis muscle. Although any muscle can irritate the sciatic, it is typically the piriformis. This is why pressure on the sciatic nerve is sometimes confused with piriformis syndrome, a condition in which the piriformis is injured or strained and emits posterior hip pain but does not necessarily impact the sciatic nerve. Buttocks or hip pain without pain going down below the knee region is not sciatica.

Interestingly, the sciatic nerve often has two branches before combining into a single branch below the buttock and one or both of these branches can run over, under or through the pififormis muscle. Either way a tight piriformis will pressure the sciatic nerve and cause symptoms all the way down the leg because that is exactly where all these nerves end up.

A single nerve — such as L4 — only “feels” a small section of skin sensation down your leg, so if you are pinching the L4 nerve, only the stripe of skin innervated by L4 will be numb, in pain or give a burning sensation. But because the sciatic nerve contains several nerves combined into one large bundle, the skin region affected by sciatic nerve pressure covers larger areas of skin (sometimes most areas) than a single nerve would. So, often, most of the leg is affected and undergoes changes in region and sensation.

So, if you can check off the following, you may be suffering from sciatica.

1. pain in the back of the hip (buttocks)

2. pain, numbness or burning sensation travelling farther down than the knee region

3. pain, numbness or burning sensation that covers a large area of skin (e.g.: both sides of calves/foot/thigh)

 

If you suspect you are indeed suffering from this condition the clinician you visit for confirmation and treatment should apply the following:

1. active release to the hip muscles to break down scar tissue and loosen the muscle(s) off the sciatic

2. PNF stretching of the posterior hip muscles to loosen the muscle(s) off the sciatic

3. teach you proper lifting/sitting ergonomics to keep the hip muscles from tightening up again.

4. prescribe home exercises and therapies to keep the hip muscles from re-aggravating the sciatic nerve.

 

Best of luck!

The Benefits of Personal Challenges

credited to: http://costculator.com/best-rowing-machine-reviews/

As we get older it is easy to tell ourselves to “slow down” and “act our age.” In some ways there is wisdom in these statements. However, many forty-plus year-olds  take this mantra too far. They stop playing their favourite sports because they do not want to take undue risks. Social circles can also take a hit as we become very career and family focused. Our worlds get smaller  and smaller. In a sense people in their forties begin to prepare themselves for death decades ahead of time. You may think this is a dramatic way of describing the natural process of aging but hear me out.

I understand that we have to be aware of the changes our bodies go through as we age. And hitting your forties does mean some things have changed. At 36 years of age I tore my inner calf muscle doing 42 inch box jumps. Now, I had warmed up and stretched and had slowly worked my way up to these over a period of years. But still, my muscle ripped. This would not have happened at 26. So I decided to omit highly ballistic exercises to forego anything worse happening. I adjusted to my age. Yet I still lifted very heavy weights. I also began to practice jiu jitsu. Having wrestled in school and university, grappling came natural to me and jiu jitsu is slower paced than freestyle wrestling. So even though I “slowed down” I didn’t downgrade my efforts or time spent pursuing fitness, I simply shifted my activity to something more intelligent. In May of 2017 I even competed in the highest profile jiu jitsu tournament in British Columbia. At age 42 I entered the 30 year-old division and won first place. The weight cutting and training camp was difficult and competing against athletes 10 years younger was daunting. But I took the challenge and succeeded. You don’t have to have that lofty of a goal, but it does highlight what is possible.

MMA fighter Randy Couture won the light heavyweight title at age 40 and defended his belt against a 28 year old challenger. He also won the heavyweight UFC title at 44 years of age against a much larger 32 year old opponent. Finally Randy retired at age 47 from professional MMA. Remember that long time NHL hockey player Chris Chelios played until he was 48 and even in his mid forties the Red Wings fitness coach said he was as fit as the 30 year-olds on the team! Jaromir Jagr is still playing NHL hockey at 46 and two years ago was one of the team leaders in points at 44 years old. At least two Olympian medalists during the 2016 Games in Brazil were in their forties. All this to say that you don’t have to hang up your hobbies just because you are in your forties. If you treat your body correctly, you can stretch your athletic prime farther than you think.

Now, let’s say athletics are not your thing, you can push your intellect instead. After finishing university in my twenties, I continued to read copiously. Instead of being “done with all that learning stuff” I put my skills to use in a more varied manner.

Credit: The Marmot (click image to visit).
Some rights reserved for image: https://creativecommons.org/licenses/by/2.0/

I read history, philosophy, science and religious texts. No longer being bound by tests and heavy class schedules, I was free to expand my mind. Even though our learning speed decreases after your twenties, the ability to make accurate decisions continues to rise until your late 60’s and usually is maintained for years afterwards if you use your brain. So instead of being done with learning, I was only beginning. And I continue to devour knowledge. One of the most common traps once our careers are established is to simply entertain ourselves during our down time. Instead, I choose to educate myself. “Use it or lose it” is a catch phrase for a reason. Continued mental challenges keeps your brain young.

I continue to challenge myself in the business field as well. I am planning on shifting my work to focus on both sports medicine (working with a professional team) and eventually to hold an academic position part time then full time. The continual shape shifting of my goals in all areas of life keeps me feeling, acting and thinking young.

As a father of four kids, I am also challenged in terms of energy and time. But I have taken this challenge head on and have reaped the rewards. Many people in their forties are really winding down and foregoing many activities and goals they could still do. But the body follows the mind. If you have decided to stop challenging yourself you will slowly convince your brain and body to get old quicker than it needs to.

Why would anyone ever do that?

Our Manual for “How To Sit Properly”

Many office workers feel they are doomed to low back pain because they sit for a living.

NOT TRUE!

There is an easy solution that will protect your low back from injury.

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MANUAL for HOW TO SIT PROPERLY

Food Coupling? What?

For several months I suffered from “acidic gut.” The bottom of my abdomen was constantly painful and I had mild nausea and bloating most of each day. My condition was most likely brought on by a combination of strong anti-biotics, high sugar diet and stress. Either way, the end result was, I had too little good bacteria in my small intestines and therefore had a fungal overgrowth. With a high sugar diet, fungus is well fed and its colonies grow unabated. As a by-product of fungus feeding off sugar, the fungal bodies are producing acid, which hurts.

At this point, I worked with Liliana Tosic, a registered holistic nutritionist (RHN). Her evaluation gave me the diagnosis I needed and then the solution: food coupling. I must admit I was skeptical at first. It seemed too simple to cure several months of pain.

Food coupling is the notion that different foods are processed at different speeds. So by avoiding bad combinations, you alleviate stress to the digestive system. Further, some foods give off more or less acidic by-products. Which also needs to be taken into account.

Within 3 days of my food coupling diet I felt at least 40% better. I have been on a slow but steady improvement slope ever since. I was quite surprised at how simple and effective “food coupling” was.

In hindsight, this should not surprise me as I have many equivalent scenarios in my pain relief and rehabilitation practice. Many of my patients are incredulous when I say that adjusting how you sit and how you lift can alleviate the majority of disc pain within 2 to 3 weeks. Yet this is the reality. Which can be hard to believe if you have had months of debilitating pain.

If you have not worked with a good nutritionist and you have stomach or digestive problems, I would highly recommend giving Liliana a call.

To your health!

Doing Nothing…. Is Real Good For You!

North Americans are known for living some of the busiest lives in the world. Few other people (if any) have as many competing demands on their time than we do. A few years ago I became aware of how obsessed everyone was with being busy.
“How are things?” I would inquire.
“Oh, you know, super busy.” came the reply.
The way they would say it was one part complaint, three parts badge of honour. It was as though they wanted to signal that they too, were “busy.” Very, very busy.
After going through a very stressful time in my life, I began a journey to live a radically less stressful existence. This meant many things, including stopping the instinct to be busy. I was shocked at how hard my brain tried to keep pushing me back to my old ways. The ways of my culture. Breathless, constant busyness was portrayed at almost every turn. Whether it is the corporate ladder climbing heroine in a movie, the businessman in a magazine ad or whatever, we have absorbed a view of success that demands 24/7 scheduling of our time.
If we have a unifying religion in the West, it is Busyness. Interestingly, our brains and bodies seem to be suffering. Stress-initiated illnesses such as Irritable Bowel Syndrome, Anxiety/Depressive Disorders and Chronic Fatigue are sky rocketing. We are officially pushing ourselves beyond what we were designed to endure.
Some times in our lives are unavoidably busy. As the owner and operator of a busy clinic, a serving member of my church and married father of FOUR kids under 14 I am a busy man. We also do quite a bit of traveling throughout the year.
BUT…
I am no longer “busy.”
How did I pull this off? Allow me to explain. Research has shown that being active is healthy, but being negatively stressed is not. A few years ago, TED speaker and researcher Kelly McGonigal unveiled new research showing how our interpretation of our busyness can make the stress good or bad. Her evidence essentially showed that if we are overloaded by things we despise or dread, our bodies suffer. But exhaustion coming from activities we enjoy have seemingly positive effects on us.
Here is my secret to strategically removing bad busyness from your life:
1. Know Your Have-To’s and Make Them Fun: All of us have to do certain things. Work, cook, commute, etc. If you are lucky enough to do what you love, this won’t be hard. If you work a less than ideal job, well, make it fun. If prisoners in Auschwitz were able to find the good in their lives, you can to. This may take some time, but figure it out. No excuses. Your commutes can be times to plug into a podcast or other enjoyable audio experiences. Be hands-free on the phone with a loved one while cleaning/cooking.
2. Know Your Strengths and Grow Them: All of us have a unique contribution to make to this world and our generation. All of us. As a Christian, I believe very strongly that we bring something to the table of humanity that no one else in history could. If you are not engaged regularly in your passion, you will suffer. Just Do It.
3. Balance Your “3 Passions”: I recently discovered a wonderful piece of advice: “Have 3 passions in your life. One that makes you money. One that keeps you healthy. One that let’s you be creative.” Find those and work them into your life. Take up jiu jitsu or biking. Get into it. Do it. Start drawing. Playing the piano. Blogging. Expand your mind and influence.
4. Embrace Doing Nothing: If you wake up on a Saturday and immediately feel the urge to “do something,” you are caught in the Cult of Busyness. Your body and brain are accustomed to always trying to do something. Make money, clean the house, prepare for some future disaster, etc. The survival instinct is in overdrive in most North American minds. Interestingly, it has been proven that being overly busy destroys productivity. For me, the Art of Nothing comes in 2 forms.
ONE, several times a day, even in busy clinic times, I take a 3 to 5 minute break. Either I close the curtain on a treatment table and nap or I watch a funny video on youtube. Just a smidgeon of “nothingness” to alleviate my body and soul. Just living, breathing, existing, being.
TWO, for at least a full day each week, I do “nothing.” I can’t necessarily lay there all day because I have 4 children and a wife. But, I don’t do anything on impulse of “I have to.” I will lay in bed as long as I can before I get up. I only do the bare minimum of “have to’s.” I will chose the activities that I want to do, none that I don’t. I will not push the kids to be “doing something.” I will fight my brain’s push to get me to “BE PRODUCTIVE.” No. I don’t want to produce. I want to just exist.
I am still an amateur when it comes to this. I am no master. And I am constantly shocked at how hard my mind and body fight “just being.” But I am improving. I am coming closer to going back to those childhood days in which there was zero guilt attached to going with the flow of your imagination and interests without checking to see if I was any good at a task or if it was “productive.”
Good luck!

Hip Problems in Women

Women are more likely than men to develop hip pain. This is due to the width of their pelvis. Because they have wide pelvises (for child bearing) but their feet come down exactly in the same spot as men on the ground, their thigh bones are at a steeper angle.

The angle of the thigh bone (femur) in relation to the hip socket is known as the “Q Angle.” The larger this angle, the more strain on the muscles that cover this region. So you can see why more strain is applied to the hips of women than those of their male counterparts.

As women age, if they gain weight and lose muscle tone, the effects on the hip soft tissue increases in the negative direction. Loss of muscular strength, endurance and size places more strain on the passive tissues such as ligaments and joint capsule and even tendons. Placing more continuous strain on these. Add excess weight and you compound the problem. Muscles of the hip are therefore under more strain because they are weaker than they used to be, so they can accumulate micro damage and the inevitable formation of scar tissue.

So… What Is The Solution?

There is a 2 part approach to solving hip problems in women when they are the result of the above scenario.

1. Soft Tissue Treatments. Sports massage techniques are effective at breaking down the scar tissue that has formed throughout the hip region. This is an unpleasant but effective procedure. It also helps flush out inflammation naturally.

2. Exercise prescription. By performing safe and specific hip and core exercises, the muscle tone of the hip region increases, taking the strain off the other soft tissues and making the muscle itself more resilient to stress and strain. Increased muscle strength also increases pain thresholds and decreases inflammation.

3. Flexibility training. The greater your range of motion, the more effectively the body spreads out the strain of movement and weight bearing, making the hip less likely to become injured.

 

If there are weight loss issues to tackle, this should be done in conjunction with the above 3 point plan.

If you or someone you know suffers from chronic hip pain, link this article to them. Thank you!