The Wall sit is one of the most do-able exercises and is a brilliant strengthening exercise for anyone with back, hip or knee pain.
Who would benefit from would wall sits, otherwise known as wall squats?
Those wanting to avoid or prepare for knee or hip surgery
Most with hip or knee arthritis will get massive benefit
Those of you that struggle to get up from chairs
Anyone at all who wants to strengthen their back and legs from home
So what is a wall sit?
It is simple a squat hold with your back leaning against the wall as shown in the video below. the key things to remember are:
Your knees should not go out past your toes. Aim to keep your knees over your ankles or feet
Keep your chest up and back straight
Do not push into pain
Expect some burning in your thigh muscles (this is a good pain and shows your muscles are working hard)
Top tip: Lean into the wall with a Swiss Ball, foam roller, basketball or anything that rolls to minimize friction – this makes the exercise far more effective and comfortable.
The idea for the wall sit is not to repetitively go up and down but squat down and hold for a period of time.
Aim to hold until your muscles start fatiguing and then come back up again and repeat 10 times – over time your hold time will get longer and longer and your back and legs will get stronger! (1)
Tip: Only go down as far as is comfortable for YOU and don’t go past horizontal thighs.
The one-leg wall squat is often used as a test of lower limb endurance(2,3) and also makes for an excellent exercise when you want to push your leg strength further while still looking after your knees.
All you need to do differently for the one leg hold is lower yourself down, keeping your feet shoulder width apart and then carefully lift one foot just off the ground – hold as long as you can (without losing form).
Below is a table giving average times to gauge where you are at:
The wall squat is a great exercise and well worth persevering with whether you can just hold a double leg wall sit for 20 seconds or a one leg squat for 100! Make it a challenge every night for one month and notice the difference.
Do you want more great exercises to improve knee strength and pain?
A great resource for doing that is our downloadable Knee Self-Rehab guide – You can check it out HERE
What if I told you that to keep your joint cartilage strong you need to put load on your joints – Not bike and swim?
Your articular cartilage forms the smooth covering inside your joints and often when someone has degenerated cartilage they are told to decrease loading and get into non-weight-bearing exercise – such as swimming and cycling.
In a way this makes sense in that if you want to preserve and strengthen your cartilage, you wouldn’t run and jump and lift weights, would you? But our body doesn’t work like that, it responds positively to the force we put through it and really lives by the use it or lose it motto.
Recent research shows that:
Through putting load (body weight) on our cartilage we actually promote Transforming growth factor beta (TGFbeta) gene expression which helps to maintain our articular cartilage strength – That is pretty awesome.(1)
So without going into boring detail – By doing exercise which loads and compresses your cartilage, you actually help to strengthen cartilage and maintain homeostasis.
So get out there and walk, run or lift to keep your joints healthy – whether it is your knees, hips, back or any other weight-bearing joint.
Often, surgery is not the best option – So what should home-rehab exercises look like for a torn meniscus?
In this second post in the series we look at your home rehab programme, covering exercises to reduce muscle spasm, improve balance and strength a well as an effective self-mobilization technique that will help you make big gains.
As we covered in the first post, a torn meniscus is a very common injury and there’s some important points when it comes to anatomy and surgery vs. conservative rehab, so make sure you have a read of that also.
NOTE: You can now get our comprehensive KNEE Injury rehab guide – a full rehab guide that you can download with the click of a button!
So, here is your self-treatment:
Rehab for a torn meniscus needs to cover four things:
Balance and muscle activation
Joint mobility and meniscus healing
This is the order we need to start them in as well as the first step of your rehab is to settle the secondary symptoms, which is mainly muscle spasm and muscle switching off. This initially reduces pain, improves the range of motion and starts you being able to use it more – which speeds up recovery by helping you optimally load the knee.(1)
Step 1: Ease pain and improve range
First 72 hours:
As with most acute injuries, you need to first look after it, to allow initial healing – basically where the “scab” forms and to allow it to settle down.
Step 2: Switch the muscles back on, decrease spasm and improve balance
After the first 72 hours, it is important to prevent loss of muscle mass and get your muscles switching on again using some simple proprioceptive and stretching exercises:
Single-leg balance: The knee loses proprioception very quickly when injured (you can think of this as the “feeling” or the balance). So to get it back, you need to challenge your balance.
Level 1: Stand on one leg on the floor, when comfortable for 1 minute, progress…
Level 2: Fold up a towel and stand on this, when easy for 1 minute, fold it up thicker or
Calf stretch: Hang one heel off a step for 30 seconds at a time. Once per side.
Inner range quads / Extensions: With knee injuries we lose activation of the distal thigh muscles, just above the kneecap very quickly. This is a nice and easy one (but still very important!). Sitting in a chair, or in bed with a towel under the knee, extend the knee by lifting the foot up to full extension or pain. Repeat this 20 times, every 2 hours.
Note: Do not force it, and take it nice and slow
Step 3: Start strengthening the knee
This is where it finally starts getting less boring! Start step three when it is comfortable to do the above exercises and remember not to push into pain.
Squats. Yes these are great for getting your leg stronger again but it is important to start at the right level for you and progress from there through the following:
Level 1, Wall squats: Lean against a wall, with your feet shoulder width apart and out from the wall. Slide down the wall 1/2 range and no more. Hold this for 5-10 seconds and repeat 10 times. Tip: make this a bit easier on your knee by having a large round ball or Foam Roller between you and the wall.
Level 2, Double Leg Squats: Again, fee shoulder width apart. squat up and down within the comfortable range. repeat 10 times for 3 sets.
Level 3, Single Leg Squats: Now, standing on one leg, perform squats, within a comfortable range, 10 reps, 3 sets. Note: with this one you won’t be able to squat very low, and that is perfectly fine!
Technique: To take pressure off your knees, don’t let your knee/s go forward past your toes and it helps to stick your bum out further!
Cardio: Keep your fitness up and boost healing by utilizing:
Biking on a Exercycle ideally is great once you have over 90 degrees range in your knee
Swimming is a good one for un-weighted exercise, just stay away from breaststroke
Walking, as able. When you are able to walk pain-free for 1/2 hour, you can try a short jog and build from there.
Step 4: Gain full knee range
There are three things that will limit range mainly at this point: Joint stiffness, muscle tightness and the knee still healing.
The knee should continue healing, as long as it isn’t overloaded, so let your body get on with that.
Muscle tightness can be addressed by stretching out muscles such as your calf, hamstring and quads and also by foam rolling.
Last but not least, joint stiffness can be helped by self-mobilization to improve it’s bending and get the joint oiled-up. See the below video for a short and easy demo:
Meniscus tears are one of the most common injuries in sports and lead to a lot of time out from sports, swelling and pain. Here is what you can do to help your knee heal strong and fast and even avoid surgery.
Meniscus tears are, without a doubt the most common injury in the knee and the 5th most common injuries that present to sports medicine clinics.(1) With this in mind, we think it is important that you know:
What the meniscus is and how they get injured
What is better surgery or physio?
What are the best exercises you can do at home to heal strong and fast.
So let’s cover these three…
What is the meniscus:
There are two meniscus in each knee, which are horseshoe-shaped and thicker on the outside to give a nice cup for your thigh bone to sit in. These give stability for your knee by adding a cup for the thigh bone to sit in and guiding the joint as it moves. The
meniscus also offer some padding between the two bones.
It important to mention blood supply of the meniscus because this directly affects healing times. Only the outer 3rd of the meniscus has blood supplied to it, meaning in general healing can be slow for meniscus, particularly in the inner 3rd where there may be no healing response. In general, allow 12 weeks healing for meniscus tears.
How do they get injured:
Meniscus tears often happen with combined twisting and flexion, such as when you land and pivot on your leg after catching a ball or step out of the car and twist at the same time.
Think of it like this; Your meniscus sits between your shin and thigh bones. If your foot is planted on the ground and you are turning your body and pivoting way, this puts a huge amount of torsion through the meniscus. This combined with you body weight can often lead to a meniscus tear in many fast-moving ball sports – Makes sense right?
Common symptoms to look out for:
Pain on either the inside (more common) or outside of the knee-joint
Swelling, often a lot above the kneecap
Popping, clicking and catching
Locking of the knee joint, indicates a significant meniscus tear
What is the best treatment approach?
There are two main approaches for meniscus tear
Surgical repair via arthroscopic surgery
and conservative treatment which generally involves physiotherapy and strengthening exercises
There was a groundbreaking study done in 2002 which really made a lot of health professionals and surgeons take note. They took a group of patients with degeneration in their knees (arthritis) and split them up so that some of them had arthroscopic surgery, but some of them just got incisions in their skin so that it looked like they had surgery. The outcomes between the groups were no different.(3)
Since then a lot of further studies have been done, looking at meniscus injuries and whether surgery is better than conservative rehab and this is what they found:
There is no significant difference in functional outcome between Physio and surgery (4)
For degenerative meniscus tears, there is no difference between surgery and placebo (5)
Arthroscopic surgery and strengthening is no better than strengthening alone in degenerative meniscus tears (6)
Conclusion: We really need to split meniscus tears into 2 groups; there are degenerative tears which are due to wear and tear and then there is acute meniscus tears which occur from one accident/incident. We can safely say that for degenerative mensicus tears surgery is not the answer and should be looked at only if conservative rehab fails – even the American Academy of Orthopaedic Surgeons state: “We are unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.”(7)
When it comes to acute meniscus tears though, it gets a bit more complicated. Surgery definitely can help here, but as a general rule, only if there is:
Instability – Knee giving way and you can’t trust it
Or if conservative rehab does not have good results after 6-12 weeks.
So if you have a meniscus tear, whether degenerative of acute and have no instability or locking up, then the best thing for you is to get onto a good rehab and strengthening programme and give it a good shot before jumping to the scalpel.
Follow this link for the second post in the series which details a simple home-exercise programme for you to follow.
There is an indisputable amount of evidence now that when it comes to anterior knee pain exercises… we can’t just treat the knee.
Here is a short and sharp explanation of why and what we should be doing:
Often people are told to strengthen up their quads and get their legs strong to help knee pain but really is this the best way to do it?
The answer is no. There is a lot of evidence when it comes to anterior knee pain (also known as patellofemoral pain) that rehabbing proximally is much more effective the strengthening the knee and quads alone. Proximally means working on the muscles further up the chain, closer to your spine, such as your:
Hip external rotators
In fact, a thorough systematic review was published recently which showed that compared to quads strengthening:
There is strong evidence that proximal rehab, combined with quads strengthening had better pain reduction
Proximal rehab alone and combined with quads strengthening results in better functional gains
Proximal rehab, was better in the short and long-term.
This basically shows us that when it comes to knee pain, it isn’t often the knees fault. We need to look up the chain at what controls the knee – The hip. Including rehab exercises that improve him strength and neuromuscular control has much better effects in outcome in both the short and long-term and cannot be ignored.
So what exercises should you be doing?
Type of exercise: This should be a combination of closed chain (feet/foot in contact with the ground) and open chain exercises in a comprehensive rehab program.
Frequency of exercise: Exercises that aim at neuromuscular training and stretching/foam rolling can be performed daily, whereas strength training should be aimed for 3 x weekly.
What knee pain exercises work well?
Follow this link for a great post for the rehab exercises to get you started, or go the whole hog and download our knee pain rehab guide HERE
Conclusion: Proximal rehab should be included in all rehab programs for anterior knee pain and if in doubt, go and see your local physio for best results.
Are you sick of trying to fix your IT Band Syndrome by stretching, strengthening or foam rolling your Iliotibial Band?
You don’t need to waste your time with that any more. Here you will find a clear summary of what really causes IT Band Syndrome and what you can do to really help it. All based, as always, on current research and good old-fashioned experience from a runner and physiotherapist to help you heal strong and fast.
What is IT Band Syndrome really?
IT Band Syndrome is a common overuse injury in runners and cyclists and is commonly thought of as a friction syndrome.
First of all, the one myth that needs to be sorted out is this:
IT Band Syndrome is caused by friction, from the IT Band rubbing over the lateral knee
False: IT Band Syndrome IS NOT CAUSED BY FRICTION and the IT Band CAN’T SLIDE OVER THE LATERAL KNEE
Recent evidence shows that it is not due to friction and that there are some easy treatments and exercises that can effectively treat it.
In actual fact, IT Band Syndrome is caused by compression of the IT Band. Lets have a quick look at the anatomy so that you can see why this is:
How IT Band Syndrome happen then?
The IT Band is a thick tract of connective tissue which connects up your hip muscles to the knee and helps stabilize the knee in the process. It originates from the Gluteus Maximus and Tensor Fascia Latae muscle (see in the image to the right) and ends up attaching into the tibia (right up the top of your shin bone).
Before attaching into your tibia, the IT Band crosses over the lateral femoral epicondyle (where IT Band Syndrome pain is felt). For years it was thought that the IT band slid back and forth over this epicondyle as your moved your knee (and this is still far too popular theory: 1,2,3). Fortunately it has been proven through studying cadavers and use of MRI that the IT Band is actually anchored to the femur by fibrous strands and so cannot actually slide – so, no friction. The MRI’s also showed that at this point, underneath the IT Band is a layer of fat, full of little nerves and blood vessels, making it very sensitive, especially when compressed.
So from this, based on anatomical findings at least (which are hard to argue with) IT Band Syndrome is associated with compression of the sensitive layer of fat beneath the IT Band rather that friction.(4) This knowledge of the IT Band and it’s attachments isn’t all that new but has unfortunately been overlooked and ignored for too long. A big driver behind the myth of ITB friction syndrome is the perception that movement of the ITB across the epicondyle can be felt, but this is an illusion because of changing tension in its anterior and posterior fibres.(5)
Risk Factors for IT BAnd Syndrome
ITB syndrome is a repetitive strain injury caused by the IT Band compressing the layer of fat beneath it. The factors leading to this happening are thought to be:
Increased hip adduction (the leg moving inwards, towards the opposite leg)
The good thing is, if these biochemical issues are found and addressed, a resolution can be found.(6)
So, here is how you should go about treating your IT Band Syndrome the right way.
1. Get a biomechanical assessment done by a sports physio or similarly qualified health professional. This should look at the strength, control and endurance of your hips, whether your have hip drop etc. They should also check out your technique.
Tip: As well as this, you can do a quick test at home to see where you are weak – See this post to find out how easy it is.
2. Start your rehab exercises that you can find detailed on a past blog post here
3. Make sure that your running technique is spot on – Your physio can help with this, or check out this post for some easy tips.
4. Shoes: Make sure that you shoes aren’t too old and worn and ensure that you do not drastically change shoe style. For example, don’t go from a cushioned, controlling runner to a minimal Nike or Vibram all of a sudden – it needs to be gradual.
Lastly, feel free to comment below and please share if this has helped you.
ITB syndrome can be painful and difficult to treat, BUT with the right pre-hab and IT band exercises, YOU don’t have to worry about any of that!
Prevention = Cure!
ITB syndrome is all too common, with up to 12% of long distance runners affected and a huge 22% of US marine recruits suffering from this, it is a very, very important problem to not only treat right but prevent. This leads to less time out from sport, training and work – and more time doing what you love!(1,2)
So to prevent this, we need to sort out the risk factors – lessening the chances of you having to take time out.
For more information on how ITB syndrome happens and the latest and greatest treatments, see our recent post here
Now from that you can likely see that three of those points are easy to sort out. You can decrease downhill running and vary up your training more. you can run in both directions around a track, if you run n one. And you can make sure you don’t increase your training miles by more than 10% per week – No problem.
But having weak lateral hips – That’s something we really need to work at.
When your hip stabilisers don’t fire up or are weak, this leads to poor control of your pelvis ad hip abduction. Because of this, other muscles have to compensate for this deficit, leading to tight muscles and poor hip extension. This is a big problem, particularly in runners and studies have shown that runners with ITB syndrome do have weaker abductors in the affected leg.(5)
One of the muscles that takes over is your tensor fascia latae (TFL) – meaning it is working harder, often leading to spasm and tension. The clincher is that your TFL attaches into your ITB – That means if TFL tightens up, this tensions the band, making it tighter and tighter – causing compression at the knee and pain for you.
So here is the IT band exercises that we need to do:
Strengthen your lateral hip muscles
Improve glut activation
Loosen off and stretch compensatory muscles – e.g. TFL
The following exercises will do this and put you well on your way to being injury free!
1. Side plank
Level 1: Rise up into the position shown and hold for 30 seconds. Each time hold it for a little longer so that eventually you can hold it for two minutes.
Level 2: When you can easily hold it for two minutes, try doing side plank leg raises. This is where you rise into the side plank and then lift your top leg straight up and down. Begin this with 3 sets of 5 repetitions and build up, until you can do your goal of 30 in a row! (easily)
Note: If level one is too hard – bend your knees, so that you are lifting off your elbow and knee.
The side plank is great to getting your lateral gluts firing together with your obliques – just make sure you do not stick your bum out – bring it forward so that your body is straight.
2. Donkey kicks
Start on your hands and knee as shown and kick your leg out behind your slightly up towards the roof.
Perform 3 sets of 8 reps.
Note: to make this harder your can be on your toes instead of your knees on place your elbows on a gym ball.
3. TFL myofascial release
The TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!
I want you to lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!
And remember, a bit of trigger point pain is expected here.
Interesting note for runners: Having a higher cadence (quicker strides) has been shown to lower the risk of ITB syndrome. This is because when you increase your cadence (which should ideally be 180 steps per minute) your land with your knee bent more and your foot below your knee – decreasing the force through the knee and making for more economical running.(5) This also links in with downhill running being a risk factor – when running downhill we land with our legs much straighter a position, placing a lot more force on our knees and hips.
And remember. You are much better off-putting in a little bit of time now that spending a lot of time AND money when you do get injured.
Most likely, you won’t need surgery unless you are a high-level athlete or want to return to pivoting and high demand sports – the above post explains this in more detail and will help explain your options.
Why does a knee need to be strengthened following ACL injury?
The ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation. It is one of the four main ligaments in the knee that give passive stability
So, simply, if you have an ACL injury – you have less passive stability in the knee and need to make up for this. This is done by improving the active stabilizers – Your muscles.
This is the same whether you have done a partial or full rupture – If partial, you need to unload the ACL and support the knee while it is healing. If you have ruptured it, then you need to replace this loss with increased muscle supports.
Why hamstrings are your savior:
To better understand a few of the below rules of rehab, it is important to know about the role of the hamstrings. The ACL works to prevent your tibia (the shin bone) sliding forward, when landing, kicking, twisting etc. Luckily the hamstring also does a similar job – they travel down the
ACL Injury Rehab Rules:
1. Closed-chain before open-chain exercises
Why: First of all a quick explanation of open and closed chain exercises for those of you who don’t yet know:
Open chain: Simply, your hand or foot is free to move in the air while doing open chain exercises – the chain is not continuous. Such as bench press, biceps curls, and hamstring curls.
Closed chain: This is when your hands or feet and planted, in constant contact with a surface. Such as a push-up, squat or leg press.
A study investigating the tensile forces placed on the ACL during a range of exercises found that there is significantly less force through the ACL during weight-bearing (closed chain) exercises when compared to open chain exercises – hence unloading the ACL and putting less forward pull on the tibia.
0 Newtons of ACL loading during barbell squat, leg press, wall squat, front or side lunge (closed chain)
59 Newtons of ACL loading during single leg squat (closed chain)
Seated knee extension (open chain): 396 newtons
The exception of this is seated knee flexion (hamstring curl) this is an open chain exercise but produces 0 ACL loading – this is because as discussed earlier, the hamstrings support the ACL by holding the tibia back in place.
It has also been shown that closed chain exercises recruit important stabilizing muscle groups of the hip which play a big part in knee alignment and proprioception.
2. Lean forward at the hips
Why: Because the hamstrings originate from your sitting bones (ischial tuberosities) at the back of your pelvis – If you tilt forward at the pelvis more as shown here it acts to lengthen out the hamstrings. Thus increasing hamstring tension. As we now know that the hamstrings are important in stabilizing an ACL deficient or injured knee – this is what we want! So don’t try to keep your body straight up and down (it is pretty hard to squat like that anyway). Actually, the optimal forward trunk tilt was shown to be 30 degrees as this increases hamstring muscle activity and force – Ideal!
Don’t stretch your hammies
3. Balance it out: Don’t stretch your hamstrings or idolize your quads
Why: Your quadriceps and hamstrings play a tug-of-war on the knee – the quads pulling the tibia forward (increasing ACL tension) and the hamstrings pull the tibia backward (decreasing ACL tension). You need to make sure there is a balance here by making sure your hamstrings stay tight and strong and when strengthening your quads – only do this in closed chain exercises in order to get co-activation of the hamstrings and hip stabilizers.
4. Keep your heels down
Squatting with your heels off the ground causes 3 times more ACL loading compared to squatting with your heels flat – so when possible (ie if you haven’t got incredibly tight calves) keep your heels flat on the ground. This is because having the heels raised up increases how far forward the knees go during a squat. As your knees go further forward the top of the tibia/ shin bone slopes down more – increasing the force on the ACL.
Note: This also applies to your shoes – If your wear shoes with big fat cushioned heels when working out – this can increase the shear force on your knee also.
5. Do not do resisted knee extensions
This is a pet hate of mine as it puts a huge amount of force through the the ACL and increases anterior tibial shear. The reason for this is because as an open chain exercise, it is working the quadriceps muscles in near-isolation, pulling the tibia forward and increasing ACL strain – Not what we want.
There are a lot of other exercises that would be far better to do such as leg presses, various forms of squats, lunges etc – these all have better co-contraction of knee stabilisers and importantly the hamstrings, leading to great ACL protection. When you are stronger and healing nicely it is important to do sports specific and functional rehab and so open chain exercises will be needed to have a strong knee – your Physio can progress you and guide you on to this as every knee is different.
For more specific information and data on ACL tensile forces during exercises, see this great paper by Escamilla et al.
Thanks for reading and good luck strengthening your knee!
Remember this is just a guideline to help your achieve your best and nothing is better than getting hands on input from your local Physio.