Get unbalanced to get healthy

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Client:

Why do they still act up? They’ll get better but then they’ll feel bad again. I thought walking through the pain would help get them stronger and build them up?

The above question is from a pretty new client who has had chronic knee pain for years. Since beginning training her knees have been feeling better but not completely.

Before addressing her question, some background on this client: As mentioned, her pain has been getting better but she still has weekly or every other week episodes where the pain will be increased for a day or two. This normally occurs after the weekend after she has had a gym session and gone for two hiking sessions.

Her knee pain is primarily a result of Knee Extension Syndrome. She walks with her knees in this position too often:

Corrective strategies include patella inferior glides, which help to loosen up the rectus femoris, and consistently remembering to walk with “a little bounce in your step.”

Due to a great deal of pain for this client while she is kneeling, the Rocking Hip Flexor mobilization is contraindicated.

(This could be a substitute.)

For this client losing weight is of great importance as it will relieve the amount of weight the cartilage between the knees bears, and because she has a good amount of weight she can –and is going- to lose, but correcting the constantly held position of having the knees hyperextended is crucial too.

I thought the above question, and my answer, would be a good write up. The principles relate to everyone and I think a written out answer would be more clear for her. So here you go Laurie!

So, as someone who sits down for 8 hours a day and right now only has about 4 hours or so of activity per week, including your hiking, the last thing I want to recommend to you is you move less.

However, if your whole body is feeling “trashed” and your knees ache for a couple of days after your weekend hikes, then we need to adjust things.

First though, I want to give you a clearer picture of why, even though with the corrective strategies you’ve noted make your knees feel great, they still flare up on a consistent basis.

There is the Law of Repetitive Motion stating:

Where

Injury to a specific tissue (in your case we are talking about the knee)

Number of repetitions of a given movement (in your case the movement is walking)

The amount of Force your knee has to produce during that given movement

Amplitude is the range of motion of this movement

How much Rest you get from this movement

I’m going to give you some math which hopefully won’t lose you because I know how much everyone loves math. Just keep in mind the specific numbers here aren’t that important but the overlying principle is.

Also, for simplicity’s sake we are going to say in your case with the above equation A and R are always the same. So we are only going to deal with the number of repetitions you partake in and how much force you apply during those reps.

Our new equation is

Ok, let’s say during the 5 day work week you walk an average of somewhere between 30-60 minutes per day. To simplify, we’ll just call it 45 minutes. Now, while you are trying to always walk properly i.e. “with a little bounce in your step” you are still in the process of forming a new habit, so we’ll estimate of this 45 minutes 75% of the time you are walking correctly and 25% of the time you are walking with your knees hyperextended.

Continuing on, we will say on average you take 5000 steps for every hour you walk. Again, don’t get hung up on the specific numbers here.

So we have the following:

• Walk 5 days per week,
  • 45 minutes per day,
  • 75% of time correctly, 25% of time incorrectly.

Thus,

5000 (steps per hour) * 75% (75% of 1 hour is 45 minutes) =

3750 steps for those 45 minutes you walk each day.

Then,

3750 * 75% (of those 3750 steps, only 75% are done properly) =

2813 steps per day where you walk properly.

And

2813 * 5 (5 days per week) =

14,065 steps of walking properly per 5 day work week.

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Now walking improperly:

5000 (steps per hour) * 75% (75% of 1 hour to get your steps for 45 minutes) =

3750 steps for those 45 minutes you walk each day.

3750 steps * 25% (Of those 45 minutes, 25% of the walking is done improperly) =

939 steps done improperly per day.

And

939 * 5 (5 days per week) =

4695 done improperly per 5 day work week.

So after your 5 day work week you walk with 14,065 steps being done properly and 4693 steps improperly.

14,065-4695 =

9,370 steps favoring walking properly.

Not bad, right? It could be better, but for forming a new habit you are walking properly more often than not. A recipe for making your knees feel better. Which you notice during the week. But then the weekend comes…

We are going to estimate you hike on average 2 times per week and each hike is 2-3 hours long. Again, to simplify we’ll say on average you hike 2.5 hours twice per week.

Due to the fact you get pretty tired while hiking, because of the incline and whatnot, we will say you walk 50% of the time properly and 50% of the time improperly.  In other words, you start off feeling great. Half way through though your knees begin to hurt because you are walking with the hyperextended impairment.

Again, using the 5000 steps per hour guideline:

(5000 (steps per hour) * 2.5 (total hours hiking)) *50% (only half the time is properly) =

6250 steps done properly while hiking.

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(5000 (steps) * 2.5 (total hours hiking)) *50% (only half the time is improperly) =

6250 steps done improperly while hiking.

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And

6250 steps * 2 (You hike 2 times per week) =

12500 steps properly and improperly respectively.

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12500-12500 = 0

So you balance out how much walking you do properly with how much you walk improperly. This could also be said as how much you try to make your knees feel better with how much you injure them.

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Alright, so at first glance this seems good. If we add up all the steps done properly, 6093 (from the week) + 12500 (from the weekend) = 18593.

And we subtract the amount of reps done improperly, 4693 (from the week) + 12500 (from the weekend) = 17193

And 18593-17193 = 1400 steps in favor of walking properly.

So, each week it would appear you are 1400 reps of proper walking above improper walking. Again, not bad. However, we’ve only dealt with the N, or Number of repetitions of the law of repetitive motion.

So this doesn’t get dragged on forever, and so I don’t lose you, which I hopefully haven’t already, we are simply going to estimate while you hike your muscles become 25% weaker than when you started. This will impact the force variable of the equation.

We now have:

(Remember I = NF)

Proper repetitions: I = 12500 (steps while hiking) * 1 (This is the force of those reps) =12500

Improper repetitions: I = 12500 (steps while hiking) * 1.25 (25% greater than steps proper steps as this is when you get tired) =15625.

If we count our total number for the entire week we now have:

Proper: 6093 + 12500 = 18593

Improper: 4693 + 15625 = 20318

Hopefully, in the middle of me doing a primer on algebra, that was clear enough you see what just happened. According to the law of repetitive motion, you are actually performing a greater amount of work injuring your knees than you are trying to make them feel better. As 20318 is greater than 18593.

This isn’t completely true due to the corrective work you are doing with me in the gym and the exercises you are hopefully doing consistently on your own. However, for the sake of argument this is why your knees are going back and forth with feeling good and then feeling “trashed.”

You are essentially breaking even. The amount of work you are doing to try and make your knees feel better is pretty much the same as the amount of work you are doing injuring your knees.

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How to alter the equation

Ok, so the answer to your obvious pressing question, what to do about this?

You could simply not hike at all, which would bring you to approximately 75% of all the steps you take favoring healing your knees. That’s because you are walking approximately 75% of the time properly right now. For someone who is so sedentary and is looking to lose weight the last thing I want to tell you is move less.

Therefore, we want to keep you moving but have you bring the number of steps you take that are proper go up and the number of steps you take that cause pain down. In reality, while upping the number of reps you do properly will alter the equation in favor of making your knees feel better, using this as justification for walking through pain is not the best idea.

If you haven’t figured it out by now, this whole thing has been one way of me saying if it hurts, stop! If I didn’t think the above was important I wouldn’t have gone to those lengths to explain it. Yet at the end of the day it can be as simple as stop causing yourself pain.

So my recommendation would be to cut your hiking time down dramatically and each time you go assess how much pain you have while hiking and in the hours afterwards. You should not cause yourself any pain at all while hiking as this is your signal you are walking wrong (in a painful manner). Continuing to do so isn’t acceptable as you’re (now) aware of how to make those knees feel better.

The pain you experience afterwards can be a little trickier. My recommendation there would be if you experience pain for more than an hour after hiking then you need to pay more attention to the form in which you are hiking. Or cut down the amount of time til you are not experiencing pain for more than an hour.

I know you are thinking you have to burn as many calories as you can but hiking an extra 30 minutes to burn another 150 calories or isn’t worth trashing your knees for days at a time. Simply eat a tablespoon less of peanut butter (or whatever) on the days you hike. Nutritionally, you can make up the difference.

I know this was long but I see people screw this up all the time with physical ailments they have, or their eating patterns. For example, so and so may burn 300 calories while working out. Then they pound a 500 calorie shake afterwards. Causing them to not lose weight, or sometimes even gain weight, and claim exercise doesn’t work.

At the end of the day it’s actually all about being UNbalanced. Whether it’s favoring poor movement or eating more than they burn, most have been unbalanced for far too long.

Analogy: You’re on a see-saw and the other person is higher than you are, but you want to be higher than them. Do you make yourself weigh as much as them (balance things out)? Or do you make yourself weigh less than them? OR them more than you?

Get unbalanced to get healthy.

* : Credit to Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines for the term “Knee Extension Syndrome.”

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Update 10/15/2014: Had a typo on one of the math sections. Thanks to Will (comment section below) for the heads up.