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How to climb stairs with knee pain

Hi, this blog is for those of you who have knee pain and have stairs in your house which you have to negotiate on a daily basis. Here I am going to share a few tips which would help you to do this activity pain-free and safe.

Before we move on to the actionable let us look at what happens when we climb up

If the step is high we bend the hip and knee to 90 degrees and if low less than that.

With patellofemoral pain aka front of knee pain

The front of the thigh muscles or Quadriceps lengthen eccentrically and the back of the thigh muscles aka Hamstrings shorten. The calf muscles shorten to help bend the knee and place the foot on the step. All of these try to push the knee cap out of the groove in which it sits aka Patellar groove. To prevent this displacement the ligaments tighten and put pressure on the knee cap and the cartilage behind it causing pain and burning.

With medial osteoarthritis

In a normal joint both the lower bulb like ends of the thigh bone femur or medically known as femoral condyles glide and roll forward smoothly on table  top of the tibia or the shin bone. This bends the knee painlessly. In case of any degeneration or tear the gliding is uneven and painful. When such a knee is loaded more while climbing up it increases the pain.

Climbing down

Front of knee pain

The quads or the front of the thigh muscles shorten actively to straighten the knee to allow the foot to be placed on the step-down. The hamstrings and the calf lengthen. Both these force the knee cap into the groove loading the patella and its joint more. This makes climbing down more painful for those of us who have this kind of pain.

Inner knee pain

As the gliding is not smooth and there is instability there is pain with loading but much lesser than climbing up.

By now you have a brief understanding of what happens and why does it pain lets get to how to do it painfree

1.Always hinge or bend from the hips

Most of us unknowingly curl the spine and flatten the low back while climbing. Be mindful to bend the hips and keep the chest relaxed and down. Keep the weight on the heels.

2. Tighten the buttock muscles or the gluts

To engage the core and the gluts breathe out and gently pull the navel to the spine without rounding the back. Try to tighten the buttock on the side which is lower. Again there should not be any turning of your chest. As you alternate steps you will alternate the contractions

I hope these tips help you to climb pain-free.

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Chondromalacia patella aka The Anterior knee pain

This week I am writing all about Anterior knee pain and how to manage it non-pharmacologically.

What is it?

https://www.instagram.com/p/CS8l-o9gqNC/?utm_medium=copy_link

It is overuse and degenerative injury of the cartilage behind the kneecap or the patella. Cartilage is a soft tissue that acts as a shock absorber and makes the patellar movements smooth and efficient. When the knee is overloaded it puts a lot of stress on this small area and causes the cartilage to break down. As with any injury, inflammation follows with pain and loss of function.

Our bodies respond to our habitual postures… here are few and their effects on our knees

Image courtesy Dawn.com  Aug 12 2021

Flatback

Forward head, flattening of the low back makes the hamstrings overactive and inhibits the gluts activity. This does not allow the knees to straighten fully and over a period of time puts excessive loads on the front of the knee aka the Patellofemoral Joint and causes degeneration.

Swayback

Weak core and makes the pelvis moves forwards. Now the knee is locked in an abnormal straightened out position aka HyperextensionThis causes overactivity of the quadriceps which pushes the knee caps into the knee joint causing the patellar cartilage to wear out.

How does it feel?

https://www.instagram.com/p/CS8mLlNgBgj/?utm_medium=copy_link

Persistent pain in the front and inner side of the knee.

Burning and grinding sensation behind the knee caps

Locking during static postures like long sitting or standing

Reduced knee bending while walking on the affected side.

Three steps for recovery

https://www.instagram.com/p/CS9LI0ygFZY/?utm_medium=copy_link

Improve torso stability and alignment so that the lower back and hips are free enough to support the knees

The increased hip extension helps to engage the big gluteal muscles and offload the knees 

Improve core muscle control to improve the position of the pelvis and free up the knees for walking painfree.

Movements which help

Standing core tuck in with toes extension

Stand with feet shoulder-width distance against the wall such that the psis touch the wall. Your weight must be on the heels. Now breathe out and pull the navel to the spine keeping the low back in neutral. Count to 4 . Simultaneously lift only the toes keeping the balls of the toes on the ground up. Hold for 4 counts and relax counting to 8.

Single leg standing and hip hiking in the unsupported side

Stand with feet shoulder-width distance and the outer border as parallel to each other as possible. Bend one knee to 90 degrees. Breathe out, engage the core counting to 4 and hike the hip on the unsupported side without leaning over with the torso. Hold for 4 counts Relax counting to 8.

Standing and heel strike

Stand as above. Engage the core counting to 4. Place a cushion in front of you. Take a step forward such that the heel is placed on the cushion. Try to contact your gluteus maximus without altering your position. Keep the knee cap facing forwards. Hold the contraction for 4 counts and release counting to 8.

Lying single leg lift

Lie on the back. Place a small towel under the left hip. Now place your fingers on the front of the hips on both sides and check that they must be in the same line. Bend one knee to 90 degrees and place the foot flat on the bed. Straighten the left knee such that the toes point towards the ceiling. Engage the core counting to 4 and simultaneously lift the left heel up by 3 to 5cms. Hold for 4 counts and relax counting to 8.

Each movement can be repeated 3 to 5 times each hour. One movement per hour.

Pain is the biggest driver to determine how we move, how much we move, and how we feel about ourselves.. I am signing off by wishing all of us pain-free bodies and movement rich lives.

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Long Covid Symptoms

A brief background 

It had started when a 26-year-old female who had recovered fully from a mild covid infection 4 months ago came to meet me. After complete recovery, she started getting back to her pre covid life and that’s when she realized that all was not the same.

Post covid syndrome

These are the residual effects of covid 19 infections. Even though one is tested negative and technically covid free these symptoms either persist or even occur new. So if you or your loved one has had covid this blog is for you…

Symptoms

A mild shortness of breath is noticed during exertional activities like stair climbing, playing with the child or pet, doing things in a hurry, or even brisk walking. She would feel that the breath stops at the upper chest level and would want to pause to take a deep breath.

Persistent irritation of the throat–  A feeling that the throat was getting dry frequently and scratchy. It was more at night when she rested her head on the pillow. 

Reduced appetite – A general lack of hunger drive and a feeling of bloating.

Restless nights- She felt that she was not sleeping deep and was getting up frequently. 

Lethargy and fatigue– Lack of restful sleep made her feel more tired and irritable towards the evening. This had started to impact her personal and professional life.

What did we do

We set SMART GOALS

SHORT TERM GOALS (0-12 weeks)

  1. Improve lung functions and overall aerobic capacity.

Posting few movement videos

Bear hug

https://www.instagram.com/p/CPcggsKg5i8/?utm_medium=copy_link

Swaying tree

https://www.instagram.com/p/CPfe2KqAvJ8/?utm_medium=copy_link

Brisk walking for 5 min every 2 hours

https://www.instagram.com/p/CPU5yYUM0Fz/?utm_medium=copy_link

  1. Move to strengthen

We started with 15 min strength work. The focus was on the quality of movements and not the quantity.. Form first. I am posting 2 great videos by Dr Kristie Ennis on the same

 Beginner workout.

https://youtu.be/S_WniP_WVLE.

 Exercises to do everyday

  1. Sleep hygiene

  It’s not always about how much we do it’s also about how much time we give for repair and regeneration. This is where a good sleep routine is required. Sharing my short post on 5 useful tips to sleep like a baby

https://www.instagram.com/p/CRx6mJRAMWI/?utm_source=ig_web_copy_link

LONG TERM GOALS(3-12 months)

  1. Regular walks 45-60 min at 60 -70%of the HR maximum
  1. Breath work 3-5 times each hour and do 1 movement at a time. Exhale double of inhale.
  2. Structured strength work as shared above ( reps 15 and 3 sets)
  3. 10 belly breathing before sleep.

Outcome

Currently she is in month 1 of long term goals and she is able to manage moderate exertion in her day to day activities with ease. Mood and fatigue have improved greatly. Sleep is longer 6-6.5 hours and fairly restful. And the work continues…

In the words of Thomas Edison” The Doctor of the  future will give no medicine but will instruct his patients in care of the human frame,in diet and in the cause and prevention of disease

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Forward head posture and low back pain

Hi sharing an interesting case of forward neck and continual back pain.A 35year old software professional presented with repeated episodes of low back pain and stiffness making sitting, standing or even lying down painful . His first episode was 3 years ago and  have been repeating since then ,each time with increasing severity  every 4-6 weeks. He had consulted many doctors and physios . He would feel better with prescription 10 day courses of anti inflammatory and muscle relaxants with physical therapy till the next episode hit and the cycle started again.Multiple MRI scans had shown that the lumbar architecture was fine and the lordosis aka the curve in the low back had flattened out. 

A detailed history and observation showed that he was a workaholic in long periods of chair sitting and screen time.  Both of these had not been kind to the back. He had a visible Forward head position, rounded shoulders and flattened out low back

Pic courtesy physioqinesis.com

Chain of events 

His habitual positioning had caused a weakening of the spinal muscles. This was made worse with the weak neck musculature.All of these had lead to poor core strength and a flat back. A flattened back is like a stretched out rubber band with poor shock absorption and flexibility. This caused repetitive microtrauma to the structures and tissue damage over a period of time. At this stage the body would respond to pain meds and passive pain management techniques like IFT and TENs but as the original faulty pattern was not addressed the tissues had never healed fully . Their ability to bear the loads in day to day life had come down and thus started another pain spasm episode. Repeated pain cycles had caused the brain to freeze or inhibit the painful part even now without actual tissue damage. This explained the constant stiffness without pain.

Solution

Phase 1( Repositioning forward head and strengthen upper back)

We started with these

Chin tucks 

https://www.instagram.com/p/CRDiIPOgQLi/?utm_source=ig_web_copy_link

Standing arm reach

https://www.instagram.com/p/CRGRx2bA52W/?utm_source=ig_web_copy_link

Wall angels

https://www.instagram.com/p/CRFwSlzgQg6/?utm_source=ig_web_copy_link

Once he was comfortable repeating each movement 30 times per day painless we moved on to phase 2

Phase 2( Functional core muscle activation and improving hip flexibility)

Chair squats

Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair . Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels . Breathe in as you go down and out as you come up. Repeat 3 to 5 times each hour. Make sure to keep the ribs in line with the hips .

Belly breathing

https://www.instagram.com/p/CPTj3FfB5N2/?utm_source=ig_web_copy_link

Toe raises with belly breathing

Stand with the feet shoulder width distance and the outer border parallel to each other.     Breathe in and lift yourself up on the toes. Breathe out  engaging the core and come down without touching the heels to the ground . Repeat this movement 3- 5 times each hour.

Outcome

Over a period of 8 weeks he reported no pain flare up. His pain at rest had gone down by 50 percent of the original reported and he had started walking at a comfortable pace outdoors for 60 min everyday.

To sum it all I’m quoting one of the foremost pain clinicians Dr Greg Lehman BKin ,Msc,DC,MscPT 

The body is more of an Ecosystem and less of a car that needs aligning. Our treatment should reflect this

References

smartphone usage and cervical pain and fatigue

file:///Users/Anju/Downloads/THE%20EFFECT%20OF%20ADDING%20FORWARD%20HEAD%20POSTURE%20CORRECTIVE%20EXERCISES%20I

Sitting posture of subjects with postural backache

https://www.sciencedirect.com/science/article/abs/pii/S0161475406000261

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STRETCHHHHHHH….

Hi, welcome to part 1 of my 2 part series where I talk all about stretching. Stretching has been a hot topic of discussion in fitness circles for some time now with researchers giving varied conclusions about the efficacy, type, duration of hold, when to do them, and what to do..

This blog is dedicated to these FAQ’s and part 2 will have selected few movements which have helped me and my patients over years.

Stretching simply

Most muscles are attached at both ends to bones and movement of the muscle moves the bones. In simple terms, it is the activity of moving one end away from the other keeping one end fixed. 

How should I feel

You should feel a gentle, sustained pull or tension through the length of the muscle. At no point should you feel pain. Keep breathing gently and regularly throughout the movement.

How much is too much

2-4 times with a hold time of 10 counts every 90 minutes is a good starting point… You can slowly increase the duration of hold as you ease into the positions.

When to do

If you are looking at performance its good to do the stretches as a cool-down routine

If you are looking to improve your overall flexibility good to do it in small doses at regular intervals throughout the day.

If you are looking to destress and unwind you can do a twenty-minute routine just before bedtime.

Stretch menu

Like a menu card stretching also has a variety to choose from…

With props

A block. yoga belt, bolster, low stool, window sill,  wall, or even your kitchen counter can help you get into a stretch. So look around you and be creative.

With breath

Breathe into the chest and the belly while getting into a stretch and out and relax…

Partner stretch

Certain lower body stretches can be done with a partner.. It adds a social component to our otherwise socially distant routine.

Active muscle contraction

Tighten the muscle opposite to the one you want to stretch. Hold the contraction for 5-8 sec and relax. Now gently lengthen the muscle you want to stretch till you feel tension. To stretch your tight biceps tighten the triceps and repeat as above.

These are my 2 cents on this.. please feel free to put in your valuable comments and suggestions … Take care and stretch well

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Breath of life

As I lay down all tucked in

Grateful for the breath of life which fills me in

I bend my knees and relax my toes

Lengthen my head into the pillows

With back rested and feet on the bed

I let go of myself from toes to head

I breathe in through the nose

Allowing my belly to fill like bellows

Now I let the air out gently through my pursed lips

My belly now sinks towards my rested hips

This gentle bobbing is a lot of fun

It’s called Breathing into the Abdomen

Do it in the morning or at night

This breathwork is sure to make you light.

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Boosting immunity the movement way

With a curb on outdoor movements, closure of fitness spaces we are now looking differently to fulfill our much-needed exercise quota indoors. Anyone who had been reasonably active and consistent with exercise would know how it feels to not do it for some time. Apart from mood-boosting and better work output I want to talk about one of the most underrated uses of movement Immunity-boosting in this blog… so let’s get moving

Lymphatic system

An intricate system of tubes that remove metabolic wastes, transport fatty acid, and most importantly produce immune cells (such as lymphocytes, monocytes, and antibody-producing cells called plasma cells) aka our natural immunity system primer.

It’s all about the forces

The lymphatic vessels are very delicate and solely depend on gravity and forces around them to push the lymph around. The forces are muscular shortening and lengthening… you guessed it right movements use muscles and working muscles move the lymph.. better lymphatic movements better WBC circulation and better immunity. In short more movement more immunity.

Let’s see how to

A simple barefoot stroll in the house for 5 min every 60 min is a great kick starter.

For the desk junkies out there, invest in a good standing desk.

While standing vary the foot position..stand with the feet shoulder-width distance and the outer border parallel to each other to use those gluts more. You can stand one foot ahead of the other as in a short step. You can change sides every 30 minutes.

Try low sitting as much pain-free- you can sit on 2 cushions then move to 1 and try floor sitting.

On the floor try long sitting ( sit without or minimal back support and stretch the knees in front of you. Toes will point to the ceiling.)

Cross legged sitting ( sukhasasana, Padmasana)

Side-swept sitting

Microbreaks to strength train-Take small regular breaks 2 minutes every 60 min. You can do your own bodyweight moves like ( Wall or incline pushups, Squats, lunges Or even jumping jacks. Start with 5 reps of 2 movements and can add more reps or more movements)

Balance trainer- A  balance pad is a great way to add whole body balance work which uses more of us in a fun way. ( Try standing on it with both feet shoulder-width, feet close, and 1 legged stand. Try to hold the for 1 min each side and can repeat 2-3 times )

Focus on how and what you eat– We are what we eat… Eat wholesome unrefined locally grown foods. Add more whole grains and nuts to your plate. This will make you chew the food more and add more movement to the jaw muscles and strengthen them.

Try to have a meal or a snack sitting on the floor.

 Breathe better and mindfully- Cant emphasize its importance enough. For actionable please refer to my previous and dedicated blog -Breath as an immunity booster….

This blog is a collection of those small changes which have helped me personally .. If you have any great ideas please feel free to reach out and we can add on to this list…. Take care and stay safe

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POSTOPERATIVE PAIN AND YOU – Part 1

Hi, welcome to my 2 part series on postoperative pain and its management with movements, food, breath, and sleep. If this interests you read on

In part one will be sharing my thoughts on moving more and reducing dependence on pain meds while being in the hospital.

Part 2 will focus on how to live pain-free after surgery and not carry on with the pain to make it chronic aka A part of your life.

So let’s get on with Part 1.

After the surgery

In this stage, you are still in the hospital under medical supervision. This is the time your physical therapist will visit you and encourage you to move the whole of you as in walking or stair climbing or parts of you as in turning in bed, rolling, or specific prescriptive exercises. The movement program is tailor-made to your needs. The idea is to help you move more and more of yourself and aid the body’s natural pain regulatory response. 

Few of those for you

Windmill in the bed

Lie on to one side whichever comfortable. Bend the top knee and hip and place the knee on a pillow in front. Stretch both the arms in the front at shoulder level or whatever level comfortable. Breathe in into the belly counting to 2 and lift the top arm up such that you do not rotate your torso. Breathe out through the nose and return to starting counting the same count or even double of comfortable. You can repeat it every hour 2 to 3 times. This improves your lung function, the movement of the diaphragm which is the main respiratory muscle, and the abdominals which are important for a good pain-free posture

Bearhug

Sit cross-legged or in a chair, breathe in and lift the arms up and outward. Breathe out, curl the spine and hug yourself gently. Repeat and breath count as above. 

Belly breathing – Can do this in any position like sitting, standing lying, or even moving. This helps in improving the diaphragmatic movement and the overall quality of breathing. The mindful practice of this activates parasympathetic and keeps stress breathing low. Choose any comfortable position. Keep the spine neutral and relax or drop the shoulders. Breathe in counting to 4 such that the abdominals move out. Keeping the same neutral breathe out gently counting to 8 pulling the navel gently to the spine. Repeat as comfortable. 

Chin tucks in lying

Lie on your back and can bend both knees slightly by placing a pillow under them. Place the neck of the head and neck on a pillow too. Breathe out and gently try to bring the chin to the chest keeping the shoulders and the ribs relaxed. You will feel some work at the back of the neck and head. Repeat it 2 to 3 times every hour. This activity strengthens the postural neck and shoulder blade muscles.

Ball of power

This activity is a modification of Foundation training work. Lie on the back such that the head and the mid back are rested on 1 to 2 pillows. Slightly cup the fingers and press the fingertips together like holding an imaginary ball in the palms. Breathe in and lift the arms up with the elbows bent gently. Keep the lower part of your ribs on the pillows. Lift it up to a point where you can keep the ribs back down. Repeat 2 to 3 times each hour.

All of these movements work on building your stabilizer groups and with breathing being in relaxation, better lung function, immunity, and pain relief… Signing off, for now, will be back soon with part 2 of this series… Till then take care and live pain-free

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Indoor warriors

This blog is all about action items because as rightly said every life-changing journey starts with baby steps.  So here are the baby steps

  1. Open the windows and allow sunlight to stream in. It will allow UVB to come in which is a Vit D synthesis initiator. Bask in this anytime between 7.30 am to 9.30 am for maximum benefits.
  2. Add more Vit b12 to your diet. Vit b12 increases D3 absorption. A bowl of curd, 2 glasses of buttermilk, 2 helpings of greens, a cup of lentil or sprouts should do the trick.
  3. Go furniture-free as much as possible. You will be using more of yourself to hold the position.
  4. Add natural functional squats by getting on the floor more often.

Move more indoors

For every 40 min of chair sitting or any stationary position walk for 5 min barefoot or with minimal footwear. Walking is one of the best weight-bearing activities which helps in bone mineral synthesis. All in a day’s walk isn’t it

Find your balance

These 3 simple words have had a profound impact physically and philosophically in my life. Let us talk about the physiological benefits for now. 

Balancing activities are whole-body movements recruiting more muscles and the larger part of the skeletal system. Larger forces call for better bone density aka stronger bones to withstand them safely. Here are a few balance movements which have helped me greatly

  1. Walk barefoot on as many surfaces as possible. You can try walking on a pebble way, sand, grass, or carpet.
  2. Cushion walk– Put 3-5 cushions on a non-slip surface 5 cm apart. Stand on 1 cushion with feet hip-width distance. Take a step onto the cushion in the front without losing balance. Then you can move back to the starting cushion. Start with 2 cushions at a time and can move up to 3-5 cushions. You can repeat 2-3 times every hour.
  3. Balance on 1 leg– Stand as above on a non-slip stable surface. Lift 1 leg up such that the hip and knee are bent to 90 degrees. Hold this position for 30 sec to 1 min each side and can repeat as above. 
  4. Side leg lift  – Lift one leg sideways 5-6 cms from the midline of the body without tilting or leaning. Hold as above. Repeat as above.
  5. Back leg raise-Stand as above and lift one leg to the back keeping the knee soft and straight. Lift the leg to about 5-8 cms and keep the toes pointed to the floor. Hold and repeat as above.
  6. Vrikshasana
  7. Chair pose in yoga ……… Signing off with FIND YOUR BALANCE. Cheers
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Bone health in captivity

We are as strong as our weakest link. This saying is aptly perfect in my practice as a pain clinician. Pain is our body’s way of telling us that it needs to be treated differently in short a lifestyle overhaul. In this perspective balanced living is vital to treat pain and remain pain-free.

For any chronic pain, fatigue, or weakness I run a blood profile specially VitD3, and have seen enough results now to say that nearly 75% of us are deficient in this naturally producing vitamin. So what has changed in the urban us?

Evolution and bone health

From the time of our evolution as homo sapiens ie present us our gene pool roughly remains the same. For our hunter-gatherers or even the farming ancestors, strong bones were essential for survival. Activities of survival like long-distance walking, occasional running, hunting, foraging for food, working for long hours in the fields, bearing and rearing children carrying heavy loads, and children placed great stresses on the skeletal system. Hence the requirement for robust bones.

So what has changed now if not the genes?

Our movement offloading. In the urban world, we have learned to outsource the so-called repetitive and boring movements. Driving for walking, robots for cleaning, washers for washing, elevator for stairs, and a supermarket jaunt for food. Even the food we get is pre-processed often not requiring the complete cooking process. 

All of these allow us to move less or not at all. When there is no stimulus to move and weight bear why should the body keep the bones robust? What you don’t use you lose…

Bone health and captivity

With the new normal our outdoor movements are reduced to non-existent. This makes us sunlight deficient. 

When your skin is exposed to sunlight, it makes vitamin D from cholesterol. The sun’s ultraviolet B (UVB) rays hit cholesterol in the skin cells, providing the energy for vitamin D synthesis to occur. That’s why vit d is the sunshine vitamin.

How does being low on Vitamin d feel like

  1. Getting sick often
  2. Fatigue
  3. Widespread muscle pain
  4. Mood swings and feeling low
  5. Weight gain
  6. Reduced appetite
  7. Low sleep quality.

If all of this is making you think about the action items please follow my next blog the Sunshine warriors. Will delve into the how to and what to … Till then open the glass windows and allow the sunshine to come in. Lounge in it and enjoy the warmth for 15 to 20 min… cheers