Your ability to sit on the floor and get back up is more important than you may think!

Getting to the ground and back up is a fairly complicated motor skill which can vary in difficulty based on one’s surroundings and physical limitations. There are many ways to accomplish this task involving movements such as squatting, lunging, kneeling, or bending over, and it requires lower body mobility, strength, and stability as well as a certain amount of comfort being on the floor. Not only is one’s ability to get to the floor and back up an important predictor of mortality, but it is also crucial for many activities of daily life as well as for recovery in the event of a fall (de Brito et al., 2012; Wang et al., 2016). Fall risk is a great concern, especially in older adults due to the injuries, disability, and reduction in quality of life that a fall can cause. Many studies have reported that reduced muscle strength in the lower extremities raises the risk of failing (Wang, D. et al., 2016).

Sit-and-Stand-test.jpg

A study by de Brito et al. (2012) scored 2,002 adults ages 51 to 80 years old on their ability to sit down on the floor and get back up. They were scored out of 10 possible points and deductions were made for the use of another body part or the floor for support while getting down or back up. The researchers followed up with the individuals over the next six years, and 159 of the participants died. Every point increase in a person’s test score correlated with a 21% reduction in his or her risk of death in the next six years. While this is a correlation study and evidence of correlation isn’t evidence of causation, the association between movement ability and mortality is hard to ignore.

Try it out now. Start by standing up. Sit down on the floor using your hands or other objects as little as possible. Every time you use something for assistance, subtract one point from five. Stand up from the floor using as little help from hands and objects as possible. Subtract one point from five each time you use hands or objects for assistance. Add your results from getting down (a number out of 5) and getting up (a number out of 5) for your score out of 10. Each point less than 10 increases the probability of death in the next six years by 21%. Are you ok with your score? Keep reading to learn how to improve!

If getting down to the floor and/or up is nearly impossible for you: 

Here are three simple exercise progressions you can work through over the next 6-8 weeks.

  1. Sit to stand
  2. Lowering and raising in a split stance (similar to a lunge)
  3. Step ups

Sit to stand

Select a box or chair that is a comfortable height. Sit down to it and stand back up without using your hands or assistance. Progress to tapping your butt on the box instead of entirely transferring your weight onto it, and gradually lower the box to increase the distance you raise and lower yourself. This increases comfort with getting down to and up from progressively lower seats and strengthens the leg muscles necessary to do so. If you progress to the point where you can lower and raise yourself to a point at more than 90-degrees of knee flexion, progress this exercise to include lying down. In this variation, sit/squat down to the low position, transfer all your weight to the box, and lie all the way down. To reverse the movement, sit up from lying supine and squat up from that position.

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Lowering and raising in a split stance

Slightly lower and raise your body (bending the front and back knees) in a split stance position using TRX straps for support. With practice, increase the distance you lower and raises your body, and then decrease the amount of assistance used to stabilize from two TRX straps to one strap to no assistance. This exercise increases comfort and stability in the split stance position one uses to get up from the ground, and it strengthens the leg muscles which are important for the movement.

trxbacklunge

Step ups

Step up to a small platform using one leg. Similar to the other exercises, this will increase leg strength, stability in a single leg stance, and comfort in a movement pattern one can use to get up from the ground. Progress by increasing the repetitions of step ups performed on each leg and the height of the platform you are stepping up to.

step-up.jpg

The next step:

Once you can get down to the ground and back up with relative ease, I’d suggest including a Fall Matrix in your workout warm-up once a week.

  1. Start standing. Place one hand on your same-side knee. Lay down, with your back against the floor and stand back up without removing the hand from your knee. Then lay down with your stomach on the floor without removing the hand from your knee, and stand back up. Optional: Lay down with your right side on the floor, and stand back up. Then repeat on the left side.
  2. Repeat these 4 variations touching the other side’s hand to its same-side knee.
  3. Repeat these 4 variations touching one hand to the opposite side knee.
  4. Repeat these 4 variations touching the other side’s hand to its opposite side knee.

Progress these exercises by touching your hand to a body part lower than the knee, for example, place your hand below the knee, on your shin, on your ankle, on your toes.

Like many things with our bodies, if you don’t use it, you lose it. Get on the ground and back up regularly so you don’t lose your ability to!

References
de Brito, L. B., Ricardo, D. R., de Araujo, D. S., Ramos, P. S., Myers, J., & de Araujo, C. G. (2012). Ability to sit and rise from the ground as a predictor of all-cause mortality. European Journal of Preventive Cardiology. doi: 10.1177/2047487312471759
Wang, D., Zhang, J., Sun, Y., Zhu, W., Tian, S., & Liu, Y. (2016). Evaluating the fall risk among elderly population by choice step reaction test. Clinical Interventions in Aging, 11, 1075-1082. doi: 10.2147/CIA.S106606
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So You Have a Case of the Kneesles

Kneesles, pronounced like measles with a “Kn,” is my way of referring to knee pain.

knee-pain1

Many suffer from achey knees and daily knee pains, especially women. It can be attributed to females’ larger Q angles, habitual leg crossing while seated, improper movement patterns, mobility deficits, and/or lack of muscular stability.

Knee Anatomy

Check out this awesome interactive knee image.

Bones:

  • Femur
  • Patella
  • Tiba
  • Fibula

Femur (1)patella-anatomy.jpg

Ligaments (Connect bone to bone):

  • Collateral Ligaments:
    • Lateral Collateral Ligament (LCL): Runs top to bottom on outside of knee joint
    • Medial Collateral Ligament (MCL): Runs top to bottom on inside of knee joint
      Front view of knee joint showing patellar ligament.
  • Cruciate Ligaments:
    • Anterior Cruciate Ligament (ACL): Runs from the outside (lateral side) of the femur to the tibia.
    • Posterior Cruciate Ligament (PCL): Runs from the femur to the back of the tibia
      acl_pcl

Joint Structures: 

  • Medial Meniscus
  • Lateral Meniscus
    meniscus-injuries-and-tears

Tendons (Connect Muscles to Bones):

  • Quadriceps Tendon
    GIANT-THIGHS-ins3.jpg
  • Patella Tendon/Ligament
    Quadriceps_VMO
  • IT Band (Iliotibial Band)
    ITBand-copy.png

Causes of and Remedies for Knee Pain

  • The Vastus Medialis Obliquus (VMO)

quadmuscles

This tricky little muscle, also known as the “tear drop,” is often under-recruited in lower body exercises (or over powered by the vastus lateralis). The VMO contributes to end-range (terminal) knee extension (from a slightly bent-knee position to a straight-knee position).

Some exercises to wake up the VMO:

  1. Terminal Knee Extensions with a Resistance Band
  2. Reverse Step-Ups
    Imagine you are going up a stair backwards. I’d suggest using a smaller step than shown in this video to begin, possibly 4 inches high or so.
  • The Gluteus Medius

The gluteus medius is responsible for abducting (bringing the leg out to the side), externally rotating (turning the leg outward), and supporting the body when on one leg.

Some exercises to strengthen the gluteus medius (Side Note: autocorrect and latin-based muscle names are not my friend right now):

  1. Banded Squats
    Squat with mini band below knees. For those of you with leg hair, I suggest a layer of clothing between your skin and the band.
    Band-Squat
  2. Banded Bridging
    maxresdefault
  3. Single Leg Deadlift (Romanian Deadlift)
    dumbbell-rdl-one-leg-one-arm
  • The IT Band

The IT Band is a notoriously tight tissue. When this gets tense, it can cause the knee cap (patella) to not track (move) properly when the knee bends. The best remedy for this is regular foam rolling of this area. I suggest starting with a softer foam roller and increasing firmness of the foam roller as needed. Be sure to roll the entire IT Band including the area to the outside of the knee.

Foam-roller-IT-band

  • Limited Dorsiflexion

What is dorsiflexion? It’s the movement of the foot in the direction of the shin.
foot-dorsiflexion-6Many have limited range. We compensate for this limitation through raising the heels or pronating the feet. You may have noticed people who raise their heels or over pronate their feet (collapsed inward) in the bottom points of squats and deadlifts.

Capture32

A couple exercises to work on this:

  1. Stretch and foam roll the Gastrocnemius and Soleus (Calf Muscles)

     

  2.  Rocking Ankle Mobility Drill
  3. Knee Break Ankle Mobilization

Regardless of if you have a case of the kneesles, give these exercises a shot!

How do you keep your knees healthy?


Further Reading:

Knee Valgus (Valgus Collapse), Glute Medius Strengthening, Band Hip Abduction Exercises, and Ankle Dorsiflexion Drills By Bret Contreras

18 Tips for Bulletproof Knees by Mike Robertson

 

Shoulder Rehab: Take #2

Shoulder injuries are common, and I encountered many patients with them while working as a physical therapy aid. Frozen shoulders, impingements, labrum tears, dislocations, separations, and rotator cuff tears are few that come to mind.

Individuals embark on fitness quests to lose weight, get strong, try a new activity, without giving a thought to shoulder health, when just a few regularly done exercises and a bit of shoulder awareness can go a long way toward keeping one out of a doctor’s office, or surgical suite.

Last week I went over some shoulder anatomy. I discussed the joints, “major mover” muscles, and smaller stability muscles. Check it out if you missed it. The last few components to cover are the ligaments and labrum.

  • Ligaments (connect bones to bones) play an important role in stabilizing the shoulder joint and help create a structure called the shoulder capsule. There are many ligaments in the shoulder joint but two to note are the Acromioclavicular (AC) ligament and Coracoacromial ligament. The AC ligament holds the clavicle (collar bone) to the acromion of the scapula (shoulder blade) and the Coracoacromial ligament holds the acromion from the back of the scapula to the coracoid process on the front of the scapula.

Shoulder-Anatomy-Diagram-image-OwxH

  • The Labrum. The tough trade off that comes into play with joint anatomy is that between mobility and stability. Joints tend to have one or the other. The shoulder is one of the most mobile joints in the body, but it lacks stability. Check out the glenoid fossa of the scapula, the “socket” that holds the arm to the body:
    Unknown
    It’s not deep. It doesn’t encapsulate the humerus (arm bone) either. This is where the labrum helps (a little bit). The labrum is a soft layer of connective tissue that lines the inside and rim of the glenoid fossa to give it depth and better secure the arm to the body.
    glenoid cavity and labrum

Common Shoulder Injuries

As stated in the beginning, there are quite a few injuries that can occur in the shoulder. I’ll never forget learning mechanisms of injury (methods of getting hurt) in one college class called Biomechanics of Musculoskeletal Injuries. “Falling on an outstretched arm” is one of the easiest ways to acquire shoulder injuries. So, just don’t fall like this and your shoulders should be okay ;-).

40efd064ea746e644c25fee8c1cf066dc7af46f2

  • Frozen Shoulder, also called adhesive capsulitis, is a condition where the shoulder capsule becomes inflamed and stiff with restricted range of motion (ROM) and pain. This condition is also the source of many of my terrible physical therapy dad jokes (Oh, your shoulder is frozen? It doesn’t feel that cold). Sometimes frozen shoulder occurs from lack of use of the shoulder, usually due to pain or other injury (for example if the arm is immobilized in a sling for a long period of time). Other times, frozen shoulder may happen spontaneously without an obvious trigger. One way to prevent this condition is to move your shoulder through the entirety of its ROM on a daily basis and address pains that prevent this movement in a timely manner.
  • Shoulder Separation. One of the more common ligament injuries (also called sprains) in the shoulder occurs in the AC ligament and is known as a shoulder separation. The AC ligament connects the clavicle and the acromion of the scapula. You can feel the location easily; it’s the big bony point at the top of your shoulder.
    95362-1There are 6 grades of severity in this injury. Grade 1 is the least severe, an overstretched, partially torn AC ligament, and Grade 6 is the most severe, including a complete rupture of the AC ligament, separation of those two bones, and injury to other nearby ligaments and structures. Shoulder separation injuries occur from direct impact to the shoulder (from a fall, car accident, sports accident).
  • Muscle injuries (called strains) can occur in the bigger muscles (deltoid, latissimus dorsi, pectoralis major) or the smaller muscles (rotator cuff muscles, long head of the biceps, long head of the triceps). One reason injuries of the shoulder are easy to acquire is that there are a lot of muscle tendons (tendons are on the ends of muscles and connect muscles to bones) and ligaments running through the joint and not a lot of space between the bones. When one of these gets irritated and even slightly swollen (inflamed), the pressure from that increase in volume between the bones causes pain and irritation in a lot of nearby tissues.
    shutterstock_89144563
  • Dislocations or partial dislocations, called luxations or subluxations, also occur in the shoulder joint, primarily because of that tradeoff between mobility and stability. The size of the muscles and structures holding the arm in the shoulder are fairly small and unstable (compared to those in other joints, for example those holding the leg in the hip).  95% of shoulder dislocations occur anteriorly, or to the front of the body from direct blows to the shoulder or falling on an outstretched arm.
    Luxation_epaule
    The other directions of dislocation are posteriorly (to the back of the body), often from electric shock or seizure, and inferiorly (downward) which is the rarest kind. The process of fixing a dislocation or returning the arm to its socket is called a reduction, and [PSA] if you ever find yourself with a dislocated shoulder, please fight the urge to reduce it yourself, and let a medical professional do it.
  • Labrum Tears. The labrum lines the “cup” where the arm bone is held to the shoulder blade to give a little more stability and security to the joint. It can be damaged during repetitive shoulder motions (throwing, weightlifting) or from traumatic incidents (falling on an outstretched arm, direct blow to the shoulder, sudden pulling of the arm, quickly reaching overhead to stop a fall or slide).
    labraltear.png

Prevent Shoulder Injuries

While we can’t do much to prevent injury from freak occurrences like falls and accidents, there are a few weekly or bi weekly exercises and a few avoidances as well that can help prevent shoulder injuries.

  1. Strengthen the rotator cuff muscles (teres minor and infraspinatus) with external rotations. This will increase the size of those muscles, the space in the shoulder joint, and the stability of the shoulder. Start really light with these movements, but don’t be afraid to increase strength. Don’t go to failure, though. This can leave the shoulder unsupported and more prone to injury.


    Notice how these are performed with the arm at a 30 degree angle from the body and not right alongside it.
  2. Learn how to bench press properly! Keep your shoulder blades retracted and depressed, have a little arch to your back, keep your elbows at a 45 degree angle to your body, and use your feet. Check out Eric Cressey’s Shoulder Savers Article for more information on correct form.
  3. Back Attack! Use the Seated Cable Row with strict form to train proper scapular retraction (squeezing shoulder blades together behind the body).
  4. Upright row with caution. Done with a barbell, the humerus is extremely internally rotated and is elevated into the “impingement zone” each rep.  A safer option is performing it with dumbbells (or not at all).
    upright row
  5. Maintain your mobility! Try out this awesome warmup.

For more reading on healthy shoulders check out:

Eric Cressey’s Shoulder Savers Part 1, Part 2, Part 3.

What do you do to keep your shoulders healthy?