By Safi Madain BS, CSCS | Contributing Author | Based on Safi’s article “Is it Goo for you?”

The Goo. Does this stuff really work while running? Some brands claim to give boosts of energy, while other brands claim to replenish energy sources. But is this supplement replenishing the right energy sources and can it accomplish such a feat in a feasible amount of time?

Let’s take a look at some facts about carbohydrate digestion and energy storage. Carbohydrate digestion begins in the mouth by an enzyme called amylase. The enzyme gets mixed around in the mouth while we are chewing. When the carbohydrate bolus (the ball of stuff formed from chewing) is swallowed, it sits in the stomach for about 30 minutes to two hours before it is passed on into the duodenum (the first part of the small intestine). The amount of time depends on if it is a complex or a simple carbohydrate, if it is a liquid or solid, and what else it is consumed with. Carbohydrates are not digested in the stomach because the enzymes required to digest carbohydrates are not active in the low pH environment of the stomach. It takes about another 30 minutes to an hour to digest carbohydrates in the small intestine and convert the sugars into glucose, and about another 30 minutes to an hour to absorb the glucose and store it for energy (liquid digestion and absorption is done at about half the time). We are looking at a minimum of 1 hour of digestion, absorption into the blood, and absorption into muscle tissue before energy is made available. The Goo will probably sit in the stomach for about 45 minutes to an hour before it is passed on to the small intestine because it is not a complete solid and it is not exclusively carbohydrate.

So the food consumed will not give instantaneous energy. By the time a runner actually has access to the energy the Goo may give, the race may very well be over. Two other factors that must be taken into consideration when consuming food during a run are, the reallocation of blood flow and blood glucose removal. First, blood shunted to the gut from the extremities during digestion may be a cause of more rapid fatigue because blood is taken away from working muscle. Blood flow to working muscle removes waste, delivers nutrients, and helps to maintain an optimal temperature for activity. A buildup of waste products, lack of nutrient delivery, and inefficient temperature regulation will reduce performance capabilities. Second, eating while exercising will stimulate two glucose transporters in skeletal muscle tissue to remove glucose from the blood, one transporter is insulin sensitive and the other is exercise sensitive. Thus, blood glucose may have the potential to be removed at twice the rate. The last thing a runner needs is to crash from rapidly lowered blood sugar levels.

Studies have shown that during long distance runs, glucose is required to aid in fat metabolism by supplying a specific substrate used in beta-oxidation. Beta-oxidation is the name of the process of burning fat for energy. This is where the saying “fats burn in a carbohydrate flame” comes from. Since we have a much smaller store of glycogen than fat, glycogen depletion may be a limiting factor in long distance running, but glycogen depletion does not occur rapidly; especially in those who carbohydrate load the week before the race. According to the National Strength and Conditioning Association, for a 2-hour maximum run, 99% of our expended energy comes from fat and that the rate of glycogen depletion is related to exercise intensity. Marathon running is considered a low to moderate intensity activity, so glycogen stores do not run out rapidly (the average human stores 300 to 400 grams of glycogen in muscle tissue). Glycogen and free-floating ATP predominate the first minute of running, and then our bodies start to shift to fat for energy. The reason? We do not need explosive movements for marathon running. Fat gives us 9 kcals per gram, compared to 4 kcals for carbs, thus it is much more efficient for long, slow running.

Many may also mistake fatigue from dehydration as low sugar levels. At two percent dehydration, our bodies can no longer function and we rapidly fatigue. This is why while running, a cup of water should be consumed every mile. Water is absorbed 4 to 5 times as fast as carbohydrate.

Let’s add everything up and see if the Goo can really work. It will take a bare minimum of 1 and a half hours to make energy from the Goo readily available for energy, we store 300 to 400 grams of glycogen in muscle tissue, and during long, maximal runs 99% of our energy comes from fat stores. The energy that we get from the Goo will not even have a chance to be used. So does the Goo really work? It probably does after the race. Carbohydrate loading and drinking plenty of water are adequate enough to keep you going during the marathon.

-Safi Madain BS, CSCS

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Offer Expires: NEVER

Physio Performance and Physical Therapy’s FREE INJURY CLINIC

We at Paulseth & Associates Physical Therapy are pleased to announce the arrival of Physio Performance and Physical Therapy’s FREE INJURY CLINIC

The purpose of this clinic is to provide YOU, a Bodies in Motion member, with exclusive access to a free 15 minute injury screening by a licensed Physical Therapist !

Our goal is to provide you with the first step in evaluation and to direct you to the most appropriate follow up care available.

Details:
This clinic takes place every Monday evening from 6-7pm. The clinic is on a first come – first serve basis, so please RSVP via email to Anthonyc@udel.edu or stop by during clinic hours from 4-7PM Monday, Wednesday, Friday to sign up. It’s that easy!

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Running with pain is exactly that – A PAIN. Hip pain, hamstrings, hip snapping, shin splints, IBS, dislocating kneecap, arch pain and more can wreck your run. Paulseth & Associates Physical Therapy and Physio Performance Centers are offering all LA Leggers a FREE initial consultation.

Get lasting RELIEF and HELP for the causes of sports injuries from one of California’a most qualified sports physical therapy clinics. Comprehensive diagnosis and treatment treat causes of injuries not just symptoms. Gait analysis included.

• Reduced rates to LA Leggers
• Most insurances accepted
• Two convenient locations
• Free parking

Learn how to prevent injuries. Learn when and why physical therapy is indicated. Learn how to continue your training efficiently!

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By: Jonathan Zimmerman PT DPT | Contributing Author | Paulseth & Associates Physical Therapy Staff Member

If you venture down to the Santa Monica boardwalk just after sunrise on a random weekend morning, you will see something that really impressed me the first time I came upon it. People from all walks of life, all shapes and sizes, and all levels of fitness are out there running, jogging, and walking up and down the coastline in giant packs. These people are smiling, socializing, and believe it or not, they’re simultaneously working out! They’re enjoying every minute of the beautiful scenery, the wonderful fresh air, and the chance to do something healthy for their bodies in a social setting. This is the joy of running. If you haven’t tried it, or you think this type of exercise is impossible for you due to previous injuries, your current health status, or because you simply don’t think you like aerobic workouts, think again after reading this article. CHALLENGE?

“As beautiful as it is to see persons of all different levels of fitness beginning walking, jogging, and running programs, there is inevitably a certain amount of risk involved from an orthopedic perspective, and that’s what I would like to address in this issue of the Paulseth & Associates Newsletter.”

First of all, I see it very often where persons become scared off too quickly from beginning a running program. Whenever we start a new form of exercise, no matter what type of shape you may be in, there will likely be underdeveloped muscles that are important for that specific exercise that you may not have used in this manner with any other types of exercise. In running specifically, the Gluteals (the rear-end), quadriceps (thighs), and the calf muscle groups are perfect examples of muscle that may become sore when beginning a jogging/running program. For example, think about the first day of skiing of every winter season. It does not matter that you had been hitting the gym on a daily basis and that you rock climb every weekend, nor does it matter that you walk up 6 flights of stairs every day to work without breaking a sweat…after that first day of skiing you come home and you are sore for at least 24 hours. Why is that? Skiing is a completely different challenge to your body, and with these new challenges to your joints and muscles, come completely different locations of joint stress and muscle loading. Running is exactly the same way. When one begins a running program, one can expect a learning curve for their body. This is why exercise physiologists recommend new runners abide by the “10% rule.” This rule says that joggers/runners advance their total weekly running amount by no more than 10%. Large studies have shown that 80% of running injuries are caused by too much of an increase in mileage. Follow the 10% rule and you can likely avoid becoming part of that statistic.

The age old question in exercise physiology also happens to be one that nearly every one of my runner patients ask me, “Jonathan, should I stretch before running?” It’s a valid question, and one that physiologists have been studying and struggling with for generations. The answer to this question may shock you. The current state of exercise physiology literature continues to contain almost zero evidence that stretching before exercise can prevent injuries. It’s true. So am I saying that the next time you run, you should simply tie up the shoelaces and hit the pavement without any preparation? Definitely not! The most recent studies done by experts in the running physiology world have all suggested that a 3-5 minute warm-up seems to be the best way to prevent a soft-tissue injury. Warm-up exercise should be similar or identical to the activity you are about to perform, so in our case of running, a short jog at a slower pace will be most effective. For a running athlete who usually runs at a 10 minute mile pace, he or she will want to warm-up at a 13-14 minute mile pace. And of course, do not forget to perform a walking cool-down at the end of your run for another 3-5 minutes. This will take advantage of the skeletal muscle pump (using your own muscles to push blood through your veins back up to your heart) to prevent pooling of blood in the lower extremities. This brings us to the other inevitable question my runners ask me, “So Jonathan, are you telling me that I don’t need to stretch?” No. While running, the muscles in your body literally become warmer, effectively increasing the extensibility, or in other words the elasticity, of your muscles. Stretching should take place at the conclusion of the run or on a non-running day, when it will be more effective, and it should be done statically (zero bouncing) and held for at least 30 seconds for each tight muscle group. If there is a particular muscle group that is tight, stretch it with higher frequency and don’t be afraid to stop during your run and perform a 30 second stretch or two. I know that 30 seconds seems like a long time to hold a stretch, but large scale studies done in the past several years have consistently shown that if you are not stretching for 30 seconds, you are simply not going to be effective. In fact, some studies have shown that 60 second stretching seems to be even more effective, but don’t worry, I’ll be satisfied if you can give me a good 30 seconds.

Prevention of injury in endurance running/jogging/walking goes beyond warm-up, stretching, and managing your mileage. There is an incredibly long list of factors that weigh into injury prevention, many are difficult to adhere to, but most are very simple things you can follow when going out on your run tonight.

Footwear: Peer-reviewed studies suggest that the single most important factor of a good running shoe is in the subjective report of comfort. In other words, are the shoes comfortable when you’re running? Remember that running shoes that are built with an increased lip in the toe and one on the heel are made for higher velocities, whereas the flatter lip and heel is going to be geared for walking or slower jogging. I also suggest changing your shoes every 300-400 miles, which is much less mileage than the typical runner will use a shoe for.

Running Surfaces: Whenever possible run on flat, soft surfaces. Yes, a treadmill is very soft. For those of you who must run through the neighborhood, if its safe, run on the asphalt pavement, it is MUCH softer than the concrete on the sidewalk!

Cross-Training: You really like to run, but you can’t take the impact of running on consecutive days or more than 2-3x/week? No problem, keep up your endurance and train your cardiovascular system by adding elliptical or bicycling exercise to your fitness program.

Resistance Training: It has been established that utilizing free weights, or some form of resistance training, can reduce the chance of injury from running. Just like starting a running or stretching program it is wise to commence a lower extremity and trunk resistance program simultaneously and build up as you do miles. The program should include calf, toe flexor, arch lifting, quad, hamstring, trunk at neutral, and of course, glut exercises. Check our website exercise area for suggestions on these.

Body Weight: While running or jogging the forces of impact on your joints can be up to 5-6x your body weight through the joints in your lower extremities! Eating a healthy diet and losing 5 pounds can take 20-30 lbs of force off your joints with every step. When you think about the fact that a mile run typically consists of 1500 foot contacts (750 per foot), there is something to be said for losing a few pounds to prevent an injury during running/jogging.

Sleep/rest: Keep in mind that the human body has an incredible ability to heal itself without any help from outside sources such as pharmaceuticals, natural remedies, or electrical stimulation. In fact, nearly all tissues in your body are constantly remodeling themselves as you’re reading this article. The majority of our tissue remodeling however, occurs while we are sleeping. Maintaining a healthy sleep schedule will allow your body to keep up with the regular breakdown of tissue that is occurring with endurance running programs.

If you try these simple steps and keep things in MODERATION, you should be able to enjoy your run and not view it as a tedious task that is too easy to skip each day. Remember, if you have questions about your running program or if you have a pain that has not gone away despite resting, icing, etc then please call our clinic to discuss a variation on your program.

About The Author | Jonathan Zimmerman PT DPT – received his Doctorate of Physical Therapy degree (DPT) from Mount Saint Mary’s College, Los Angeles in 2009.  During his graduate work, Jonathan was selected to complete his clinical affiliations at multiple highly respected clinics in the outpatient sports orthopedics community, as well as receiving well-rounded experience at prestigious settings such as Huntington Memorial Hospital in Pasadena in an acute-care setting, and at Kaiser Permanente in the managed care patient population.  As an undergraduate at Northern Arizona University in Flagstaff, AZ, Jonathan majored in Exercise Science and worked with multiple collegiate athletic teams.  Jonathan was also involved with an adaptive recreational training program for youths and adults who were persevering through learning and movement disorders.  When Jonathan’s not at work, you will either find him on the golf course, or spending time with his family in Orange County, CA.  Jonathan’s treatments typically contain a blend of manual therapy, therapeutic exercise, and movement science principles to provide the most effective plan of care specifically tailored to each patient.  Jonathan prides himself on emphasizing evidence-based practice using the latest Physical Therapy research as a basis for all evaluation and treatment techniques.

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By Kristina Nelsen Miller, PT MSPT OCS CEES | Contributing Author | Paulseth & Associates Physical Therapy Staff Member

Have you ever felt stiff & sore while you are working or at the end of your work day? If so, maybe you are not working in a good ergonomic environment.

What is Ergonomics?
Ergonomics is the science of fitting jobs to people & affects health, safety, & productivity. Ergonomic design is the application of the body of knowledge about physical abilities & limitations to the design of the workplace for safe & efficient use by workers.

Why practice Ergonomics?
The most prevalent & expensive work-related injuries in the U.S. are due to musculo-skeletal disorders. Carpal Tunnel Syndrome, Tension Neck Syndrome, & Low Back Pain are some examples of musculo-skeletal disorders which account for at least 1/3 of all  work-related injuries. These disorders cost employers $15 to $18 billion a year in direct workers’ compensation or about one of every three workers’ comp. dollars.

What are the benefits of Ergonomic Programs?

• Decreased errors & product defects
• Decreased time required to perform tasks
• Reduced training & associated costs
• Reduced hidden costs (such as disability salaries & insurance premiums)
• Improved morale
• Reduced worker discomfort
• Reduced fatigue related costs
• Improved hazard identification & control
• Improved quality
• Improved organizational performance
• Decreased loss of customers
• Improved company efficiency resulting from smaller workforce (resulting from reduced absenteeism & lost time injuries/illnesses)
• Reduced management & supervision costs (fewer incident investigations & time spent solving related issues)
• Increased labor pool (older, less fit, & disabled workers can be employed in ergonomically designed workplaces)
• Decreased ergonomically designed litigation
• Reduced disruption of work teams
• Reduced productivity fluctuations resulting from late-shift or late-week operations
• Improved & increased general health awareness
  Financial savings

What can you do to improve your ergonomic environment?
Our clinic offers full Ergonomic Evaluation Assessments, where a Certified Ergonomic Evaluation Specialist comes to your workplace. A full assessment of the workplace will be performed & suggestions for improving efficiency & safety will be outlined in a report. In addition we will be offering Ergonomic & Posture Education Group Seminar Courses beginning over the next year. You can also begin by trying to arrange your work area with some basic Ergonomic principals.

What are the basic Ergonomic principles for working at a computer & desk?

• Top of monitor at or just below eye level
• Head & neck balanced & in-line with torso, not forward
• Shoulders relaxed & upper arms hang relaxed at the sides of the body
• Elbows bent to about 90°, close to body, & supported by adjustable armrests
• Lower back fully supported in a neutral posture(back NOT slumped forward & NOT too arched backwards either)
• Thighs & hips are supported by a well-padded seat & parallel to the floor
• Knees are about the same height as the hips
• Wrists & hands in-line with forearms parallel to the floor
• Adequate room for keyboard & mouse
• Feet flat on the floor or footrest

How can you prevent developing musculoskeletal disorders? Some of the most beneficial  activities you can do periodically throughout the day to prevent musculo-skeletal disorders are:

• Adjust your working position
• Stretch your fingers/hands/arms/torso
• Stand up & walk around for a few minutes

Preventative Measures | Stretches that can be done throughout the workday:
There are several stretches you can learn to help prevent your muscles from tightening up during the day & there is also a variety of strengthening exercises to help increase your posture muscular endurance. We are now offering preventative exercise instruction for individuals provided by a physical therapist in about a 30 min. duration for a cash rate. Please call our clinic for more information on this or to set up an appointment with a physical therapist for preventative exercise instruction.

“There is no one posture or Ergonomic setup that is perfect for everyone. Everybody is different & one Ergonomic setup may work for one person, but not another. The most important thing to remember is that no matter how good your working posture is, working in the same position for prolonged periods is not healthy. Throughout the day, you should adjust your working position by making small adjustments to your chair or backrest, stretch your fingers/hands/arms/torso, & stand up & walk around for a few minutes periodically.”

NOTE: Do not perform these stretches without first checking with your doctor. These stretches should only be performed if there is NO pain during the exercise & extreme care should be taken to keep these stretches gentle. If you feel any discomfort or pain during these you need to see your doctor before continuing.

Corner Stretch:
Stand with feet shoulder width apart and one slightly in front of the other, facing a corner, place elbows at shoulder level on either sides of corner on the wall; slowly shift weight onto front foot, until stretch is felt across chest..
Hold (10-30 seconds).
Repeat(3-5 times).
Perform(3 times per day)

Upper Trapezius Stretch:
side-bend neck by letting ear fall toward shoulder while keeping eyes facing forward, then place fingertips on opposite side of head to increase stretch gently; can also place opposite arm behind back to increase stretch if needed.
Hold (5-10 seconds).
Repeat(3-5 times).
Perform (3 times per day).

Levator Scapulae Stretch:
turn head to opposite side you want to stretch, let head fall downward nose toward armpit, and then place fingertips on head and gently pull head toward armpit to increase stretch if needed.
Hold (5-10 seconds).
Repeat(3-5 times).
Perform (3 times per day).

Standing or Half Kneeling Hip Flexor Stretch:
(a) standing with one foot on step/chair & other foot on floor; pelvic tilt, tighten abdominals & keep back straight; move hips/trunk forward toward foot on step until you feel a stretch in front of hip on standing leg or (b) kneeling with one leg forward repeat above.
Hold (15-30 seconds)
Repeat (3-5 times)
Perform (3 times per day)

Wrist Extensor & Flexor Stretch:
Keeping elbow straight, grasp involved hand & slowly bend wrist down &/or up until a stretch is felt.
Hold (15-30 seconds)
Repeat (3-5 times)
Perform (3 times per day)

About The Author | Kristina Nelsen Miller, PT MSPT OCS CEES studied physical therapy & graduated from Washington University in St. Louis with a Master’s of Science in Physical Therapy Degree in 2002.  Kristi attended Augustana College in Rock Island, IL as an undergraduate where she majored in Biology/Pre-Physical Therapy & was on the Varsity Volleyball & Varsity Track & Field teams.  In the fall of 2004, Kristi moved to California from the far west suburbs of Chicago, IL where she worked & gained experience treating a wide variety of orthopedic patients.  Kristi has continued to further her physical therapy knowledge & experience through continuing education classes in manual & orthopedic treatment techniques, ergonomics, & golf fitness.  In Jan. 2009, Kristi completed the requirements to become a Certified Ergonomic Evaluation Specialist.  She also became certified as an Orthopedic Clinical Specialist in the summer of 2009.  Kristi’s treatments focus on posture/muscle imbalance & impairments, movement science, manual therapy, & therapeutic exercise. Kristi can be contacted by using our contact page.

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“I have pain over the outside portion of my elbow. Is this “tennis elbow”? What if i dont play tennis?”

Answer:
Lateral (outer) elbow pain over or near the bony protuberance is frequently labeled “tennis elbow” and may be diagnosed as lateral epicondylitis. This condition, when associated with tennis may be due to poor backhand technique, improperly strung tennis racket, and/or excessive playing time or frequency. However, this condition may also occur following a blunt traumatic injury to this area of the elbow, improper weight training/lifting technique, or any repetitive over use of the wrist and hand muscles on a daily basis. An example of an overuse type of activity might be the use of a computer at the office for several hours and then again on the computer at home the same day.

“It is important to note that “tennis elbow” or lateral epicondylitis, is frequently the cause of lateral elbow pain, but this is not always the case. Thorough examination and differential diagnosing is imperative to rule out other possibilities, e.g., localized entrapment of a nerve at or near the elbow, or referral from nerve entrapment at the neck”

If you have questions about elbow pain or tennis elbow, feel free to contact us.

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The nervous system is essentially a continuous structure that begins with the brain and runs throughout the entire body down to the fingertips and toes.

Ideally, this system slides and moves without disruption in the body as we move. For example, as our elbows bend, our nerves also bend, stretch, and adapt to the shape and direction that our joints and muscles are moving. However, it is not uncommon for nerves to be compressed somewhere along its pathway. Nerve compression can be secondary to several mechanisms, such as insufficient space between spinal vertebrae and excessive muscle contraction. The result of nerve compression includes symptoms, such as numbness, tingling, and paresthesias. Additionally, nerve compression leads to decreased range of motion secondary to the nerve’s inability to slide and move with the body.

Nerve entrapment/compression is a common result of poor ergonomics and posture. Examples of ergonomic-related nerve compression disorders include: carpal tunnel and cervical radiculopathy.

When there is repeated compression and undue forces acting on a particular nerve it can change for the worse! Treatment should include altering the forces acting on the arm, leg or spine by ergonomic re-positioning, learning proper spinal posture and specific exercises and stretches that promote increased circulation and restored neural impulses down the affected nerve. This is rather complex for this discussion but should be evaluated by a physician or physical therapist.

Acute treatment for upper extremity paresthesia should include ice, rest periods from a sustained position, active and passive motion of the nerve from the spine/neck, where it exits, to the shoulder, past the elbow, and to the wrist and hand. Subtle movements and rotations of these different areas glide the nerve providing a mild stretch and restoring normal circulation and oxygenation to the nerve. Restoring normal neurodynamics is vital for the health of our peripheral nervous system and significantly reduces pain.

At Paulseth & Associates Physical Therapy our certified staff is well versed in treating the symptoms of cervical radiculopathy, carpal tunnel and neurodynamic related disorders. Use our contact form or call 310-286-0447 schedule an evaluation.

About The Author | Stephen Paulseth, MS PT SCS is Board Certified as a Sports Clinical Specialist. Stephen graduated with a Masters degree from the University of Southern California Physical Therapy program in 1982 and recently completed the post professional DPT program. He has been on faculty at Mount St. Mary’s graduate Physical Therapy program teaching biomechanics, anatomy and acting as a research advisor. Stephen works with the US Olympic Committee, APTA as President of the Foot and Ankle Special Interest Group of the American Physical Therapy Association, Federation Internationale de Volleyball, LA Leggers and has served as head trainer to numerous Los Angeles area high schools. He served as director of Century City Hospital Rehabilitation Services and is experienced in all orthopedic and sports patients. Stephen also participated as a US Medical Delegate for the 2004 Olympics Games in Athens, Greece. Stephen has also consulted on the development of KorFlex(tm) brand physical therapy systems. Stephen has a special interest in foot and ankle injuries and holds a US patent (Patent # 5069202) on a specialized therapeutic ankle brace and has written articles for many physical therapy, and sports research journals and fitness publications.

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By Adam Smith PT,OCS | Contributing Author

Knee pain is a complaint of people of all ages and all walks of life. In some cases people have arthritis and sometimes people have traumatic injuries to their knee. In these situations the knee is definitely the culprit to the individual’s pain. these incidences are NOT what this article will be addressing. This article will be addressing the vague knee pain that is often iagnosed as patellofemoral or illiotibial band (ITB) syndrome. The patellofemoral joint describes the relationship between the kneecap and your thigh bone. The illiotibial band is a fibrous band that runs from your hip down your lateral thigh to your knee. This pain is commonly seen more in women, runners, hikers, people who sit for prolonged periods during the day, and people who must use stairs on a daily basis.

This may sound hard to believe, but the knee pain that I have just described is not always CAUSED by the knee. I emphasize the word “caused” because I do want to confuse the cause of the pain with the actual area of irritation. Patellofemoral pain is due to a mechanical dysfunction at the knee, but this dysfunction is not always caused by the knee. THE KNEE IS OFTEN THE INNOCENT MIDDLE MAN. To find the source of this knee pain I often have to look up to the patient’s hip or down to the foot.

The knee and/or the patellofemoral joint are often held victim to forces created by the abnormal mechanics of the lumbar spine, hip and/or foot. When I watch individuals with vague knee pain, I look to see if the individual has excessively pronated feet (commonly thought of as flat feet) or if the angle created by their hip and knee (the Q angle) is greater than normal (see picture). This angle increases when the individual’s hip strength is not sufficient to maintain his/her body weight or when the individual has wide hips. Unfortunately ladies, this is why patellofemoral symptoms are more common with you than with males.

One important concept to understand is how hip strength can affect your Q angle and thereby create an abnormal force on your kneecap. When the hip muscles that allow your thigh to rotate outward (External Rotation) or the hip muscles that move your lower extremity away from midline (Abduction) are weak, your Q angle increases. If you can, visualize your knee diving inwards as you step down off of a stair. This inward motion is a result of your hips inability to hold your thigh in a neutral position and it is this motion that can cause an excessive pull on the knee cap.

This concept of treating the knee by increasing stability above and below the knee is relatively new. However, recent evidence has shown that interventions concentrated on improving hip strength and mechanics have been successful in improving knee and patellofemoral pain. This is reason I now incorporate hip stability exercises into most of the treatment I provide to the patients I see. Consequently, I am writing this article to staple one thought into your minds.  Strengthen Your Hips!! It will prevent abnormal forces around your knees and will help prevent many back problems as well. When people think of core stability, many often look to the abdominal muscles. Unfortunately, they miss the hips, which are the location of some of the strongest core muscles you have.

If you are suffering from unexplained knee pain and are not sure how to address your problem,  please contact a local physical therapist or your orthopaedic doctor. He/she will be able to point  you in the right direction, or initiate specific treatments if necessary. I have cited a number of research articles that were used in this newsletter.

If you would like more information about these articles, or if you would like to discuss their content further please contact us at (310) 286-0447

About the Author | Adam Smith PT,OCS graduated from the Medical University of South Carolina in 2003, where he received a Master of Rehabilitation Sciences-Physical Therapy. In 2003 Adam received the American Physical Therapy’s Association’s (APTA’s) Mary McMillan Award, the highest award given to a physical therapy student. In 2004 he participated in Kaiser Permenente’s Orthopaedic Physical Therapy Residency and in 2005 obtained Orthopaedic Clinical Specialist status.. Adam is presently acting as the Chair of the Membership Committee for the APTA’s Orthopaedic Section. Adam is a native of Long Island, NY and moved to Los Angeles in January 2004. (OCS).

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Do you feel your office or work station is the source of your pain?

Poor ergonomics at a work station can be the cause of decreased work efficiency, decreased production, and increased health care costs. Paulseth & Associates is currently providing ergonomic assessments to local offices. These assessments can be used to identify areas at a work station that may be presently causing pain as well, as areas that could be potentially problematic.

“Work can be a real pain – literally. The tasks you perform every day can take a physical toll on your body if you’re not prepared. As of 2000, the U.S. Occupational Safety & Health Administration (OSHA) reported nearly 2 million workers in the US suffer from work-related musculoskeletal disorders (WMSDs) every year. Ergonomics is the best preventive medicine.”

If you have any questions or if you are interested in setting up an ergonomic assessment, we can be reached at Paulseth and Associates, PT, Inc., (310) 286-0447 or email us info@paulsethpt.com.

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