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Squatting with Knee Pain

So, your knee is starting to give you a little trouble when you squat. Many times, people come to us having been told they need to stop squatting and rest it, or that “squatting is bad for your knees, you should never go that low.” And don’t get me started on the “knees shouldn’t go past your toes” myth… All of this couldn’t be further from the truth! If your healthcare provider is telling you otherwise, it’s time to find someone else. A big part of getting you back to 100% is volume management. This means your recent squat volume may have been a little too much for your tissues to handle and we need to take some time to calm them down and build them back up. But in the meantime, we can still find ways to get after it in the gym!

An experienced PT will not only assess your knee and design an appropriate loading program, but evaluate your squat mechanics, make future programming recommendations, and most importantly, find a way to keep you moving! Our goal with physical therapy is not about telling you what you CAN’T do, but helping you figure out what you CAN do. Rather than telling you to stop squatting, we work with each patient to figure out a squat variation that allows them to continue moving without increasing their symptoms. This could simply be moving them toward a more hip dominant squat to decrease the demand on the knees.

An easy rule of thumb is to move across the squat continuum to variations that utilize a more vertical shin. For example, if you’re having symptoms when you front squat, try a high bar back squat. When the load moves from the front rack to the upper back, the torso angle changes and the squat becomes more hip dominant vs ankle/knee dominant. Having an issue with high bar back squats? Try a low bar variation, or try box squats. This will let you really load the hips and keep your shins more vertical. From there we can keep adjusting by increasing the height of the box, decreasing range of motion to further remove the demand on the knees. There is a variation out there that will let you keep squatting, you just have to find it!

Over time, as the specific interventions for the knee continue to progress, we can gradually work back into the variation of the squat that was causing symptoms. Your rehab should be an active process, and there is no reason you can’t keep squatting!

Have questions? Send us a message at josh@vertexpt.com

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TMJ Dysfunction Case Study

Temporomandibular Joint Dysfunction Case Study

14 year old male baseball player presented to Vertex with a chief complaint of left sided jaw pain that occurred after being hit on the chin by a ground ball at practice.  Additionally, he complains of his jaw “locking” and “clicking” with end range mouth opening, specifically while eating.

Clinical Exam:

Palpable Click with opening and 25mm left mandibular deviation (ipsilateral)

Apical breathing pattern

Decreased left upper cervical rotation (+ left cervical flexion rotation test)

Tenderness to palpation left masseter and left medial pterygoid with patient reported familiar pain

 

Treatment:

HVLAT directed to bilateral C1/C2 with + cavitations.

Upper and mid thoracic HVLAT

DN with electrical stimulation to left masseter, medial pterygoid, and joint capsule.

Manual TMJ distraction

Home Exercise Program:

Cervical SNAGs, cervical retraction with over-pressure applied to maxilla, postural resets, diaphragmatic breathing

Patient Education:

Postural considerations; specifically with school and smart phone use consisting of spending less time in forward head posture in order to minimize mandibular retraction.

Result:

Chief complaint of “click” and “locking” resolved within session. 25mm deviation reduced to <5mm.  Patient followed up 6 weeks later and maintained treatment effect.

Four Exercises to Improve Dance Technique and Strength

 

1. Hip Flexor Pulse
a. Purpose: Improves strength in hip flexors, especially Iliopsoas, to increase leg height. This exercise works best in combination with stretching the hamstrings to allow greater mobility and active range of motion.
b. How to do: start sitting with legs extended and leaning back on hands. Perform a posterior pelvic tilt and lift one leg with the knee bent. Pulse the leg closer to your body for about 4 reps while concentrating on using the Iliopsoas. Repeat 4-6 times.

2. Attitude Raises
a. Purpose: To increase turn out (external rotation of hips) and leg height in second position (to the side).
b. How to do: Start lying on one side. Raise top leg (both knees facing forward and knee bent). Turn out the leg into attitude al second (to the side with knee facing ceiling). Repeat this while bringing the leg closer to the trunk with each rep. Repeat 4 reps 4-6 times.

3. Hip Flexor Stretch
a. Purpose: To stretch hip flexors more efficiently
b. How to do: Start in lunge with both knees at 90 degrees. Perform strong posterior pelvic tilt. Add more of a stretch by bending the trunk to the same side as the front leg. Hold for at least 30 seconds.

4. Calf Raises with ball
a. Purpose: To improve strength and control of plantar flexion in heel raises without inverting at the ankles.
b. How to do: Place small ball in between the ankles. Raise heels off the ground while squeezing the ball. The goal is to not let the ball fall to the ground. This helps train the muscles to not invert, but to remain neutral in plantar flexion.

 

-Lauren Rowell