Reclaiming Your Squat Part 2

If your body is prepared for deep squatting, it is time to train this movement.

The best way to progress your deep squat prep from the quadruped position (on hands and knees) to a vertical deep squat is to start with a partially loaded squat. Here is how you do it.

Hang onto something that is fixed like rails, a pole, or anything that can help you up and down. After you have found a good and safe fixed object it is time to position yourself carefully down into a deep squat position. If your body is unaccustomed to this position, only spend 10-30 seconds in the deep squat. After you are done pull yourself up with mostly your arms.

Another tip is that you need to position your feet forward to make your lower legs (shins) as vertical as possible. This takes the mechanical load off your knees. Sparing the knees is very important for beginners.

Worried about foot position? Don’t be. Everybody has variations in their anatomy (there are several different shapes the human pelvis can take on). The shape of your pelvis, the amount of rotation in your leg bones, and a few other factors will determine your ideal foot position. For now, just get comfortable.

If you are able to do a deep squat as discussed here today start with a round or two a day. Stay down in your squat for 10-30 seconds. As the days go on add a bit more time or more rounds throughout your day. In time, your joints, ligaments, cartilage, and muscles will adapt and become stronger (as long as good progression is used and severe injury is not present).

When practicing be fully aware and present with your body. Try to determine if this level of deep squat works for you or if it is too much. If your body does not accept it, go back to the previous level as discussed in part 1.

Next blog: how to take the deep squat one step further. Practice and be ready! Remember that deep squatting has been a health promoting normal part of human existence until we put furniture everywhere.

Disclaimer: Please consult your doctor before you being any exercise program. The content of this blog is for educational purposes only. You are responsible for the outcomes for the use, misuse, or lack of use of the information presented in this blog.

Reclaiming Your Squat Part 1

How many people do you know that have gone through a hip replacement? How about anyone with a pelvic disorder or low back pain? I know a few….ok dozens and dozens…. and I have worked with many both before a surgery and long after any produce.

I am often told by new clients or I hear them comment that their pain or dysfunction is “just part of getting old”. Most people hold the idea that more birthdays equals painful joints and are surprised when this common narrative is challenged. As I remind everyone I coach, both young and old, time on this planet is only ONE factor that leads to degeneration and dysfunction. This is good news. When thinking about the causes of modern day joint issues, behavior and what a body is asked to do (or asked not to do) is the BIGGEST driver of joint health or dysfunction.

Why do many hip joints and therefore body’s break down? One major factor is most people have lost their squat, especially their deep squat abilities. With the loss of the squat, which has been a basic human movement for our entire existence until very recently, our wonderful and powerful hip joints have lost a vital nutritious movement.

Did you know that joints get nutrition through motion and load?

Most modern human hips are squat deficient. It is like how vitamin d deficiency can lead to a dysfunctional immune system.

As a consequence, the pelvis and some aspects of the cartilage, ligaments, and muscles atrophy. The wonderful human pelvis becomes weak and breaks down. The human body has never lived in a time when it did NOT have to squat. Furniture, chairs, and seats placed everywhere in our culture has allowed our hips to do so little throughout the day.

Good new: Your hips are a living part of you and can respond to stimulus.

Ready to take action and reclaim your hips? They are likely crying out for squat nutrition.

Beginners can start here:

Start by going to your hands and knees with a nice knee pillow:

Next: rock back until your butt touches your heels. Go to the point where it feels restricted or that you feel a stretch. If this position is a challenge for you, the goal is to spend 10-20 minutes a day in this position. If you feel that you are very “out of shape” start with 1-3 minutes. Others could start by spending about 5-10 minutes in this position a day. Do what works for you. It is OK and expected that you break up your time throughout the day. I would also expect that you do something else while being in this position. Talk on the phone, listen to a podcast or music. watch TV, read, or whatever. Do what you like to do with your time but do it in this position.

Was this position too hard or perhaps it didn’t work for your knees or hips? Try the same pose on your back instead:

The goal of this position is to achieve a squat position from your back while not trying to flatten your back (this is not a back stretch). In fact, you can even put a small support (rolled up towel) to hold your low back up in place. Same goals apply to this position as mentioned above. Slowly increase the time you spend in the position.

Try these positions out if you want to better the health of your hips. These are the beginning position for hips that have lost their ability to squat. If you already have replaced hips or knees, these poses may not be suitable for you. I often use a different tactics for people with replaced joints which I will not go over in this blog today.

Next time I will write about how to progress the squat pattern or what to do if you can still squat from your feet.

Enjoy and reclaim your squat.

Disclaimer: Please consult your doctor before you begin any exercise program. The content of this blog is for educational purposes only. You are responsible for the outcomes for the use, misuse, or lack of use of the information presented in this blog.

Rehab Stories: Bone Marrow Stem Cells and PRP (Episode 2)

The following post is from my original blog that has been deleted for years. The following entry takes place after my first injection of my 2nd episode of cell therapy.

Last Friday was episode 4 of my stem cell injections. It was full of blood, sweat, and needles. Who doesn’t like those?

This time around, I got a large concentration of bone marrow and fat stem cells (FYI-you get free liposuction with these procedures…..). My right knee was pumped full of these two different concoctions. This gave me an angry swollen knee full of potential which I am currently enjoying.

I feel much more educated about these injections than I did last year at this time. What brought me back for more injections was studying micro fracture surgery for the last several months. What really struck me as odd was how micro fracture (a bone marrow stimulation technique) is considered mainstream and is covered by insurance while autologous (i.e. from yourself) bone marrow injections are NOT considered mainstream and are not covered by insurance. While it is obvious that micro fracture surgery and inter-articular bone marrow injections are different procedures, the goal of both of procedures is to deliver bone marrow (with its growth factors and stem cells) to chondral lesions.

Both methods have a glaring similarity.  Bone marrow is brought to the site of injury with the hope and expectation that new cartilage will form. Currently, studies on micro fracture clearly demonstrate good short term benefit to patients. Studies on the use of bone marrow stem cell injections is mixed and highly variable. Here is a nice summary of some key studies of various stem cell injections by Blue Cross Blue Shield and why this company still lists such injections under experimental.

https://www.bluecrossma.com/common/en_US/medical_policies/254%20Orthopedic%20Applications%20of%20Stem%20Cell%20Therapy%20prn.pdf

In direct contrast, studies on micro fracture surgery are well done and well standardized. The results of micro fracture are repeatable. Most importantly, what patients do after micro fracture surgery is greatly emphasized in the literature. The post therapy protocol after micro fracture is critically important. After reading about micro fracture surgery outcomes for several months a few themes kept coming up. Many researchers noted again and again how the post surgical rehab is one of the biggest indicators of how successful a patient will do with micro fracture surgery. It was noted that many doctors, patients, and therapists get caught up in quick rehab protocols that doom a patient’s new cartilage because the blood clot and forming cartilage is exposed to too much load too soon. The bigger, faster, stronger/ no pain, no gain fallacy strikes again.

Last I checked, no studies on stem cell injections talk about what they tell their patients (or study participants) to do post injection. During my last 3 injections, I was simply told to rest for a few days, listen to my body, and to get back into activities slowly. (FYI, this last time, I was given more instructions on what to do after the injection…a mobility/ exercise page). I think it is safe to say that any micro fracture surgeon would think such advice would certainly set any micro fracture patient up for failure.  Again, I realize that micro fracture does not equal stem cell injections, but I think clinics that treat patients with injections of bone marrow, PRP, and fat should consider the well established rehabilitation protocols of micro fracture surgery. At a minimum, micro fracture patients are told to be on crutches for 6 weeks, but many of the researches advise more time (8-12 weeks!).

The primary reason for so much non/ partial weight bearing time is to allow new cartilage to form and to protect it. Whether a person gets micro fracture surgery or bone marrow injections, any cartilage that forms starts out as a blood clot. Should people be running around on a blood clot? I don’t think so, nor would many rehabilitation professionals. Therefore, I plan on using crutches for up to 12 weeks. It makes a lot of sense to follow the same protocol as micro fracture surgery.

With some luck, I will hopefully reap all the benefits of a micro fracture surgery (minus the nice cartilage bed the drilling provides) without any of the downsides.

After thinking about how I treated my newly forming cartilage during the past 3 injections, it makes sense that I got minimal results in regard to gains in function. If I had gotten micro fracture surgery and started walking a week after the procedure, I would have  gotten very poor results.

For those interested here is a great page on micro fracture rehab:

http://lowerextremityreview.com/article/rehabilitation-following-microfracture-surgery

Let’s see how this goes.

The Ultimate Exercise: The Turkish Get-Up

Here is a great video of how to do the Turkish Get-Up.

There is so much involved in this move. It is one of my favorite exercises and is a great way to keep functional strength. In other words, if is an exercise that when used will enable a person to get up and down from the ground with grace. This ability is something we need to keep strong during our entire lives.