June 12

All about fixing knees with Carl Reader

We discuss how:

– We have another chat with Carl, functional movement coach from South Africa
– Through Skype calls he has helped many members of the Paddison Program Support
– By looking at the actual movement in the video he provides suggestions on the correct exercises for each person
– Moving the joints in the right way is crucial to their functionality and recovery
– The amount and order of the exercises in a workout is another key factor
– With rheumatoid arthritis, the focus has to be on the whole system rather than on the knee alone
– Carl shares many other valuable insights throughout the episode

Clint Back by popular demand, I’ve got Carl Reader on the episode today. And he is a functional movement coach, an expert who has been really really helpful to several members of the Paddison Program Support. And some people who just watch the podcast on YouTube or subscribe on iTunes or whatever, they have contacted him and he has been able to help them with challenging situations with their body. Whether it be rheumatoid arthritis in the knees or elbows, and other physical challenges. He’s based in South Africa and does Skype calls, and I wanted to get him back on the episode today and talk all about knees, because it’s come back to my attention, I re-injured my knee nearly 12 months ago now. And I have been going through a rehabilitation process again with my very osteo arthritic knee that became all damaged from the years that I had inflammation in it. So we’re going to today talk to Carl about knees, how he helps people specifically with knee challenges and inflammation in the knees to improve them. We’re going to talk about my knee, and we’re gonna talk about the things that I’ve done, and the improvements that I’ve been able to make with my very challenging left knee in the past 8 to 10 months or so. So Carl thanks for coming back on the Paddison podcast.

Carl Yeah. Thank you for having me back. It’s good to be here.

Clint Yeah. Now you’ve done some great things with some of my clients or some my audience, and it’s been really really wonderful to hear their feedback. So I thought let’s take this to everyone that share it. Let’s talk about what you actually look for when someone books a Skype call with you, and you arrange a time, and then you get on the video just like we are now. They’ve got the knee problems, what sort of diagnostics are you after? And what information do you need to then begin to put forward a personalized program for them?

Carl What it’s really useful to have their views easy going to see physio or someone has done that physical examination, and then I generally send through the reports which helps me because I see him being over Skype according to a physical assessment. And then it’s helpful to have someone so just be able to video them, so I can watch them actually physically move and they will go through the exercises and show me this is what they are doing. And then through the Skype and the video I can actually see quite clearly where they are moving in my opinion incorrectly or not functioning. And the whole idea is that the body is designed to move. And so looking at movements that would potentially strain them. Very often they’re being given exercises already by health professionals, and I will say to them. That those are good exercises but in your case we need to modify that or cut it back or only do the left hand side or the right hand side based on their physio report. And it’s quite often they say but this has been given to us by a doctor or a surgeon and I have to just say I understand but you need to maybe leave it out that’s that’s going to cause harm or damage. So those are the things I’m looking for and really helping them to identify the difference between pain, and stretch, and workout, because they often get confused between say does that exercise hurt you? Yes it does but it feel like it’s doing good. And I’ll say well if you feel pain during a movement that’s not a good thing and just to help to describe the pain over the Internet is very useful.

Clint You know I think we should never really push an inflamed joint when it.

Carl Absolutely.

Clint Feels actual acute pain, that’s been my experience. We know that all joints when they’re inflamed have discomfort when they’re being exercised. And it took me a long time to come to appreciate that whenever I’m going to work out an inflamed joint it’s going to feel uncomfortable. And it was for me about how the joint felt the next day. And I am actually only referring to big joints here never worked out the little joints, but the big joints the knees the elbows always benefited from cautious exercise. And I think the knee especially is a joint that needs some needs a bit of challenge to actually improve doesn’t it?

Carl Absolutely and I think it’s important here for your listeners to realize also the difference between the rheumatoid knee, and an arthritic knee, osteoarthritis. Because with the rheumatoid this sort of auto immune diseases with the knees the joint say they need movements, and it sort of feels like a cancer (inaudible). But you need like you’ve stressed before, you need them movements and the reason for that is that the exercises actually stimulates the hormone cortisol and it’s an immune suppressant that actually helps with the inflammation in the joint. So the right amount like dosage which you said cautiously you know common sense actually has tremendous benefits for rheumatoid patients, and other immune problems. But often with osteoarthritis and the arthritic knees you’ve got to be careful because even slight movements can aggravate it. So that’s why we got to just look at what works for you. It’s too tricky but it’s sort of like a puzzle, it’s quite fancy work with and to play, and it’s very individual in some movements would really hurt. Like food I mean often your podcast that would inflame someone the other person says they love it you know so that’s why it’s important to work with someone like myself or yourself you know.

Clint Yeah totally agree, my approach with what I’ve done in the last 8 months or 10 whatever it is with my recent knee aggravation being oteoarthritic is quite different than what I did when it was full of inflammation. But we’ll get to me more in a minute, and I think it’ll be interesting for people to hear me talk about the knee in great detail much more than we’ve shared before. Because a lot of people have knee problems and it’s such a interruption to your happiness in life. So let’s talk about, let’s give a case study I recently had on the podcast a lovely lady called Jo and her son Luke was one of the people who you’ve worked with. He’s only 13 years old, inflammation in the knee, in fact both knees if I remember correctly. Can you talk about about Luke? Tell us really in detail how that process went along, because she said he had fantastic results working with you and loved working with you. So can you walk us through his situation?

Carl I first met him his knees you could see straight away over skype just how swollen they were and that redness. And so we started with a very, his posture when he stood up I could see quite clearly over the camera how his posture had taken a knock with his sitting down and being in bed. And so we looked at doing very basic exercises, chair exercises which you’ve covered in the previous podcast but just really getting him to learn how to move correctly. I got all the strengthening exercises out because that was putting too much strain, just getting him to get very gentle movements up and out of the chair. A spinal mobility, he had a very straight spine and that compromises a lot of the neuro components and then just bad muscle recruitment. So we worked a lot the first couple of weeks on just improving his spinal mobility, and then when he was more mobile and we saw slight changes and improvements in the spinal mobility we then started doing strengthen exercises mainly for the glutes. And I got him doing some a lot of core exercises in the chair, and the core doing proper functional core exercises has a real effect taking Vitamin C in winter it’s just wonderful. You know it’s one of the things I teach other guys in the industry here, if your’e ever in doubt just go for core exercises but proper core exercises not just in anything. And that really helps him a lot once you started adding those core exercises.

Clint No go ahead, I’ll remember my questions.

Carl Yeah. We were so lucky I had a bike set up, he was on the bike every day or every second day and his bike was set up really badly for his knee. So I altered that alignment and that made a big difference straight away. You can imagine it being 20 minutes every day in a bad alignment that’s going to really hurt him. He had big staircase, so I teached you how to climb the stairs functionally and property that we’ve done before and that made a big difference as well. And I gave him which is important as well, 7 repetitions. You will see a lot of exercise programs now are trying to bring down the number of repetitions, but 7 is a very safe number, so you tend to find it round about 5 to 6 repetitions and you’re doing any exercise. That’s the sort of number where either you’re good to go or it’s a time to slow down and stop, because once you start getting to that 6, 7 that’s where the pain or your nervous system starts getting all these were tired. So that really made a difference as well we never took him into place so he could do damage.

Clint Yeah loved that. I love how unique this was, because you’ve not just gone with like a cookie cutter approach here. You’ve made it very bespoke, and very unique for his situation to work on his back posture in just the first couple of weeks, I mean it just goes to show how much the knees are impacted by the entire body. And I pay attention to some physical training experts like these are personal trainers for bodybuilders and stuff. There’s a couple of who I pay attention to on their YouTube channel, and they talk about how the knee is really susceptible to the hip, and the ankle alignment or the entire alignment of the lower body and it can be really impacted if anything isn’t set up correctly. So it really is a it’s down the down the river kind of joint isn’t it?

Carl Yeah it is. And I think it’s so solid too like the food and the gut and not to digress, but you know rheumatoid it’s not even a joint disease it’s more like a stomach problem as you know. You know so the knee is not a knee problem is it’s the whole system. And so once we look address the system, and it’s finding our (inaudible) system it’s the whole you know the kinetic chain. And that’s not even the kenetic chain as well, it’s got to do the other muscles and thoughts. And as it gets It’s quite a complex in nature but once we sort of find the roadblocks and release the handbrake and get the right things, it’s sort of the body’s amazing in its ability to regenerate and to heal. So it’s just find those little points and then working with those, and if after a day or two don’t get results and you move on and you don’t continue on and on and on you sort of move. It’s like playing chess really trying to find out what it is, but it’s usually a small thing a small change in a movement or a removing in movement. And do you get the result instantly.

Clint Yeah absolutely. Okay, well you mentioned at the end they’re talking about removing a movement. At the end of this we’re going to talk about toxic knee movements, and things that we absolutely must avoid. But between now and then, let’s get into detail about my history with my knee. Normally I don’t like to be too self-indulgent on these podcasts especially when I have a guest on and it’s about their story. But in this case the story is really my story, I can speak with I believe justified authority on this topic. I’ve lived many many years with absolute debilitating left knee chronic inflammation for multiple years despite every best effort. And then years and years where it’s been pretty much a non-issue where I haven’t been able to run too much. I can you know beat a child to a soccer ball on a field just for for a short space, but then that went on for several years, hiking mountains, carrying kids on my back oh good. But then I got up off the floor in my daughter’s room as I said on this most recent occasion. That’s been the only time in the past 6 years or so where I’ve actually really aggravated it again to the point where I went and saw a knee surgeon only about 6 weeks ago. And they said to me after looking at my most recent MRI that my knee is completely bone on bone, and that I would need a knee replacement that they want to wait until I’m 55, because knee replacements they might last 20 years and they consume some of the existing bone to implement the knee replacement joint. And therefore you don’t really want to be wearing out that joint and having to have another one which would take me through to 75. And if I’m still kickin at that point I would need another one and then it’s harder to do a second one and certainly a third is out of the question.

Clint And so he said look I’m 43 now, so he said Look just wait 12 years. And I said before we go can you have a look at the MRI that was done in my previous one before that was 9 years ago, 9 years right? And so we took a look at it and he said your knee was terrible back then as well he and he looked at, I said how much deterioration has there been in the last 9 years? And he said they don’t look much different. And I was very very pleased with that.

Carl Oh yeah that’s great.

Clint Yeah he said, so whatever you’re doing just keep doing it. And he said you know your slim and therefore you’re not adding a lot of body weight to the knee. You’re obviously very active, I talked about my Bikram yoga that I do and also my go to the gym and stuff every day. And he said just keep doing what you’re doing. And as long as you can walk as far as you want to each day without having to stop, and if it doesn’t keep you awake at night with those two criteria we recommend no knee replacement until 55. That’s what he said. Okay?

Clint Now what that did for me is to give me absolute clarity that I’m not going to go out and get distracted about trying to have surgeries and stuff. I’ve just got to get back to doing for me what I need to do. And for me what works with a completely damaged, smashed up knee is regular Bikram yoga and certain things that I do at the gym which I can talk through with you because I’m sure other people be interested to hear how I’ve managed to improve this knee a lot. Now by way of comparison when I re-did my knee this well this only other time, since it recovered many years ago. I was getting up off the floor, and so it looked like a lunge, I was coming up into like a lunge position. But my knee was at an angle, and I was rushing, and I I felt like some kind of instant burn and pinch in the knee and I was very familiar with it from the good old days. And then I have been limping ever since in the mornings and throughout the day up until only like the last couple of months and it’s been keeping me awake at night definitely. So I think I retore some remaining meniscus or something like that on the side of the knee because I had inner knee pinch, very bad pinching scenario. So what has worked in restoring that is as I said the Bikram yoga, and being careful not to do anything that irritates it, we’ll go through those things. And I think yes probably best to talk about what does irritate it before I then talk about what helps and you can jump in at any time.

Clint So, sitting Japanese style trying to put my bum onto my heels whilst kneeling without if I attempt to do that outside of a Bikram class that is agonizing, and that causes massive amounts of problems and I have to be very careful and it only works in a hot yoga studio towards the end of the class, and that’s where it’s located. So that’s one thing that I must avoid always. Other things, any lateral like the original damage I originally tore the ACL by doing a sidestep playing touch football, and so any thing that mimics a sidestep like lateral movement through the knee, very very painful. Well I don’t do it, so I don’t want to experience that movement. But anything that is I guess coming back to the to the Japanese style sitting. Anything that that takes it through more of a flexion than the range of motion naturally can handle at the moment causes problem. And what helps is building the quadriceps, building the glutes pretty much that’s it. If I build quadriceps and glutes, my knee feels like it’s getting better and trying to stretch those same things. So strengthening them and stretching the quads and hamstrings sorry quads and glute muscles.

Clint So that really is the nuts and bolts of it. Avoid trying to put it through a range of motion that it doesn’t like unless it’s in a really warmed up hot yoga room at the end of the class. And when I’m cold in the gym, work on my glutes, and quads, and in methods that have evolved with time as I have gotten stronger. And we can go into those if we like as well we probably would people would probably find it useful. An avoidance of all the things that upset it. So that’s how I’ve been. And now it’s feeling much much better, It’s not back to where it was before I re hurted but it’s getting there, it’s going to get there.

Carl Yeah absolutely. I mean you said you know with the glutes and the quadriceps strengthening that plays a big role. But again based on (inaudible) what you’re doing, I know from start off the bat, the extension exercise where you’re sitting and you have to straighten, that’s generally not an exercise to do.

Clint Terrible.

Carl And the other one is the leg press when you’re lying back in a leg press and pushing also not good. You know it’s (inaudible). So those are the 2 straight off the bat you got to you know cut out. It’s just not natural, I always say to my clients the cars fall on top of you, you might have to push it off. But besides that you know they’re going to find yourself in that position you know, (inaudible) most of these things you’re only going to find in the gym never never in your house.

Clint No, you’re absolutely right. And my personal experience has been to avoid those at all costs.

Carl Absolutely.

Yeah. So we’re so far we’re all on the same page. So what I did when I started out was just two very similar to some of the early work that you do with clients when you get them started I believe. Which is just to start on the chair, and then just to stand up off a chair with a with weight in heels. Okay weight in heels and stand up weight and then sit back down and stand up again. And so that’s all I could do really in terms of physical strengthening. And then at the gym after that I was then replicating that instead of coming down to a chair. I would come down to a bench at the gym that you might lie on to do a bench press or something. And I would put some plates down so I could always touch the same point with my bum as I came down. So I knew yes that I wasn’t going too deep because I recall that too deep for me massive re-injury problem.

Clint So I was coming down never below horizontal with my femur, Okay?

Carl Good.

Clint With my thigh muscles never below and in fact I would always cheat a little bit above, so I never had to even work to the horizontal point. And then I started loading, so I would then do goblet squats. So I would hold a small weight in my hands as such, and then I would squat with a small weight tucked up under my chin with my hands, and sit down like that. And I would do quite high repetitions compared to what I like to do from trying to build muscle. So I would do like 2 or 3 sets of 20. And then I was able to also start some very light deadlifts because my lower back, not in a spine injury way but in a muscle way was very weak and compromised. And I found that starting a deadlift program at the gym again just through my own experimentation, helped me to regain some strength and a relief of a lot of pain that had begun to form in my lower hips just from up inactivity. Like not moving correctly, sleeping badly because of the knee and stuff like that. So once again, so we got squats now happening at the gym with low weights added, and I’m now starting a low weight deadlift. And that then developed into a few months of escalating weight until I was able to squat pretty good down on to the chair onto the bench. And then I was able to deadlift heavier weights. Now this introduced some other challenges.

Carl Can I jump in?

Clint Yes please please.

Carl So with you the lower you go you mentioned the strain on the knee the other thing is is a massive strain on the low back if climbs, Oh this is often here with the hip flex the muscle. So the hip flex and muscles, is the muscle that lifts a leg up basically flexes the hip. It’s one of the major handbrake in the body. Handbreaks in your body and if clients or listeners have tried hip flexes, the lower you go the harder it is to squat and the more the knee works. So you’ve got (inaudible) part of the program as well as trying to release those hip flexes before you go down lower and lower, and that’s two core exercises and spinal mobility. And the deadlift, did you ever deadlift bar in front of you or do you taken a like a kick a ball or weights and just going up and down?

Clint The latter, I had a weight on each hand and just went down. Because I experimented with a barbell style lighter than a 45 pound barbell but that’s style, and what I found is that I was getting upper back like upper back and scapula problems from just the weight pulling me forward.

Carl With the bar?

Clint Yeah.

Carl The bars no good, you must cut the bar. Yeah.

Clint Yeah. And so I was just to wait in each hand going down with them beside me with my hands both running parallel as opposed to sort of closed grip.

Carl When you do that is to look down in front of you, a lot of the clients look straight ahead, so just get your head looking down about 45 degrees and funny because that sets the posture for the core to work. Otherwise you’re using a lot of your knees and your lower back muscles to do that. But that up and down movement is fantastic for the glutes, also really good for hamstrings and we know hamstring problems can be the causing a lot of back problems as well.

Clint Okay. Good. And then from there I proceeded to very very carefully introduce some walking lunges without weights. So for people who aren’t familiar, it’s just basically a bigger step than you’d normally take forward, and then allow the back leg rather than just to swing forward like a walk to come down and touch or almost touch the floor and then the front knee has to your hips basically come down to the bottom. And then they come back up, and then pause, and then take another step forward. So and I found that to be really beneficial for the knee because it exists I guess a hip opening that those other exercises had not. So each of them had different benefits but I can tell you there’s no way I could do any kind of lunge after I initially injured the knee. It was out of the question, it was felt very unstable and dangerous for me.

Carl Absolutely. So the walking lunges is the way very advanced, and what I would start with clients if you’re a client of mine would be stepping back. Instead of stepping forward you step back which gives you a sense of gravity leaning forward, because when you step forward your centre of gravity is now behind you especially (inaudible) so that the knee becomes the axis of rotation. And it also takes the load and that’s why it gets strained but at the quadriceps you have to work really hard. And if people are going to do this in gym is to do smaller steps, don’t go down as much you know so the coaching can help but it’s just it is an advanced movement it’s a very good functional exercise. So they are if you do it properly it’s very very good to. But it is advanced.

Clint Good yes, It’s taken me a good part of a year to get there and I. Yeah go ahead.

Carl Do you do when you do. Are you still doing the walking lunges?

Clint I am, and I actually find that they really helped me to put on muscle mass. So I’ve gained 3 kilos in the past 3 months or so, and prior to that it was very frustrating because I just couldn’t add enough weight to be able to build that lower body back up again. But now that I can do these lunges, it’s kind of like chin ups you know once you can do chin ups suddenly a weight goes up because it’s such a heavy load and the body responds so much to the real exertion.

Carl Exactly like climbing stairs. But when you go, are you going straight up in the lunge position and then stepping foot or are you leaning forward and you’re in your upper body?

Clint I am trying to not lean forward much. I’m trying to just basically look like take the lunge forward which requires a small amount of upper body leaning, and then just coming down and then trying to think okay keep the upper body back more.

Carl Okay. So you know I’m just going to share this advice but if you can try it and if it works for you it works. But is when you keep the body upright then the knee becomes to the centre of the axis of rotation and it takes all the load. So you will have major quad work there, a lot of calf work, and a lot of hamstring, and the glutes will be slightly working. Where if you do lean forward slightly from your pelvis, get a centre of gravity move forward you’ll see that there’s a lot of load comes off any back into the hip which is what we want. And then you’re driving off on a glutes and you’ll definitely have the quadriceps but you’ve got in that exercise in my opinion you’ve got too much quad and hamstring work and not enough glutes. Because you’re centre of gravity is way behind the knee that makes sense?

Clint Yeah.

Carl So you’re welcome to try just a little lean, not lean forward from your back obviously. So this is leaning forwards from your pelvis just it’s almost like you’re about to lunge forward as opposed to lunge up.

Clint Yeah good. Okay. I’ll experiment with.

Carl And when you do experiment don’t lunge (inaudible) the ground. Maybe go down 45 degrees and play around. You don’t want to one bad move again.

Clint Yeah. Yeah. Hey this is something that as we’ve been chatting as is it’s come to my attention as well that was crucial for me to be able to get to the point where I could do those walking lunges. One of them was working on my glutinous Medius muscle. And now what I would do is I there were two ways that I work on this first of all for people who are watching or listening to this. It’s the muscle that gets activated with the old Jane Fonda workout videos when you lie on your side and you do a scissor lift like that.

Carl That’s it.

Clint Okay. So for most people as far as I can understand from the people that I watch like my guy who I watch on his YouTube channel who trains weightlifters and stuff. He says one of the relatively the most weakest muscle in the body it’s the stabilizing side glute muscle that doesn’t really do a lot of the heavy lifting but it’s there for stability. Now when he was talking about this, I realized that if I want that stability in my knee I’m gonna have to have good glute mediu’s muscles. And then I realized you know what, it’s the same muscle that helps me stand on one leg at in my yoga class because it really is engaged when you’re on one leg. And so I thought it’s also a good idea because it’ll help me stay longer into that posture as well. So I began working on that muscle every single day, and I noticed that I got stronger and stronger and I could do more of those like scissor lifts and there’s some other ways that I was doing it that are too hard to demonstrate right now. But activating that same muscle, and as that muscle got stronger and I noticed I could stand on one leg with more stability and confidence for longer. I also felt more intuitive confidence in the knee. It was almost like. So you wanna talk about this a bit more?

Carl Yeah. You know the glutes. And again I wanna get back to functional and I love what you said single leg and I’ll get back to that now. So lying on your side doing the scissor lift it really does target the glute medius. But if you think about it it’s not a movement you do everyday or functional movement. So we’re standing on one leg and balancing is functional, and so if I haven’t seen you do. But the key thing is to get the gluteus medius to fire as you gotta keep your knees soft, a lot of the guys when they’re standing on one leg is a lock they need and they lock their ankles. So they still get ugly working but if you just soften that knees slightly don’t in a bend into a usually a quadriceps working it then causes such as on that gluteus medius really tight. And then any movement where you are standing and swinging the other leg. So you imagine when you’re climbing stairs you put the foot down the next leg is coming as that leg is transitioning, you’ve got a rotation in the pelvis and glute medius does internal rotation and (inaudible). Because it actually it’s got a fork like a Y shaped on the muscle goes over the hip so does both movements. But that basically any sort of rotation to the pelvis really challenges the glute medius. Again highly functional stabilizing.

Carl And then the other thing is, just make sure that you look straight ahead. Looking down, looking up or forward changes it activates different muscles. So yeah, so the gluteus medius is very important. Any sort of low back pain or tightness in the lower back, also switches off the glute medius. And a great exercise to do so that is if you have tight groin muscles, we call them adductors. The gym exercises, that exercise are you sitting close again (inaudible) maybe horse riding better real life better. If you can do an exercise, you know that punching exercise that you is sitting on the bike and taking your arms. If you do that before your glute medius exercise you’ll see it’s really fantastic, because what happens is that rotational exercise releases your groin and if the groin is tight it switches off or inhibits whatever we want to talk about and the glute medius. So if you release the groin muscles first you get a much better glute medius activation. You can try that in the gym.

Clint I may have experienced that sort of unknowingly because those the funny exercises you mentioned with the abductor and is it the adductor and the abductor. Where one is you often see more females use it than the men and they’ll sit there and they’ll open their legs against resistance and then another machine next to it close their legs against resistance.

Carl Terrible.

Clint Well so yes. So I was utilizing those again when I was searching for anything where I could build muscle that wouldn’t irritate the knee. And so they served their purpose for a while too in the earlier months after I did the did the what I think is a meniscus tear. So okay, so we’ve talked at length about the things that I’ve done in the past 12 months or so to work on healing this really arthritic knee into a into a position where it doesn’t cause me to have severe lifestyle depletion or impairment. And I think the point that I want to drive home the most here is that it’s totally possible to have a junk knee and still have a pretty good life. And I’m only a few months away, God willing to being able to get back to where I was before this happening. And as I said my surgeon said the only option is a replacement, they didn’t want to look at doing an arthroscopy he said there’s nothing we can do. You’re going there with an arthroscopy and you repair what’s there he said, but there’s nothing there it’s just touching each other. And yet remarkably it doesn’t hurt to walk once I’ve gotten it moving into the late morning and stuff. And I anticipate that in a few months it won’t hurt to walk even when I first get out of bed in the morning as it didn’t used to for many many years prior.

Carl Wonderful.

Clint Yeah. So this is encouraging for everyone else. You can do amazing things with a junk knee. And I think I read a scientific paper that said that when they do autopsies and look at people’s knees so many of them have arthritic symptoms, and yet many of those people did not report knee complaints before they passed away. And so where I’m going with this to say is just by having a really osteo arthritic knee with damage does not necessarily mean that you will have pain, and it doesn’t necessarily mean at all that it’s going to ruin your quality of life.

Carl And you know (inaudible) inject there a little bit is that the picture that they take the MRI, the X-Ray. You know it’s not always telling a true story. And I think that’s nice from throwing a lot of the medical guys and even ourselves. And it it’s helpful to see if you can’t make a diagnosis straight away and say well that’s causing, even if you have impediments or even if you have these things called Bones spares or calcification or whatever it is narrow joints space they talk about the knees hard it there’s a narrow joint space. It’s not an indication for pain, and pain is complex you know there’s a lot going on and as modern science and I still size to today discover and learn about this we’re realizing that we actually the more we find out the less we know. And it’s going back to the basics again and that’s what I love about what you do, with your food, and what I’m trying to do with movements is simply going back to the basics of human movements or good quality food and then let the body do the rest. You know it’s got a self repairing even enamel in the teeth, I mean they’re now showing that it can not grow back but repair depending on the extent of damage you know. So we were quick to pull the tooth to a cavity, during surgery cut the joint, if you look at rheumatoid arthritis I mean the medications sort of obliterates the immune system. I mean it’s crazy like what’s been on offer there.

Carl And I’m going back here quickly on the balance exercise but with balance try to do not too long, I don’t know how many seconds or minutes to balance for you the longer you leave it the more you risk for the long you stand on one leg. If you do have a sore knee to where you start to feel that slight discomfort then change onto the other side, don’t sort of push through. Someone says do it for a minute and after 20 seconds you feeling this is not feeling great but I’ve got to do minute, get off that knee. And build the time, I mean that’s common sense again but you’ll be amazed at how often people go oh yeah that’s a good idea.

Clint That’s such an important point that we haven’t discussed which is that at any point that I have ever felt a pinch it’s a get out of there as quick as possible.

Carl Absolutely. And not pushed into pain you know (inaudible) clients maybe over 50’s are saying their journey still love this, no pain no gain and it’s amazing how it’s just like it’s crazy.

Clint Yeah great. I’m glad you mentioned that. So just to recap then, what I’ve done with the heavily osteo arthritic knee is work on the glute mediu’s muscle because that was chronologically early in the piece even though in our discussion it came up later. Work on the glutinous mediu’s muscle by building that which enabled me to build some more stability in the hips and then the muscle. Then I was able to or simultaneously I was doing daily sit up off the chair to build a very small amount of improvement in my all my sort of lower leg muscles. And then I was able to add a little bit of weight and do it at the gym with great care over several months. And slowly introduce deadlifts as well because, I want to say my hip muscles were tender and weak not so much the lower back and that helped my hip muscles improve a lot. And all of this I did with great care and patience and with great record keeping. I have a little blue book that I take with me to the gym every time, and it’s got the date, my weight, and every single thing that I do, and every rep that I do every single day. And it’s my bible of history of everything that I’ve done with my body, and I record everything from the spacing between my feet. Like I said with the with the depth how many plates I put on top of the bench, so I know how deep I’m going, how many reps of course. And even sometimes I put what order I do things, I might try doing deadlifts before the squats and I’ll make a note of that because I everything seems to matter. When you’re dealing with something that’s so precarious, like the knees so delicate when it’s so smashed I found everything matters. And then I’ve progressed now to the lunges and now I feel like now I’m on the homestretch because as you said the lunges are advance and it gives me that feel good that if I can do those then things are obviously a lot further ahead than what they used to be.

Carl Good you mentioned the word order, that’s what I do is I help get the sequences right. It’s makes a huge difference which exercises you do and how the order that you do them makes a huge difference. And so that says I start off with the back release the back, release the hip flexes. Everybody has a side that they stronger and there’s not I don’t think there’s a human who’s got the absolute perfect balance. You’ve got to have a good body awareness as to what side because sometimes even the side it’s painful isn’t your weak side. So you got to work on understanding what you’ve done so nasty you know I take a record. Get to know your body and know what how it feels afterwards and (inaudible) order out. Because it’s also the order of, every muscle is lacking is like an alphabet. So when you look at a word made up of letters. So the word, just take mat if you have image your glutes as your glute medius and T is your hamstrings even though you maybe you got MTA you working all the right muscles. And this is what we find a lot of the exercises and other methods and systems that’s out there, that people say we have a column working that I’m working on but you haven’t got the order of the sequence is wrong. And when that sequence is wrong say MTA or ATM, until you get MAT you’re never going to really get that flexibility to desire, because the order is wrong. And you can stretch, and stretch, and stretch, and stretch, and yes there’s a neurological improvement but you’ll notice a lot of (inaudible) slow. And the reason it’s slow is because the order is out. And so that’s why we want to work on that order. Does that make sense?

Clint I love that. Absolutely. Oh yeah. You’re talking to someone who’s pedantic about these things because you don’t get well by accident. All the odds are against you when you have an auto immune disease whether it be suppressed or an active, you’ve always got to have extreme diligence with being able to either keep it at bay or to get it under control. I mean it’s a lifelong full time job, and so you know you develop these this level of detail with you thinking that’s pretty obsessive almost. Something I’m glad you mentioned which was stretching. So for every time I would work out the muscles I would then after stretch them as well. So I want to make sure that everyone understands that everything that I have done, and will continue to do, and did when the knee was inflamed which I will talk about next. Involved strengthening and stretching, because I find that if I only try and strengthen then I’m all tight and sore the next morning because the muscles seemed to be worked but not released. So I’m looking to your sort of comments around that the stretching side of things. Is this something that you also incorporate as a key part of your coaching?

Carl I do. Stretching, it’s a tricky one because there’s two types in the sense you have a dynamic stretching where it’s not the old school you sort of hold a position or straight you know for 30 seconds. It’s more taken the joints slowly through a range of motion sets called dynamic stretching. The other thing is often it’s the nervous system that’s tight. So if you look at the hamstrings for example, if you were to lie on your back and put elastic band round your foot and pull the your, it’s quite popular in the gym and you pull your leg back. People tend to feel a burning, pull behind the back of the knee, and then they say I’m stretching my hamstrings. And you are but very often you also stretch and the nerve, there is a big nerve that runs down the back of your leg called the Sciatic nerve. And so people get confused between am I stretching the nerves or am I stretching the muscle and that we can talk about it if he won’t go into that just now. But when you’ve worked and muscle like you said you’ve done squats, you’ve done some exercises and the muscle feels tired. Then taking it into a nice gentle stretch afterwards to release the sort of you know. But basically that stretching is fine, but stretching to really try to make a muscle more supple can can be a challenge sometimes because it’s more complicated. It’s governed or regulated by the nervous system. So I rather to release the muscles I work on actually stings the right strengthening, and and getting people into the right positions which then naturally releases the muscle as opposed to then getting them to really hold long stretches. It does feel nice and stretching feels great and it has an effect on the mind and it also is it depends on individual. Because if you stretch some people’s knees like you said can aggravate it, and other people’s knee they said it feels fantastic. So it’s different, I hope that answers the question.

Clint Yeah. The active stretching something that I was completely unaware of until I started yoga, and when I realized that everything that’s done and that’s not true. A lot of the things that are done in Bikram yoga, your stretching and strengthening simultaneously and I’ve never seen this before. And to be very specific about one exercise that has always been a winner for this left damage knee, and it’s hard to explain. But the best way to explain this would be, imagine if we’re standing on one leg and we when we reach down and we pick up our ankle of the other leg as if we were to do a high school quadriceps stretch like you would in high school. Okay. And then to actually start kicking with the leg that is being held so that your pushing the ankle against the hand which isn’t moving because it’s attached to your shoulder so it’s not going anywhere. So what you’re really doing is you’re basically using force against the hand to kick into it and you end up coming forward. Right? Because called the bow pose. So you go you’re moving forward. And I have found that if I can cheat that at home with my shin or my ankle against the back of the couch, here with me? So stand behind the couch, and then put my shin against the back of the couch stand on one leg and then start to lower myself down. And the whole time, and the absolute most critical component to be kicking pushing with the ankle against the back of the couch. What a wonderful stretch into the quadriceps, and it feels to also to lengthen the quadriceps at the same time. Which I feel is just both interesting and fascinating but also wonderful.

Carl As it’s called (inaudible) pro preceptive neuromuscular facilitation is a long word for it but it’s not exactly contract, relax and very used quite often by physios very effective in that. And again you’re having a play on the nervous system. But if we go back to our analogy with the word mat, if the quadriceps muscle is the T in the word mat, and you moving doing a squat so your lunges and that T is in the front. So you’ve got TMA as opposed to MAT, now you go you do your quadriceps stretch, you do all the stretches as you’re going to get the release. But the minute you go into life or into your exercise and you go and put the T back in the wrong place, it gets tight again. So you’ll find that once you get that order right you’ll go do that same stretch on the couch and it will be significantly improved and you’ll be to I’ve done nothing, I haven’t even had to stretch my quadriceps why is it so loose. That’s because you got the order right. So I’m helping my clients ready to do the stretches but saying, do you really want to take this stretch to the next level? Not in terms of pain but release and they said of course, and then you say well let’s leave the stretch and let’s get that and then I go back into the stetch and theys say I can’t believe the difference. And it’s not like 5%, it’s like 20 30 % is huge.

Clint Yeah. That’s awesome.

Carl Simply by moving, changing that order I talked about the MAT, TAM

Clint Yeah.

Carl (inaudible) because it is a good stretch (inaudible) follow up within a few weeks when you start to get leading forward. If you get that change in the quadriceps with the lunges to do that stretch to see if you feel better we can.

Clint I will do that, and it does take me some time to make that progress. I only do the walking lunges every probably every approximately about every 8 days, 7 or 8 days. And the reason I only do them that infrequently for a few reasons is because my current routine is I go gym, gym, Bikram yoga, gym, gym, Bikram yoga. And any little trouble that I might get myself into at the gym, if my muscles are getting tight you mentioned the hip flexor for example or sometimes I noticed that if I can sometimes get a little bit of a sore ankle if I grab the ankle in some stretches instead sorry the foot gets sore. Actually the foot if I grab the foot instead of the ankle in some postures. And then I go into a Bikram class every third day and that’s my insurance, and that’s where without a coach like yourself that’s where I can just go and just let that the teacher in the process be my coach and that gets me out of trouble. And then I go back into the gym and I do my cautious gym work again. And I found that this process has been both safe but also very make great progress as well. So Bikram Yoga really has been, I said to Melissa the other day that the only reason I walk, we don’t even have a knee replacement now at 43 is because of Bikram yoga. It really has enabled me to get out of some extraordinarily awful scenarios.

Clint So why don’t we Segway with that into when I was inflamed, because a lot of people have inflamed knees. And I hope as we get sort of you know towards the end of our conversation is we talk about inflamed knees. Everything we just spoke about, I believe to a more cautionary level can still be applied but with much more care. So if a knee is inflamed or at least let me speak at least from a personal viewpoint. I found that challenging, and inflamed, unhappy, aggravated, red swollen knee still felt better the next day than if I didn’t use it. And similar exercises to what we mentioned before with an emphasis on building some strength particularly where the quadriceps connects to the patella or to the knee joint down low. Particularly around that area, and then stretching it. So trying to strengthen a stretch because I got so weak from the inflammation where the quadriceps meets the knee. Can you give us some comments around that?

Carl Well I think a bit of background. You know the immune system really kicks in well it’s always there but it’s sort of at around midnight. That’s why you often say it wakes you up at night, where people complain they wake up in the morning in pain and emanate the idea but to exercise or live and it goes away. You find that your cortisol levels tend to spike, that’s your stress hormone that’s released. But that cortisol comes in and around and by just before you wake up it sort of prepares you for the day, and then that cortisol is an immune suppressant it helps regulate inflammation. So when people do these exercises or gentle counter sort of your intuitive why would I move a painful joint. But as I said that cortisol is released and it actually has an immune suppressant just what your drugs are doing or the medications. So that’s the benefit you’re getting from that. And again is just using your common sense and how much you have pain, and if you don’t do a lot you know just in that gentle movements and this thing you can learn you are even on your bed you can do some quadriceps strengthening and pushing down a little ball. And I would be careful of doing what we call an active leg raise, where you line your back and lift a leg up because that involves using the quadriceps but it also the hip flexes which is directly attached to your lower back. So anybody’s got a lot back problems or strain that can can cause pain, I’m not saying it does it depends on your situation. But if you if you’re prone to back pain lifting a leg up in the air can cause a lot of lower back problems.

Clint Yeah. When I think about the concept doesn’t make me feel comfortable. When I’m on my side doing the Jane Fonda scissors as we talked about, completely different level of confidence with that. Yeah that’s great, that’s great I’m glad you said for people who are in bed because some people are just really struggling. And they might be listening at the moment with the kind of yeah but attitude which is yeah but it’s fine if you’ve got gym access. Yeah but, I’ve got both knees inflamed and I only had one knee right. So I had that level of confidence and security and the other one. But I would still just as a general words of personal experience I don’t use the word advice because everyone can has to make their own decisions about this. But if I had to step into someone else’s shoes with the knowledge that I have, and have those bad swollen knees again I would try and keep them active. I just really would, I would look to go and do it like I found that with my terrible knee. In fact that one the biggest insights for me was when we’re in Hawaii on our honeymoon ,and my knee just responded so well to just doing some small hill climbs, and trying to do some sightseeing in Hawaii of course. Cycling, like just getting some activity. The worst thing for rheumatoid joint is to be left still in my view.

Carl Absolutely. Absolutely I agree with you completely.

Clint My old left elbow being a classic example where I was my first major kind of question mark around what to do. I mean it locked up in a position and the medical professionals said well if it’s hurting to try and move it then don’t move it. Well that ended up in me having elbow surgery right. And so then when I, if it hurts they move it right? And so when I started to get inflammation in my right elbow, don’t you know that I thought well I’ve got to do whatever I did with the left one. It cannot be worse than what I did with the left one like that was a complete file. So do the absolute opposite, so then I moved the right elbow like crazy and that one avoided surgery has no inflammation never since. And I mean it’s not perfect because it had a couple of years of inflammation. It’s not perfect by any means but I avoided surgery. So we’ve got to move the inflamed joints in the right way and you are the person I send people to in my support group, I say book a session with Carl. I refer to yourself as the knee expert when it comes to inflamed knees because it’s complex. It’s like when you’re talking about Luke. You worked through all of these issues that I would have no idea to comment on these back and core and this sort of stuff I mean that’s just not my expertise. I’ve got my own personal experience with my own personal journey and my knee issues. But you’re working over Skype, and you’re seeing the actual condition with your own eyes, and being able to witness people’s physical posture and so on. And having a coach targeting those areas is very powerful and so that’s why rather than me you know just saying hey watch my knee training video. Which people do and get a lot out of as I hope they do out of this discussion. But my knee training videos like me demonstrating all of this stuff but beyond that it’s one thing just to watch that, and it’s another to have a coach actually keep you accountable. And when you hit troubled areas then actually correct them and to work with that.

Carl And thank you for that Clint. You know how you document how the foods, different foods have an effect on you. And it’s the same thing I’ve been doing now for the last 20 years pretty much is documenting the effect exercise has on our bodies and joints. So you get a good picture of you know you may say what is a like olive oil. It’s a healthy thing but you through your experience you’ve realized that in certain cases it’s actually not good. (inaudible)t I’ve done with the exercise. Even though it’s looks like a very innocent you know well prescribed exercise, we know that certain things are not (inaudible) of people so that’s very very good. I wanted to say (inaudible) I feel for the listeners as well is a lot of people look at being overweight as a barrier to exercise, and also for knee pain they say if you’re overweight you’re going to have sore knees. Obviously if you reduce the load in the body it does help but it’s not all be all and end all. I have a lot of patients who are really overweight, who’ve done the movements, who’ve lost no weight but the knee pain is better. So you don’t have to feel like I’ve got to go to the gym smash it, and I’ve got to starve myself and otherwise my knees are never going to come right. And it’s really is another potential roadblock for people to get going. I’m never going to go anywhere on my knees because I’m so overweight and I might as well give up. So being overweight just like having an MRI, it’s not always of cause of you back pain or knee pain.

Clint Yeah absolutely. Well whilst you while still talking about that kind of I want to say possible challenges or things, are there any other blocks that people might have in their mind as to why they can’t make improvements? Being overweight maybe one but one I think that having pain is one that we’ve covered the inflammation. So we can just sort of clear people’s objections here as to why they shouldn’t get started. The bed one was a very good one, if people are in bed there’s still things that can be done. As you mentioned right?

Carl Mindsets a big thing as well. I mean you know that if they’re negative not don’t believe in exercises or what difference is it going to make or you know all those sort of objections. It’s also a barrier just to get people started I think. The great thing about with the people who are in that sort of condition is the small little things makes the next change. It sort of drives that sort of hope. It gives them hope.

Clint Yeah. No matter what state someone’s in the knees or any other joint is not so far gone that you can’t do something, can’t do something. And you work on not just the knee joints but you work on elbows shoulders the whole body as a unit. So yeah I’m sure you’ve seen plenty of situation where a joint is apparently out of use, but we can always make some improvement. And I know speaking with my situation with my elbows for example which have been damaged over the years they don’t straighten. That doesn’t mean that I’m never a day goes past when I don’t try and get one fraction of a millimetre more of extension through those elbows. Whether it be hanging from an overhead bar at the gym or whether it be just trying to stretch them in the morning when I wake up, get you know through my forearms just do for stretches and stuff. Never stop trying to improve things that have been damaged.

Clint So let’s talk about the toxic knee movements and then we’ll wrap up. So to conclude out our our knee episode here what are some things that people always are going to have trouble with if they do these things?

Carl You know the deep bends going down to when you squat down in the knees go past your toes that that’s one of that number one you know. Some people who don’t have problems they go that’s fine but the average person when you squat down in the knees go way forward, that’s you know it can be a toxic movement and just to you know carry on. It’s not everybody is going to feel (inaudible) the majority of people who’ve bend down like that are going to feel a strain. That’s why when you go to the gym they say don’t let your knees go pass your toes, it’s for that reason. Sitting with your knees bent for long periods of time or in awkward positions you know it’s again it’s can cause a lot of pain. I find just doing things in they’re in a rush in a hurry you know, I’d say if you if you you just quickly turn twisting that’s so rotational movements like you talked about is you know it’s fine if you’ve been doing them in the gym. But if you’re standing still and you’re clicking turn or that can really especially (inaudible) you haven’t got the mobility and the knee takes the strain. Carrying very heavy heavy loads incorrectly, you know pushing things if you’re saying you have to push something out the way or move a box you know something it’s amazing how we do that and then all the thing in the car with the kids you want to reach back behind you clicking, there goes a shoulder. It’s it’s just being aware of movements now that shouldn’t be a painful movement to normal but because it’s done so fast without thinking it becomes toxic. I don’t think it’s a single person and maybe a few but have actually reached back in the car to get something and it’s either a neck go.

Clint I’ve done the neck that way I still remember to this day, I think I might’ve been 17 and I remember it like it was yesterday. I was getting out of the car at school and I was like in year 12 or year 11 or something, no it was year 12 because we we had a car and we were driving to school. And I remember like absolute shocking kink neck you know when one of those ones when you like. Absolutely like just pathetic and you can’t move it a millimetre.

Carl And the reason that neck is sore is because it’s a neural a lot of stress in the nervous system and that’s why you get that horrible (inaudible) in the neck.

Clint When you were you when you were running through that list we mentioned last time about it actually being quite a challenge sometimes just getting up off the toilet when you were in a pretty bad way with your knees. If folks are travelling a little bit rough, and they need to get a tip for getting up off the toilet. Do you encourage people to utilize a wider foot span with toes pointing out knees further apart to help get up off the toilet or should they just work aggressively to try and build more strength so they can keep you know feet parallel or nearly parallel?

Carl I think you know it’s such a, it’s like a deep scar like we talked about it the last time. The key there is like what you saying (inaudible) apart slightly turned out but you’ve got to use momentum. You know you’ve got to kind of like one two three and get the centre of gravity forward and really push up. If you go slow motion or you come straight up you know a lot of people actually push off the toilet but then they go straight up, and that just puts a lot of strain on the knees again. Like I told last time as I’ll get that seat you can raise in seats. I mean I was doing saying different I would have to design seats in kitchen all these appliances just make everything higher everything so low, it’s really killing our backs. Everything, everywhere you go even sitting now talking to you I’m on a low (inaudible), and it’s low it’s killing. It’s really destroying our bodies slowly.

Clint For a while there I was doing a lot of standing up there had a desk where I was standing up and so forth. And whilst it was a bit of a trend over the previous few years throughout sort of 2015, just (inaudible) standing desks. I’m not sold on it. I’m not sold on it I think that sitting to get a little bit of work done for an hour and then get up and go and do something else for 10 20 30 minutes. I mean I’m talking ideally we’re not stuck at our desk with our job. But yeah I feel that just being constantly up and down, just constantly kind of moving around is helpful.

Carl Yes it’s a great point I mean people often ask me call what’s the best posture for this one I’m sitting and I’m like well there isn’t really the best posture. You can sit slouched, it’s actually quite a nice slouched actually relaxing a lot of tension a lot of muscles but it also think creates problem in the neck. Then you can’t stand or move. But just sit like a robot, in an idea for three hours is yes, it is no good. I want to say quickly as well like all movements it may be possible but not all movements are beneficial. And I think that’s the secret very important thing you know it’s just because your body can do it like like you said you can you can do these deep knees things or you can do these reaches but you’re going to find out sooner or later that the more we get back to how the body is designed to move. And it’s not just a random movement you know when you need you bring on a whole sequence, you’ve got a lot just a word MAT got like 20 or 30 or 40 muscles are all operating in synchronicity to produce that movement. It’s really important for listeners to just not just go there and say I need to strengthen this muscle, and I need to strengthen that muscle because that’s not how the body works.

Clint You’re absolutely beautiful. Well it could be a good place for us to wrap up. Thanks again for recording this episode with us there’s your second one of these but you’ve also been and joined me on my monthly live support calls inside Paddison Program Support. So members of Paddison Program Support have been able to get your direct coaching just as part of membership. So that’s been very valuable as well. And we’ll have you back on there again I’m sure there’ll be a lot of interest again after people see this podcast and I’ll get the nice request once again to have you back as our special guest on the monthly call. So I’ve got a little girl here yelling out poo poo poo. What do you mean poo poo poo? So I’m going to say thanks so much once again. It’s been absolute pleasure, I always learn stuff when we talk and it’s always inspiring to me and it motivates me to make my body as good as it can be. And I thank you for that. So have a wonderful rescue day. And how can people contact you.

Carl Well I’ve got my email address which is carlwellness@gmail.com and my South African website is www.carlreadercoaching.co.za and they can find me there.

Clint Yes. Fabulous. And I can vouch that everyone who has contacted you has said how quickly you reply and how and how much they’ve enjoyed working with you and thanks again Carl, and we’ll be in touch. I’ll go. Bye for now.


functional movement, knee, rehabilitation, workout

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