July 23

Everyday injury prevention with RA

We discuss how:

– Carl is a Bio-Kineticist / exercise physiologist
– He’s a specialist in injury prevention and best practices for everyday behavior
– He teaches how to move functionally and how to give joints good mobility
– Everyday movements like getting up off a chair or  toilet are examined
– Finding a functional position is crucial to a correct movement
– Specific exercises aimed at strengthening muscles can also greatly help in doing these movements
– Climbing stairs also can be approached with a correct functional movement
– Awareness and correct movement of knees, shoulders, elbows are key in all these situations

Clint: Well today I’ve got a special guest with me who is currently in Cape Town, it’s about 6:00 a.m. in the morning, so he’s done me a great favor and arranged the time that was mutually convenient. He’s got a early start for his business. He works in the field of exercise physiology. He’s an exercise physiologist or an athletic trainer or a Bio-Kineticist, depending on which country you’re in. He worked in Dubai as an exercise physiologist and runs his own business, Carl Rieder Bio-Kineticist. Hello Carl, how are you?

Carl: Hi Clint. Thanks, good to be on the show. And yeah I’m doing well thank you.

Carl: Awesome. Well I’m going to let you explain more of what you’d do. But let me just tell the audience today why I wanted to get you on this show. The main reason that we want to have you on the show today is to talk about injury prevention, and suitable day to day alignment, and behaviors when we go about our simple movements. Like getting up off the toilet, going up and down stairs, getting up off a chair, and so forth. When we have some limitations in our movement, particularly around the knee, maybe hips, maybe our ankles or feet hurt. And so we’re making adjustments that may be counterproductive for other parts of our body. And so today what we’re going to go over, we’re going to talk about how do we do these basic things around the house or at work so that we don’t overload or overstress other parts of our body, and then create more problems.

Clint: So we’re talking about injury prevention and best practices for everyday behaviors when we’ve got joint issues and and physical limitations. So how does that sound? Does that’s sound like the sort of thing you’d like to share upon?

Carl: Yeah that sounds good. It’s a good description of what I do.

Clint: Awesome. So tell us, someone comes in with rheumatoid arthritis. They’ve come to see you to get some help. What approach do you take with people?

Carl: Well it’s simply just looking at where they are in terms of their condition in terms of how the knees are, how their joints are feeling, and then just teaching them basic functional movements. What we’re finding is a lot of clients are doing exercises but that’s not actually functional, and actually strained themselves. So what I do is take them gently through their movements, their range of movement where they’re able to move in a comfortable range. And then teach them how to move functionally, and so they would do strengthening, and stretching, and just giving that joint good mobility. It’s cheerleader’s no a hands on approach on my approach. And so it’s purely using exercises to really help them to get through that process.

Clint: Right, in that way you differentiate yourself from a lot of other practitioners who are as you say very hands on. Who are like our massage therapy kind of friends, acupuncturists sort of friends, and then there’s the physical therapy group. But what you’re saying is that you basically just teach people how to use their body through exercises that they can learn, to then have a better way of injury prevention, and better strengthening of their supportive muscles when they’re going about day to day activity.

Carl: It’s moving in accord with the body. If you notice many of the exercises are designed to strengthen muscles as opposed to looking at how we’re designed to move rather than designing for the body. So there’s a spinoff because a lot of guys are using things like squats and some natural movements but it’s just really getting to the real when it comes to people you’ve got pain your technique and that small little deference and adjustment you’re getting close to back to where I call back to basics of (inaudible) makes a real big difference.

Clint: Yeah. What impressed me about your work after you reached out and said Hey I like what you’re doing and like I’d like to share some thoughts around this topic. What I really liked was that you were absolutely spot on with your minor adjustments to some of these common positions that we find ourselves in because I’ve experienced problems in virtually every joint and you’ve sent me through paperwork and you say hey this is how I work with my clients with rheumatoid arthritis and these are the adjustments that I make based on these common movements. And I’ve looked at them and I’ve thought to myself “It’s almost as though you’ve been through all of this yourself because the insights that you’ve got and that you’re providing a more accurate than what I’ve seen elsewhere”. And that’s why I wanted to talk to you. So let’s get stuck into the first one that you have on your description here. And it’s around just getting up and down off a chair or a toilet. Now, this sounds so trivial if you’ve never had a condition like rheumatoid arthritis.

Clint: People if they were watching this now and maybe they’d just but say they’ve accidentally stumbled upon this video. Those are why on earth would you want to talk about getting up and down off a chair. But do you actually know that I’ve actually asked my wife to slowly get up off a chair in the past so that I can watch her because you almost have to learn it again when you’ve had a terribly debilitated knee problem. So tell us how should we get up off a chair. What should we look for and give us some tips around this.

Carl: Yeah. Well I think as you said most people don’t think about the muscles they use to get off a chair. They simply get off a chair and you’re fine with people in pain. The first go to is going to.. is using your legs. We’ve all been taught that that you’ve got to strengthen the leg muscles and when you to (inaudible) you have to bend your knee so the natural inclination is to use leg muscles. And the other thing especially if your weak is you use your arms. You’ll notice that most people can get out of the chair and this is a good point for rheumatoid arthritis is that in pushing to their elbows using their upper body strength to get up so that the most important muscle that you want to use is your core, abdominals and you want to use your glutes. And for those who don’t know where that is it’s a (inaudible) point that they know learn where the glutes are you know and your abdominals.

Carl: It’s amazing how many estimations after how many people have no idea what muscles they use. But the idea Clint is for people to realize that it’s all about the center of gravity. And when you are getting out of the chair you’ve got to get your sense of gravity forwards and you’ve got to position your feet slightly back at your knee and you’re at the angle between your knee and your ankles slightly back of 90 degrees. What most people do is it cool their heels back when you ask the average person to stand up. The first thing you see is a pull the ankles back and what that does is it gets them to use their knees to stand up instead of using their hips. So it’s really about getting the center of gravity forwards leaning forwards from the hips not leaning forward from the waist. And there are notes and again provide notes to show but I’m happy to do that or do videos just to show people how to actually get up properly from a chair. The other mistake we see with chairs is that the chairs are too low. The modern look at a toilet for example. It is really low and the ideal position especially with someone with RA is to get them to have their hips higher than their knees and that helps you then get the weight forward into you less pressure on the back less around the knees you’re able to then get up to. I mean if you think about the average chair, it’s almost doing a full squat position and if you are overweight, so we struggle with that it’s just makes the problem much worse.

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Clint: Well there’s a lot of information in there and I bet everyone in their mind is trying to do what I’m trying to do which is to picture the positions of the heels, the ankles, whether or not the feet are flat on the floor or whether or not the balls of feet remain on the floor and whether or not you shuffle forward to the front of the chair and pushed down with your elbows which you’ve said not to so I think what we’re going to have to do here is definitely provide a couple of if you haven’t already got videos made, I think what would be most beneficial is definitely a couple of diagrams that can go along with this and what we’ll do is we’ll make it really simple for people so this episode will be located at paddisonprogram.com/carl C A R L, real simple so people can go paddisonprogram.com/carl. Not only will we have the transcription of everything we’re saying so that you can read through quickly if you want to go through the content quick, but we’ll also have some images in here for each one of these. But I don’t want to give up for those people who just want to continue to learn more if they’re on the treadmill or on the way to work. Can you at least do a little bit, the best job you can in trying to paint the picture for us. Let’s say I’m sitting in my chair, both my feet are on the ground. It’s time to stand up.

Clint: You’re saying I should contract my abdominal muscles, my core muscles and then roll my weight forward and then push up through the heels, perhaps. What should we focus on?

Carl: Yes. Step one will be to shuffle to the front of the chair. That’s good but that’s a good point and then number two would be to look down at your feet and just look at the position of your ankles relative to your knees. What you’ll notice is that often if you were to draw a line to your knees, your knees are ahead of your feet or your ankles. So you want to bring your ankles and start off with just in line with your knees and then shuffling slightly back. So that will if you put your knees and your ankles at 90 degrees or further forward you’re going to show it’s natural to stand up even if there’s no way I can stand up from this position and that’s correct, you want to actually bring it back. In a good position is also to put your hands on the side of your hips at your hip level. And you want to roll and lean forward from your hips to get sort of a momentum forward as you lean forward. It’s almost if you think about a tennis player who is in that position he’s got that sort of leaning forward position, you leaning forward and you’re pushing thru the heels of your ankles and then activate the glutes rather than using your quadriceps and hamstrings. It’s not to say that your quads and hamstrings are not working but the power that gets you out of the chair must come from the glutes. You can try squeezing the abdominals but you want that to happen naturally.

Carl: You’re finally getting out of the chair actually naturally engages the core muscles if you’re doing it correctly and you apply the technique that I’m going to be teaching.

Clint: Interesting, very interesting. I’m having a personal trainer on the show in the next few episodes and he’s going to be talking all about strengthening the abdominal muscles and also the glute muscles stating that most of his clients…that’s where he spends a lot of his foundations over the first few months working with people and sees everyone’s week in their glute muscles or if you’re not sure and you’re wondering it’s the buttocks muscles like the buttocks muscles and the abdominal muscles. Working with clients yourself, do you find this also that everyone seems to be weak in their glute and ab muscles or do you think it’s more pronounced with people with rheumatoid?

Carl: No, it’s a general problem we see in our class and patients. And I hope I’m not going to be you know it might be kind of controversial but what are the things we see with a lot of the people now because it’s a weakness and structures and physios and a lot of the chiros are instructing their clients to squeeze muscles.

Carl: And the reason that they’re doing that is they’re trying to bring awareness to these muscles, but the actual problem is that because people are not moving functionally and are not naturally engaging this muscles. So you can have someone who is doing squats or an exercise in general you’ll see a lot of these sort of Pilates base exercise where clients are squeezing their glutes, squeezing their abdominals because they are weak but if we actually just let them move and do the exercise, you’ll find at the office I don’t feel my and I don’t feel my abs but I do not believe them squeezing them and then I take them and I say to them. Well let’s put you in a different position, let’s put you in a position that’s functional. And then funny the person said, but now my (inaudible) are working, and I’m like there you go. So it’s all about getting the right positions.

Clint: I like that. Okay. And the controversy is good because it enables us to you know challenge our way of thinking. So just in your personal practice you would prefer to not have to squeeze a muscle to activate it. You would prefer to put people into the position so that the muscle is clearly activated on its own.

Carl: Correct. Exactly.

Clint: Okay. That makes sense, it makes total sense. Okay. So I think I’ve got this right. So I just want to labor this point because are some people who are only going to listen to this or watch this then they’re not going to go and look at the picture. And I want them I’m passionate about helping people get this right. So we’re going to be sitting on our air we’ve just finished our big vegan meal, and then we shuffle forward to the edge of our chair with the tips of our knees should be may be a roundabout sort of the metatarsal muscle of metatarsals or like the padding of our feet, roundabout that. If we were to draw a vertical line.

Carl: Yeah.

Clint: Okay. But certainly forward of our heels or we won’t be able to stand.

Carl: Correct.

Clint: And then we can put our sort of palms of our hands right next to our hips, and then we can roll just roll our upper body forward a little bit. So as to shift the center of gravity off the chair, and we can push down a little bit it out with our hands and roll and stand up.

Carl: That’s great and key here is gain the center of gravity forward, because that then brings the hips into a play. Where if you just go straight up out of a chair which most people do, that’s why they have to use our arms because pushing directly up against gravity.

Clint: Oh yeah right yeah yeah. Gotcha.

Carl: And you’ve got to get that leaning forward with that couple with the ankles in that specific position, and then you will you able to feel the glutes come on.

Clint: Otherwise it’s kind of like doing a mini dip. You just kind of using your triceps.

Carl: And I that just strains the elbows for a lot of clients.

Clint: Right. Okay. Well I hope people are enjoying this I’m finding this fascinating. Tell us about the toilet, toilets a little lower than the chair. Is it basically just more like a more difficult chair to get rid of, but the principles are the same?

Carl: Correct. It’s exactly, I if you look at it from an athletic point of view it’s a real deep squat. So (inaudible) Africa here but it’s a deep squat. And so for me the key getting off of a low object to a toilet, you’ve got to use momentum, you’ve got to almost get a luck of 1, 2, 3, go and use momentum it’s provides the impetus the energy to get out. If you just sort of go from a standstill position it’s fine if you’re young and you’ve got the power. But if you’ve got pain or you know a little bit older that’s a challenge. I would even suggest to someone who is older is to get their seat their seat raise high, that’s really struggling you can get those I don’t know if you were in Australia.

Clint: We have them for the kids you know like these little a little sort of raise that up by about 5 centimeters little platform that has a smaller size for the kid to sit on so they don’t fall in.

Carl: That makes such a difference. I mean it really makes a big (inaudible) if you got a lot of pain. If you think about how many times you go to a toilet a day, that day that alone can can keep your knees inflamed, just getting up and out of a toilet.

Clint: Okay I’ve got to throw in some experience on this, this is so close to my heart. People who pay a little attention to my personal history know that I had the worst knee that has miraculously managed to avoid having an arthroscopy or even a replacement even though it has been suggested. Now trying to get off up a toilet that has been very difficult over many years for me and even to this day. What I’ve noticed is that if I get up off the toilet in a way in which I think I’m strengthening my quads. For instance which I like to do sometimes and think I’m just going to get up without using arms and I’m going to find a balance. Sometimes I’ll do a counter balance and put my arms out in front of me so that the arms out in front of me kind of pull the center of gravity forward, and then I treat it literally like a squat like your arms out in front of you. Now what I find is that that really tends to over several days create tension and tightness in the lower part of my quadriceps above the knee.

Carl: Correct.

Clint: And if I don’t stretch my quadriceps after several days they become quite upset and my knee begins to hurt a little bit at night when I’m sleeping. It needs more, like I just have to roll around a little more and it’s only this year that I’ve discovered that it’s that that tightens up my quad on the left side that’s the one in the damaged side. So I mean have you observed to that level of detail that that’s the area?

Carl: Yes exactly. And you’ll notice we you again look at the foot position, you’ll notice that when you and you go you can tuck your ankles back closer to the toilet. And so you then using your brain on the quadriceps which is overworking your quadriceps but the other thing you’re getting there is you’re getting a lot of compression. We call it axel compression loading on the knee joint. So you’re actually really straining the joint, you’re getting the patella tendon I’m getting little detail now the knee but the tendon in the front and he is taking a lot of low and strain and so it doesn’t surprise me at all when you say that your quads are overworking. Apply the same technique, get in the ankles slightly forward not 90 degrees but slightly back but you’ll notice when you go to the toilet and most people tuck their ankles. They break their ankles almost right back to the toilet bowl, to then push up from their knees and their legs. Not having the mindset, I’ve got used my (inaudible) so I’ve got to get my weight forward.

Clint: Yeah.

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Carl: The other thing you can try with toilet if you got a really really sore left knee, is you put the left foot slightly in front of the right foot, which will naturally cause the right leg to work harder. When your feet are parallel to each other, they’re both gonna share the load. Although you may subconsciously or you know shift to one side anyway. But try just putting the sore leg slightly in front, and then getting up and that also takes the strain away.

Clint: Yup, I’m smiling because I have experimented with all these things over the years, and I know that that is something that that does help. Now look we’ve got some other things to cover here we’re going to talk about air stairs in a minute, and we’re going to talk about some basic bending and how we should reach down and pick things up and so forth so we’ve got that to come but before we move on. Why don’t we talk about, we’ll just sort of take a deviation for a moment and talk about a way in which we can actually build some strength in our glute muscles so that this process of coming up off chairs and toilets become easier. So how could you guide us through a way that is the most straightforward, and basic, and something people can do at home so that when they do then do the chairs and the toilets it becomes easier?

Carl: Yeah. So first if you’ve got a cushion in your chair and you raise the height so your hips are high then your knees. You can start off by just doing a couple of exercises from that height. Then the next progression would be to then lower the cushions, lower the high. So you want to get it built on by 90 degrees or you’ve got your hips and knees almost in alignment. And then I would go back up with the cushion but then holding like a kilogram or 2-kilogram weight, where you hold the weight in your hands like this it can be a catabolic, can be a water, it can be anything over a kilogram, and literally it stand up. Because that’s not adding weights to the glutes, and you can go from 1 kg, 2 kg, to 5 kilograms. I would be careful then doing that weight at 90 degrees because that would be quite a progression, but that would be how we and I can put a list of progressions for your class so they can sort of go through that but that’s really effective. And you’ll notice that’s a really effective course drinking exercise. I must just point out the core, your abdominal muscles work together with the glutes and you’ll notice that most exercises that doesn’t happen unless sucking it in. Which in my opinion what are we actually got to move away from.

Clint: Right. So let me repeat back so that you can gauge my understanding. So what we’re talking about now we’re talking about actually doing some exercises so that when we are coming up off chairs and toilets over time this becomes easier for us because our muscles are stronger, and they are more almost trained to be able to do this under safe conditions and we’re putting them through repetitions in a safe environment.

Clint: So what you’re suggesting is at first, raise the height at which we want to touch our buttocks to by actually putting a pillow or something on top of the chair.

Carl: Correct.

Clint: And then what we are to do, is to with the weight in the heels and we hold the weight in front of us maybe a kilogram or so in front of our chest perhaps out in front of our chest.

Carl: And it’s specially important with any exercise, is to keep the elbows by side. That’s called a chicken wing, so you don’t want to hold, you’ll notice (inaudible) keep it low.

Clint: Yes okay, and you are allowed to lean forward?

Carl: And then sit down. So you’re basically doing the same technique just with the weight by a side or holding a weight. You’re adding weight to the squats.

Clint: Gotcha. We come down, we touch gently on to the pillow, and then we come back up again, and then we repeat that. Now once we get good at that then we can either decide to increase the weight a little bit or we can lower the take the pillow off and try and come down and touch our bum onto the chair. Yeah?

Carl: Can I just interject this Clint?

Clint: Yes.

Carl: What’s actually important is you want to actually depending on your level of pain, you want to sit back down because going down and just catching the pillow is a big big progression. Especially with your lower back muscles and knee muscles, so having the patient sit down get back up, sit down get back up. When they go to just going to pretend to sit down or just touching that pillow that actually requires a lot of muscular strength and coordination. So for someone who’s not in pain they won’t pick up the difference, but someone who got any sort of back pain or knee pain straight away they’ll say this is too much. So we want to first that would be actually a final progression is having the weights touch the (inaudible), get back up. Does that make sense?

Clint: Yeah, because you’re not allowing any moment where you can get a rest.

Carl: Correct. (inaudible) you’ve got lots going on there.

Clint: Okay. And so I think we’ve got our, I think we’re clear now. So the early early stages of this you actually want to use the weight, sorry early stages would be put a pillow on top, no weight, come down, touch the pillow, and actually sit down. And then you come back up off again, and maybe do that 10 times, and then we’re good, we’re done okay. But then as we get better and stronger, we can then add a weight and continue to sit down in between set, in between repetitions and then the ultimate end game is no pillow, quite a lot of weight, and go down touch come back up, go down touch come back up. And then if we get to that point then getting up and down off the toilets and seats here and there throughout the day, should be pretty easy.

Carl: Yeah and you’re ready for, you’re ready for what we call the functional squats as well. You ready for the next step which is great.

Clint: Okay. Awesome. Well I’m glad that there’s a continual progression to higher levels that’s awesome. Okay. So what we’ll do is we’ll definitely get a picture of that particular weighted squat technique, which I think we have here in the notes you’ve sent me but we’ll get that embedded into the show notes. Okay. I’m sorry.

Carl: I’ll send that through, I hadn’t sent it through yet.

Clint: Okay, fantastic. So just to recap where we’ve gotten so far, we’ve talked about sitting and getting up off a chair and a toilet and the best way to do that if we’ve got problems with our lower body. And then we explored some ways to build strength in the areas of our body that is needed to do those movements, so that we get more and more stronger and better at that. Now let’s talk about some stairs, let’s talk about how to walk up some stairs. I’ve done training on this myself in a video that I recorded some years ago, and it’s called “How to Reverse R.A. in the Knees”. It’s a long video that goes for about 50 minutes, it’s loaded inside Paddison Program Advanced Healing package and also inside our support platform.

Clint: I may have made a mistake in that based on your training here. No one’s called me out on it and certainly I didn’t aggravate my knee by this small adjustment. But let’s talk about this as we go here with stairs, tell me the correct approach and then I’ll discuss with you the potential mistake that I’ve got in my training.

Carl: Yes. You know people often laugh at me and say, come on Carl there can’t be a technique for climbing stairs. But again, it a functional movement and so no one’s really taught us if I think about my school background. No one’s ever shown you how climb stairs, taught you how to land but it’s something you do every day and again if you’re someone in pain it’s really important you get the technique right. The first problem we found with stairs I don’t know what it’s like in Australia, is that the actual tread the size of the stair is quite narrow the width. So you find a lot of people struggle to put their whole foot on the stair, and that’s actually the secret you’ve got to get your whole foot if you can onto the stair. And we can cover that later that when you target your whole foot on, but the first step is you’ve got to get the whole foot onto the step. Then the next thing is that we’ll see is because we have this mind set or just the way we been naturally moved is we use our knees again. We use our knees to push, we push into our knees and we use the quadriceps and the hamstrings again without getting their hips to work. And it’s all about the position again, so here once the foot is on the step you want to make sure that your knee remains at 90 degrees to your ankle. So you’ll notice when you’re climbing stairs and you look at the picture your knee goes way forward, if this is my ankle and there’s my knee you’ll notice that the knee does that it goes way forward instead of staying 90 degrees. And any sort of movements towards the toes will just aggravate the knees and bring on all the wrong muscles.

Carl: So when you put your foot on the step and there is your knee you want to keep that angle 90 degrees. Then leaning slightly forward again from your hips again that’s bringing the center of gravity forwards, and you’re not going out vertically and that’s again another problem people make. They go up, they sort of go up against gravity and that’s again you’re pivoting around your knee and low in the knee. So you want to lean forwards and and I think the picture will be much more easy to understand, you see what it looks like with the pictures but that is the general idea. As the usual glutes, I see lots of people climbing stairs with the wrong technique. But because they’ve been instructed again to squeeze their glutes, they are using their glutes but because they’re squeezing. But you know if you go up 100 stairs or 50 stairs you get a lot of squeezing and it is not a natural movement anyway.

Clint: Right. Okay. So no squeezing of the glutes or generally any muscle has come up again which I am learning is an important thing for people watching this online and watching the video I’m just going to show the correct posture right here in fact I can’t see my own video so I might be able to hang on let me see momentarily if I can get this. Yeah. Here we go. Okay.

Carl: That looks good. yeah.

Clint: Yeah. So look if you are listening to this then this moment is the biggest waste of your day because he can’t see what I’m doing here. But if you’ve watching this online, then what I’ve just shown on the screen here is an image whereby the knee is directly over the heel or the ankle and the body weight is definitely leaning forward. So probably by about 30 degrees not quite 45 degrees so a lot of forward momentum, and the full foot is on to the stairs. Now let me just give you a couple of questions around this, at first does this feel uncomfortable when people transition across to this style of stair climbing because are we then engaging some muscles that we don’t normally use?

Carl: Absolutely. I think it does take a bit of time to get and often people said that this feels so weird and I said because you’ve been doing it you know you haven’t been taught how to do it correctly. It’s color holding a golf club for the first time or doing anything for the first time really. It becomes, the interesting thing is it becomes really people pick it up quite quickly and then I ask them to do it wrong and yes I can’t do it wrong anymore because I’ve always learnt the correct way. Their body naturally to do it that way so, yes it does feel strange in the beginning but again starting small steps don’t go start on deep steps, get the technique right. And then you can progress deeper steps, but it does become natural. It’s not something you’re gonna have to think about every time you climb stairs.

Clint: And now let’s talk about the modification. If the stairs don’t hold the whole foot.

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Carl: That’s a great point. So if you put your foot halfway up a step, I’ll use my hands again I hope you can see in the video. That’s your foot, and that your knee, what you’ll find is that your knee will have to go forward, and because of the thing. And what you want to do is you want to picture an elastic band around your knee that as you step up the stair that the knees almost being pulled back into a 90 degree angle. So your almost using your hamstring and glutes to stop the knee going further forward, and causing the problems. It’s like someone’s got an elastic band it’s just tagging your knee back. But you don’t want to yank it back, you want to slowly pull it back. You’ll notice it gets the glutes to work really effectively and it takes a lot of strain on the knee.

Clint: Okay.

Carl: My knee replacement patients people have had knee replacements this is you know they should be the first thing people learn is how to get out of the chair, and how to climb stairs after any knee. But it’s funny, you know we don’t see it after about a year after operations and they say they’re killing them and then we like having to learn this and that no one’s ever shown us this.

Carl: Wow okay. Good. So there needs to be a mindfulness, and an awareness, as we climb stairs if our knees are injured. That if we’re not able to get our full foot onto the step, then we have to imagine that the back of our hamstring and our glute muscle is pulling the knee backwards as we rise up the stairs.

Carl: Well said.

Clint: Okay. Now you know something that I observed when I was doing the Inca trail and we were on this very big hike in Peru my wife and I. Lot of observations but a couple of key ones is, first of all just a comment which was even with a really really damaged knee, my knee felt better after miles of hiking than what it did through inactivity. And I think that’s an interesting point. It’s amazing how we forget that all the joint is there for is to be moved, and that if we weren’t meant to move that part of the body it would be a bone. It’s only purpose is to move. So even if it’s damaged it still wants to be a moved part of the body. So that’s the first observation and then the next one that I’d like your comment on, that I found it harder to go downhill than up. And are there some downhill or down step, some down step tips that you might have for us. And I know we’re headed into some territory that we didn’t prepare for but, what are your thoughts on going downstairs if you’ve got some sore knees and weak muscles?

Carl: Yeah. If you think about the action you’re going now with gravity, you’re going down, the potential for loading is obviously increased. And that’s why a lot of people do struggle with the downhill. The thing I find with going down, I love a trail running and hiking is that you’ve got to transition the weight quickly over the knee. What people do because they so worried about hurting the knees they go down really slowly, and then they put their foot down and then actually load into it and they’re almost anticipating the pain. And they sort of quickly hop over anyway. So they actually transition quicker in the first place, but it’s a technique you have to learn it’s hard to describe it over the internet. Say I can certainly show people a video and I can describe it in the notes, but the idea is that you don’t again if this is your knee joint you don’t want to go like this. You don’t want the knee to go forward again. And so a lot of people in their climbing going downhill, they put their foot down and a knee goes like this and there’s a load into the knee and in this problems again. So it’s learning how to actually bend and the hips going down when your hiking, and taking and absorbing the load into the hips rather than taking the load into the knee. And that’s the actual keep going down hill.

Clint: What you just said triggered a memory from, have you read a book called Born to Run?

Carl: I haven’t read it, it’s on one of my lists but I hear it’s very good.

Clint: Absolutely brilliant book that I highly recommend, the sort of thing where you kind of in your particular profession that sort of thing that you might want to read from a point of view of providing some more insights into what you bring to your work. But at the same time you get so caught up in the story that it becomes like an adventure thriller and you just can’t put it down. I mean it is a fascinating book Born to Run by Christopher McDougal true story. In the book he talks about the mechanics of running, and you’ve just reminded me with your discussion about going downstairs about the mechanics that are described for the ideal physiological position for running. Which is to sink low into the hips to be very very light through the knees and the legs, and to almost be like your just touching the surface, just gliding quickly over the ground as you move forward with the weight into the front of the feet as opposed to the heel. So it’s almost like you’re just sweeping dust underneath your body as you move forward sitting down into the hips. And that apparently is the mechanical way to run.

Carl: I coach running that’s one of the things that I do and like if anyone’s interested in looking at that, I do coach runners and I teach exactly I don’t even know that was his thing. But I teach the softening of the hips, soft ease and then again a slight leaning forward which is a big thing runners don’t do. They lean forward from their upper bodies or they lean forward from their ankles which we see a lot of problems cause for them to digressing. But I love that description because that’s exactly what I teach, just again is all about positioning the body. If you get the people in the right position and so many people are going for therapy’s and there is a time and place for receiving sort of physical therapy and whatever you go in for treatment. But what I’m seeing with my runners now I’ve had problems is just getting them in the right position. And it’s amazing heart so that a lot of these common symptoms you see with runners.

Clint: Awesome. Okay well that’s another thing that came out of this that’s very interesting. Let’s move on to our last stage of things we wanted to cover today, which was just some basic bends moving down into picking up something that’s on the floor so that we get it right and we don’t cause a problem.

Carl: So you know there’s a lot of history to this. The problem I see with bends is that in our generations that we’ve all been taught that were need to pick up something to avoid back pain, we are to bend our knees and keep our backs straight. It’s kind of a mantra we’ve been living, I don’t know but that’s certainly is Africa what we’ve been taught here is to you know use your knees, keep your back straight, squeeze tummy muscles. Unfortunately while it saved our backs it’s really messed up our knees.

Carl: If you look at 1st world countries, everywhere you go in first world you can’t even see a surgeon in six months to book knee up. I mean if you look at these, in these 3rd world countries they’re like what’s a knee replacement? What’s the hip replacement? And I said you know, it’s amazing that we’ve got all this wisdom and knowledge that we rootle with all these hip and knee problems. And I put lot down to the poor movement, simply the most important thing is bending like you’re going to sit down in a chair and there’s no other way to describe that you’re basically bending down is like doing squats. We are to keep our knees in that 90 degrees position or that soft position I talked about. And then let’s you go down as if you’ve gotta take a seat. Don’t ever bend down with your knees straight especially you’ve got pain or if you don’t have the mobility if you’re not a yoga instructor, it puts a lot of strain to the back of the knees, the neural systems in the back, the back muscles. I would rather you bend your knees than bend from your back, but the optimal bending position is actually the way you would sit down. So the start of bending is the same you would start to bend down as if you’re going to sit down in a chair. That you would have to just practice because I wouldn’t want you to go straight away and lift a heavy object without practicing that technique first you might actually strain your back.

Clint: Okay yeah. Well I guess it glows with common sense doesn’t it? I mean if we hadn’t learnt anything intellectually from intelligent, educated, people like yourself and Western society and we were out living in tribal community and we wanted to bend down. You probably would bend your knees, you’d bend your back, you’d reach your arms out and you’d just pick the thing up. You wouldn’t kind of get into this nomos character like position that they show you on sides of carton boxes.

Carl: (inaudible) with a big cross.

Clint: Yeah that sort of thing. So it’s reassuring to know that you know our intuition is still relevant today. Okay cool. Well let’s get some pictures from you to embed into the show notes for the squat exercises, to come up and down and build our important muscles for the chair and toilet, the stair climbing approach, and also for a basic bend for bending down to pick something up. Now I’d imagine that if someone has some problems with their hips, knees, ankles, that just learning these techniques should be a big improvement for them. And have you seen that with some of your clients?

Carl: Yes, it’s been amazing to just see how that the joints are actually in a sense grateful for the natural movements, and not being put them into positions with actually strained. Another thing is a lot of people are passionate by doing exercises while they are strengthening one area of the body, they’re actually straining the other area of the body. And when you talk to them after the next day, they never say to you I don’t know what exercise I did that hurt it. But then I will go to the techniques again, and say what did you do this? And they said yes, what’s that got to do with my ankle? And I say everything, because you know you’re stepping up from your ankle joints. And so making this small changes, the biggest comment I get from people is that you’ve hardly done anything, you’ve hardly moved. You’ve basically moved my knee back one centimeter on the video or you’ve just turned my foot out. And I say it’s all about the small changes, and it makes the biggest difference.

Clint: Yeah most definitely. You know when I do bikram yoga which is just a specific form of yoga same 26 postures over and over again in a hot room, very challenging class.

Carl: I can imagine.

Clint: But let me tell you, it’s like hard core military rules around alignment. Sometimes instructors will state the script because it’s all scripted word for word as to how the positioning of the body should be. And if one person hasn’t got their foot perfectly 90 degrees to the other in setting up for a posture they’ll say do it again, from the start let’s do it, because it is so injury adverse focused. We do not wanna have one person getting an injury in the class. And so if it means putting your left hand before your right hand, and you go right and then left hand, then they get upset the teachers they don’t want to take any risks. And it comes down to like you say millimeters, centimeters, it matters doesn’t it?

Carl: That makes a big difference. And the thing just to also put in here, the body awareness is Klan’s you’ve got to start to understand and feel their body. It is just that they have an awareness of what muscles are using, and what they’re feeling. Even if they’re in the right position sometimes the right position can hurt, so just to know, you know I’m doing exactly what Carl is saying or what the instructor is saying. But I still feel pain is just stop. I have saying now which is very, goes against the common thing is you know no pain no gain. Well that’s true if you’re going to be working as an athlete and you want to be you know breaking muscle as they say. But my thing is gain without pain, and that’s really how I try to coach my patients and my clients are no gain without pain.

Clint: Well that’s why you’re doing so well because people are in a lot of pain already and they don’t want to add to that. The word gain is an interesting one for my audience and most of my folks who are doing really well with their pain reduction, but then they want to gain a little weight, add some muscle and so forth. And so I’m going to be paying more attention to that over and above what I’ve done in the past with my own work by having some guests like yourself, like a personal trainer coming up shortly. Now I just want let people know that I’ve invited you to come and speak and answer questions and handle one on one situations with my support group and we’re going to be doing that the first week of August. So if you’re listening to this episode in the future, you may have missed that opportunity. But you will be able to watch the replay of the Q and A session that Carl is going to be doing. And if of course you’re listening to this when it’s gone live a week or two within when it has been released, you can participate if you are a member of Paddison Program support. Then you can just simply join us on that live training and get help directly from Carl. Not just on the lower body, but he has information across the shoulders, the elbows. And I’ll let you expand on that in a minute, but I know that you’ve got those parts of the body covered. And that way you can get one on one help at my cost, and as part of being a member of my support group. And I’ll have Carl there available to you and as I said you can watch the replays and we’ll load all of the answers into the frequently asked questions. So if you’re not a member of Paddison Program support definitely try and join when we open again shortly, and be with us for when we chat to Carl.

Clint: Carl what else can you help my members with other than the shoulders, elbows? I mean if they’re presenting with physical symptoms, I’m sure you’ve got ways that you’ve worked with clients who’ve had lots of various joint issues other than the lower body.

Carl: Shoulders seems to be quite a popular joint, a lot of people are struggling with. Again just you know it’s a” technique what we talk about how one of the problems we see was shoulders as that people generate power from their shoulders. So an example of that would be, if you had an arm wrestle or if you were to push or punch or do any sort of movement with the shoulder. Where we’ve got to educate people how to generate power from their core muscles. The shoulder, the muscles around it are powerful but it’s all about it. Again the position, is all about how you position. I find that a lot of the movements when it comes to the shoulders, and you might be able to relate to this in the clients you do shoulder exercises, is it’s not functional. So what I mean by that is it’s almost robotic, if you watch people and then I want to try demonstrating the video here but it’s literally like a robot. You kinda arms goes up, arm goes to the side. It’s very robotic, there’s no movements or any sort of rotation and fluidity in the movement. And so the shoulder becomes just this isolated joint, and it just gets absolutely smashed. And so we’re teaching coach you had to actually move, it sounds funny we’re like human really.

Clint: Yeah I like that. The chiropractor that I have seen a few times over the last few months, he talks about the same kind of approach. And how rather than going to the gym one do rock-climbing, right? Or if you’re at the gym, rock-climbing for example I mean it’s back closer to what is natural right? At some point. Awesome. What we might do on that live training call with the support group, I might have you go through some of the exercises for the shoulders, for the core muscles, and maybe for the glutes as well and we’ll just cover off some of that content before we take the Q and A.

Clint: Well we’re out of time though for today, and I just want to thank you especially regarding the short notice on this and especially regarding the time in which you have set aside here early in the morning. And I want to be able to offer your contact details to people who want to be able to reach out directly to you. So how should people find out how to contact you?

Carl: Well at the moment my web site is doing work on it, but they can get me via my email address which is carlwellness@gmail.com and I’m happy to answer any questions. We’ll go give them some contents, also ideas on my notes that the pdf documents with details, all the tips and things and how to go about these exercises. And also do large Skype consultations, so they’re welcome to skype me and we can set up appointments and go from there.

Clint: That sounds fabulous. I certainly wish that I had to have access to your services when I was going through all the darkest days of my struggles so I’m really grateful that you’re able to share what you have today and offer these services to everyone else. So as of now though I want to say thank you and I’ll see you again early August for our online support group call. Thanks Carl.

Carl: Thanks Clint. Looking forward to it, cheers!


functional movement, injury prevention, joints, physiologist

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