Pain Free Performance — Posture Alignment Therapy

Live Pain Free!

Knee Pain

Knee Pain: How to treat, prevent, and live Pain Free with Egoscue Method

by

Knee pain is a frequent issue that brings individuals into Pain Free Performance. Pain in the knees can often be diagnosed as arthritis, instability, weakness, or tearing of the supporting structures. In order to identify the root of the pain and not just treat the symptom, the first assessment needs to focus on the joint position of the knee that created the diagnosis.

During an initial assessment, it is important to palpate the joint position and identify muscular and structural imbalances. Clients with knee pain often present with knees that are rotated externally or internally from the hip. A kneecap (patella) or femur position (the position of the thigh bone from the hip) that is not straight creates an uneven distribution of load on the knee, ankle, and foot. The knee was designed to be a hinge joint and function by bending and straightening. If many of us are walking, running, and jumping with knees that are rotated, it is no wonder acute and chronic knee pain are frequently diagnosed and treated!

Our bodies are brilliant at compensating for muscular imbalances and changes in function. Clients with acute or chronic knee pain often stand with their knees bent in flexion to take pressure off the knee. This creates a cascade of compensations throughout the body. The hip begins to tilt, the spine is altered through rotation and flexion, and the ankle and foot begin to turn outward. Compensation for joint position and pain can lead to more issues down the road. When the joint position of the knee is rotated and out of alignment, individuals with knee pain who undergo imaging, such as an MRI or CT scan, may show a meniscus tear or cartilage degeneration. In our practice over the past decade and a half, many of these clients had been advised to have arthroscopic surgery that did not resolve their knee pain but instead made it worse. Recently, medical literature has supported this observation, stating that “for most patients with osteoarthritis of the knee, arthroscopic surgery offers little benefit” (Mounsey A, Ewigman B. Arthroscopic surgery for knee osteoarthritis? Just say no. J Fam Pract. 2009 Mar;58(3):143-145. PMID: 19284940; PMCID: PMC3183924).

So how do we treat knee pain? At our practice, we use postural alignment therapy, the Egoscue Method, to identify the root cause and imbalances creating pain and work toward lasting change in a functional body. This is accomplished through a whole-body assessment designed to reduce knee pain while enhancing overall mobility and function. The Egoscue Method does not just address the pain—it addresses the root cause of the pain.

Alignment: Treating the Body as a Whole to alleviate Pain

by

Healthcare today is focused on the parts. Our healthcare practitioners are specialized and focus on specific sites and no longer view the body as a whole. As a result, we are missing how each site impacts another directly.

With the Egoscue method, alignment matters. When the position of the head, shoulders, vertebrae, hips, knees, and ankles are in line the forces through the joints are distributed to allow movement with minimal effort. This is the ability to move freely and without pain.

When our body is not in alignment, our joints wear down and uneven load is placed on parts of our body that are not meant to bear the added weight. This dysfunction is often the root of pain.

Many clients find Egoscue after trying other modalities that are not addressing the compensation created by their tissues, muscles, and joints. When we see clients for the first time, their gait and the movement of their body tells the story of a system trying to fix its parts. In order to determine what is causing their neck pain, knee pain, or hip pain we must determine what body part positions are misaligned.

Our job is to release the muscular compensation and strengthen the correct muscles to bring the body into alignment. We do this through specific exercises targeted towards what is off in a client’s specific body. After each exercise, we use gait analysis and functional testing (like an arm circle or reaching to touch the toes) as tests to see how the body is changing. As things become in a better joint position, the body is noticeably moving more fluidly, straighter, and more balanced.

This is why we must consider the body holistically when pain is present. Often the site or location of pain is not the cause. Our goal is to identify the dysfunction and create an integrated muscular skeletal system where movement is freer and function is unlimited.

How long does it take to create pain relief using posture alignment therapy?

by

Most of the clients we see are in pain. These clients come to us for relief with their knee pain, back pain, hip pain, and shoulder pain. Oftentimes, our clients have been to chiropractors, physical therapists, doctors, massage therapists, and acupuncturists that have been unable to create a lasting change with their muscle and joint pain. This can be challenging for our clients because their journey for pain relief has already taken weeks and months before we meet our clients for the first time. 

 

In order to create lasting pain relief, as Postural Alignment Specialists that practice The Egoscue Method, we assess the muscular imbalances in their bodies. This begins through a complete health assessment and history to understand the patterns of movement (or lack of movement) that led to pain. We complete postural photos to see how their joint position aligns against a grid to understand how their joints are loading. This can reveal if an elevated shoulder and hip are leading to the back pain or if a forward head position is causing the shoulder pain. Finally, we complete a series of functional testing and gait analysis to determine what muscles are active or inactive that are resulting in muscular compensation and pain. 

 

When our clients leave their first postural alignment session, they can expect to feel a change in their body. This often results in a decrease in pain. If a client’s body has compensated for years, they might notice feeling “lighter” or “straighter” after doing their Egoscue therapy exercises. This is a sign that their body is becoming more functional and balanced. 

 

The work towards alignment and health takes time and effort. Our muscle memory begins to take effect in 90 days and is often the time our clients begin to notice less pain due to their enhanced alignment. Change is not always linear and might result in peaks and valleys. We encourage clients to remain focused on what is changing. Our cells and tissues are constantly adapting and we will continue to adapt new exercises and stimuli to create a change in the muscle structure. One of the great benefits of our bodies is that they are dynamic and constantly in motion. This is why the method works! Now, let’s get moving!

A look into Knee Pain

by

As postural alignment specialists and graduates of Egoscue University, our focus is on the position of the client’s load bearing joints. Our shoulders, hips, knees, and ankles bear the weight of our body when standing and moving upright. When we look at our client’s joint position, many of our client’s are surprised by their knee position. 

The load bearing joints of the shoulders, hips, knees, and ankles should align.

Try this:
Stand in front of the mirror
Look at the middle of your thigh bone that is named the femur. Then look at the middle of your knee cap.
Draw an imaginary line from the center of the thigh bone to the middle of the knee cap.
Does the knee turn to the outside of the body or does the knee roll toward the middle of the body?

If the center of your thigh and center of your knee cap are not in line, the rest of your load bearing joints are picking up the work for the uneven load. This uneven load leads to knee pain, arthritis in the knee joint, bursitis, and torn ligaments!

When knees turn out or roll toward the middle of the body, there is significant wear and tear on the knee joint. Imagine going up and down the stairs with the knee cap pointing outward. The friction and demand on the uneven knee joint will lead to knee pain. Over time to avoid the knee pain we begin to sell our house to live on one level or we take the escalator to avoid the movement that leads to pain. This avoidance of triggers will decrease the feeling of the knee pain, but does not address the cause of the knee pain.

Oftentimes the exercise we do to be healthy and support our heart, aggravates our knees and we begin to wonder why. If your knees turn outwards and you cycle or run for 30 minutes, that is 30 minutes that your knee joint is impacted and inflamed. Frequent wear and tear from a misaligned knee exercising on the elliptical, bike, or treadmill will lead to arthritis of the knee and the need for a knee replacement. The exercise is not the enemy, but the position of the knee cap in relation to the thigh bone and pelvis. 

How do we avoid knee replacements, ligament tears, and arthritis? We must consider the muscles that support the thigh bone (femur) and knee cap (patella). Through a postural alignment assessment, we will identify what is off in your body and which muscles need to be activated to bring your body into alignment. By correcting and supporting the position of the lower legs, you will continue to be able to tackle stairs and maintain your heart healthy cardio!

Cartilage Regeneration

by

The body has an innate ability to heal. What does that really mean? It means that our body produces over 500 billion new cells a day – without conscious direction from us. Cuts heal, broken bones mend, muscle tissue builds, and brain cells, cardiac muscle and, yes, cartilage regenerate!

The key to a healthy healing body is the environment we provide it. Consider your nutrition, how much you move, if you’re getting enough sleep, how you’re managing stress and how aligned your posture is.

If you consistently work on all of these aspects of good health, your body responds. In order for cell production to be optimum, each of these needs to be happening simultaneously. I want to focus on how all of this enables cartilage regeneration, from an alignment standpoint. Maybe you’ve been told your knee (or hip, ankle, wrist) is “bone on bone” and you think the only answer is a replacement. Not true!

Research shows that under the right conditions cartilage can regenerate like any other tissue in the body. The first question to ask if you are told that you are “bone on bone” is why is that joint wearing away? Where did the cartilage go that is supposed to be there? It’s all about the position of the joint and the uneven force going through it as you move. Once the joint position is corrected, the body will produce more tissue to repair itself. Take a look at these before and after x-rays:
Look at the narrow joint space (bone on bone) on your left
knee pain
One year later after a postural alignment regime. Notice the uniform joint spaces!
repaired knee without surgery
Here at Pain Free Performance we watch the way bodies move and stand. We determine if body weight is equal front to back, side to side. We evaluate the position of all major joints looking for proper loading (head over neck, over shoulder, hip, knee, and ankle.) If there is disparity, the body is not functioning properly. There are muscle imbalances causing an uneven force in the joints which creates friction. The friction wears down the cartilage. The joint becomes a victim of the imbalance and bone surfaces begin to wear away. Bone on bone.

What is the remedy? Posture alignment. And I’m not talking about your mom telling you to “pull those shoulders back”. I’m talking about retraining muscles to do the job they are intended to do. Why?…because muscles pull bones. The bones are out of alignment but they are innocent bystanders because the muscles are either doing too much or too little. At Pain Free we unravel what the muscles are currently doing and give you the tools to get them working together again. When the muscles that propel the joints are working correctly again this provides increased blood flow to the area, and allows more movement. And, yes, this gives the cartilage an opportunity to regenerate. It’s not magic but it’s amazing and possible for you too.

The Psoas

by

The psoas muscle!  Ever hear of it? Most of the people I see in our clinic have never heard of it and yet it is the most important muscle in the body.  Also known as the hip flexor muscle, it joins with the iliacus muscle to form the iliopsoas.

This muscle is the only muscle that attaches/connects the upper, middle and lower body.  For a quick anatomy lesson, it starts at the lumbar vertebrae, goes down on top of and attaches to the inner bowl of the pelvis, then crosses over the top of the thigh bone (femur) and attaches to the inner thigh.

It often does two jobs, one on each side of the body, as it helps stabilize the standing leg while also initiates the swing of the opposite leg while walking.  It is the lead domino and as the lead domino goes, so go the other dominoes.

Many of us have become so sedentary that our hip flexors lose function and shut down.  The hip flexor can and will get too tight, too lose, too weak, too strong or some combination of these traits.  It becomes short and weak as we sit for long periods of time.  Then, when we try to make up for lost time and get in a little movement or exercise –our back flares up, neck starts hurting or we get knee pain.  Maybe we get a case of hip bursitis or plantar fasciitis.  It doesn’t matter what the symptom is or what the diagnosis is, the culprit is our lack of hip flexor function.

So, it’s not your back or knee or foot or neck.  Those are just symptoms. We have to get to the cause to alleviate the symptoms and more often than not the cause is that your iliopsoas has shut down.  Because it attaches to the lumbar vertebrae, the spine and upper body are affected.  It attaches to the pelvis so the hip joint can be affected.  It attaches to the top of the thigh bone so the lower body can be affected.   The psoas is really the most important muscle of the body.  Remember the domino analogy.

The body is an inter-related system so the site of the pain is rarely the source or cause of the pain.  If you are experiencing back pain or neck pain or any other symptom, come let us take a look at you and help you regain your function…and get those hip flexors working!

HOW POSTURE THERAPY WORKS

by

HOW POSTURE THERAPY WORKS

I had a client the other day that came in with major pain and I thought I would share his story with you because this visit clearly illustrates how posture therapy works.

“Tom” came to us with left knee pain.  He had tried all kinds of things to help it – yoga, massage, stretching, chiropractic, physical therapy, even medication.  Nothing seemed to help and often his knee hurt as much if not more after these activities.

The focus of our posture work is looking at the body as a unit, as a complete system.  Most people think the problem is where the pain is, but that is hardly ever the case.  Tom’s pain tells us there is an issue with his left knee, but the cause of that knee pain is most likely somewhere else.  How do we find out where the root of the pain is?  Let me take you through our thought process as Posture Alignment Specialists certified by Egoscue University.   

As I said before, we look at the body as a unit, without focusing on the symptom (Tom’s knee pain).   I look at him to see if his ankles, knees, hips and shoulders line up in straight lines and at ninety degree angles.  I’m not thinking about what I can give him to make his knee feel better but I ask myself how is his body working as a unit?

Looking at Tom, the first thing that jumped out at me was that his right hip was an inch higher than the left.  Viewing from the front or back, his right hip was definitely elevated.  Just standing there, I could see that he did not really put equal weight on his right side.  With a hip that is elevated, it is so out of position that it is unable to do its job taking equal weight.

As a little test, I asked him to stand on one leg at a time, bending the other and bringing it up waist high.  Standing on his left side, the painful one, he could balance easily, but he could not balance standing on his right side.  So, I’m thinking that hip elevation is probably the major cause of his left knee pain, but I want to watch him walk first.  When he walks across the room and back I can see that he definitely shifts more onto his left side.  When I ask him if he can feel that he lands harder on his left side, his answer was “yeah, sort of” but when I have him watch himself walk in the mirror, he sees it clearly.

It’s a little strange that he shifts onto his painful side.  Most people shift away from the painful side.  Tom agrees that it doesn’t make any sense to him and has no idea why he would do that.  I explain that with his right hip so out of position, he simply is unable to load his weight equally from left to right.

So, Tom’s thought was “If my left knee hurts because my right hip is elevated, I’ll do some hip exercises to even them out and we’re good, right?”  “Hang on” I explained, “Let’s figure out why that hip is elevated.  Maybe that hip is the problem, but there could be something else going on.”

Often what we see in the clinic is that the client’s upper body position has a huge effect on the ability of the lower body to work properly.  When I look at Tom from his side views, I see his head way forward,  his shoulders hinged forward and his upper body rounded over.  He looks like a big “C”.  Tom’s spine should have three little curves in a gradual “S” shape, not a big “C”.  I put my hands on the top of each side of his pelvis to confirm that his right hip is higher and leaving my hands there I have Tom interlace his fingers together and put his hands behind his head and pull his elbows back as hard as he can.  He grimaces as if this is a bit difficult, then jokes about the only other time he did this, he was talking to a police officer!  But, guess what, with his hands up like that his hips become even.  I have him walk across the room again keeping his hands behind his head and elbows back and as he does that his hips stay level and load equally from left to right.  The hip disparity is gone and he can see it for himself as he walks toward the mirror.  He is amazed.

He laughs, “so all I have to do is walk around like this the rest of my life?”  I said “yeah, and in your neighborhood, they’d think nothing of it!!”  In all seriousness though, we have to get Tom’s upper body in that position without him having to put his hands up to get there.  I could see that Tom got it.

Putting his hands behind his head took his upper back that was stuck in flexion and shoulders that rounded forward and got them into a more extended position, closer to where the body was designed to be.  In this position the rest of his body changed and we could see his hips were level and his walking become equal left to right.

Bottom line:  Tom’s left knee hurts because every step he takes, he makes it work harder than it’s supposed to by putting more weight on it than it should normally get.  Along with that, as he keeps loading that left hip more and more, it gets tighter and tighter and over time stops rotating the way it should, so then the knee has to take up that job.  The knee was never designed to rotate – it’s a hinge.  So he’s not only putting more weight on that side with every step, he’s asking his left knee to do something it was never designed to do — rotate!  That knee is working like crazy taking more weight and twisting with every step – one hard step off a curb and the ACL tears – ouch!!!

Because the right hip is out of position he cannot load evenly left to right.  The right hip is out of position because his upper body is pulling it there.  In order to resolve the knee pain we have to get his upper body and shoulders in a more extended upright position.

All the other people trying to help him were only seeing his knee as the problem and so focused on the knee.  But the cause of his knee pain symptom was not the knee but the position of his upper body.  He could have done and did all kinds of things for his knee (the symptom) nothing changed because the cause of that symptom was not addressed.  We gave him a sequence of exercises to get the upper body more extended and some others to help the hip change position and stabilize so by the end of our session he felt better and walked better than he had in years.

This is not the end of the story.  In fact, it’s just a beginning.  Tom has to do his exercises every day to retrain his body so it will live in the better position.  It’s not a quick fix, but if he does the work, he will begin to stay in that better position and he won’t have knee pain. 

Where you are having pain (symptom) is rarely the actual cause of the problem.  The body works as a unit.  When we observe and treat the whole body as a unit the results can be amazing; some people have said miraculous.  It’s not so much a miracle, it’s just returning to the body’s original design of straight lines and 90 degree angles.  If you would like some help getting your body back to this basic design, give us a call or check out our website.

If you can understand these simple concepts, you don’t have to live with or be afraid of pain.  Pain is just a message that something is wrong and your body is asking for help.  Instead of ignoring it, let’s listen and then respond to it with grace and intelligence.  Believe in your body and honor it by giving it the motion it needs and the results can be truly amazing.

 MACKIE BOBLETTE

Go Barefoot!!

by

The Egoscue Method is based on the idea that health is motion.  The more we move, the healthier we are, the healthier we stay.  In the poorer regions of our world, people move more.  They may walk to get from one place to another, perhaps they grow their own food and actually harvest the fields to put it on the table – they’re moving because they have to.  They often keep moving longer than we do in our wealthier, more sedentary culture.  We could learn a lot from their lifestyle.

In these cultures, often we see folks going barefoot – while they work, run, play and walk!  People ask me at Pain Free all the time about what kind of shoes they should be wearing.  The answer is in another lesson we could learn from these other cultures– no shoes are the best for your feet!  In May of 2010, Harvard Medical School released a study that found that the more support, more cushioning and more expensive the shoe, the more likely for injury.  The reason?  Most shoes do not allow your foot to go through its natural motion.  The support of a shoe can actually weaken the muscles of the foot and the muscles of the leg and hip that work as a team with the foot.  The muscles of the feet are no different than any other muscles of the body – they need movement and lots of it! If you don’t use them, they become weak and atrophy.

 I am not suggesting that you throw away your orthotics and expensive shoes.  If you need them to walk without pain, then use them.  What I am suggesting is that if your body alignment is good and you can go barefoot, by all means do it. Your feet will thank you for it!