The Two Lower Body Exercises to Stop Right Now


Last month I detailed the 1 Upper Body Exercise to Stop Right Now, and now its time to stop the insanity with the legs as well.  This time I am giving you two exercises.  Now, let me preface this with one detail:  If you have ever competed in  bodybuilding or have already paid your entrance fee to compete, then you get a pass.  I understand the need to isolate muscles for a competition.  This list is simply for the person working out to get in shape, get stronger, or just to be healthy.  Alright, let’s get started.

#1:  The Knee Extension Machine


This is the reason I am giving you two, because this one showed up as an example during my previous post.  This machine is great for my career as a physical therapist, not great for your knees.

Muscles:  Quadriceps


Mechanism:  Works in an open-chain environment, which in this case means you are not bearing weight through the foot.  When you work the quads in open-chain the quad tendon and patellar tendon work as a pulley over your patella (knee cap).  During the knee extension exercise research shows a significant increase in joint reaction force and joint stress.

Advantages:  Hypertrophy?  Not really, research does show increased rectus femoris activity with knee extensions, the squat showed better recruitment of hamstrings, overall quads, glutes, and a better functional carryover with steps.

Disadvantages:  Imagine you are Eazy E crusin’ down the street in your 6-4, then over time your tires, wheels, and axles fall off the car.  Do you hear that screeching, grinding sound?  Yeah, that’s what the back of your kneecap sounds like during the knee extension machine.

You can hear his voice, can't you?

You can hear his voice, can’t you?

Reason to use: Can’t think of a great one.

#2  Seated Calf (soleus) raises


Muscle:  Mostly Soleus


Mechanism:  By bending the knee you reduce the force the gastrocnemius can generate. The gastrocnemius is a two-joint muscle which means it crosses two joint lines:  Knee and Ankle.  The soleus on the other hand crosses only one joint the ankle therefore with the knee eliminated, the soleus is left to take the brunt of the force.

Advantages:  Isolating the soleus can be advantageous for overall calf development.  Research has shown that the soleus contains significantly more slow twitch muscles fibers than the gastrocnemius.  Therefore, with the distance running population, it can be theorized that development of the soleus can help.

Disadvantages:  The isolation, while good for distance runners in theory can also create a significant reduction in ankle dorsiflexion (see picture).

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A reduction of dorsiflexion can create a loss of efficiency with step length and force absorption in walking and running.  Over time this can cause a breakdown in the feet, knees, and hips.  In addition, trigger points in the soleus can mimic Achilles tendonitis pain.

In both cases there are better exercises to do for functional gain, and the increased risk of injury isn’t worth the effort.


Running Away From Pain


Runners are a special breed, along with cross-fitters they will gut out the toughest of situations to complete their workout.  However, running while in pain can lead to a host of other issues.  It is common for runners to experience discomfort at one time or another especially as mileage is being ramped up.  If not addressed, these aches and pains may lead to chronic, often performance-limiting issues.

What are some of the main issues with running?

  • Knee Pain
    • Often triggered from an imbalance in the glutes.  With increased training or a change in gait the glutes can stop firing efficiently leading to tightness along the outside of the thigh.  This tightness often times is manifested by pain at the outside of the knee joint where an area that has blood vessels and nerves can become compressed leading to the sensation of pain.

Iliotibial Band Syndrome (ITBS), liac crest, Gluteus medius, Tensor fascia latae, Gluteus maximus,Vastus lateralis, Iliotibial band, Tibia tubercle, Patella, Inflammation of the iliotibial band (ITB) causes outer knee pain and possible pain in the hip, MendMeShop TM  ©2011

  •  Foot pain
    • Foot pain is often caused by tightness in the calf muscles with special emphasis on the soleus muscle.  When overly tight, the soleus can restrict proper ankle dorsiflexion leading to improper landing and push-off with stride.
  •  Back Pain
    • Back pain is caused by excessive tilting of the pelvis forward.  With this tilting the runner will likely overextend the back to stay upright.  This overextension puts a lot of stress on the joints and muscles in the low back.  In addition, this pelvic tilt can limit hip extension which can cause a vicious cycle of back issues and hip pain.


To treat these symptoms you must address the underlying cause.  If you are unable to complete your workout, or the pain lingers for more than a couple of hours after the activity you should seek a physical therapist with experience treating runners.

In general a few things you can do to prevent these issues include:

1.  Gradual increases in training

2.  Limit activity if sore.  Soreness, although accepted as normal can change mechanics, faulty mechanics can cause chronic issues

3.  Have  a proper warm-up/cool-down routine, don’t just walk 50 feet, do the general 5 second stretches and call it good.  Do some mobility drills and activate the muscles including the glutes, calves, abdominals.  To cool-down, foam roll, stretch.

4.  Don’t sit all day.  One of the things we can all agree on is that sitting after activity can severely limit recovery.  If you have to sit for your job be sure to stand and walk as much as possible.

For more information, or to see a specialist to help with any of these issues visit

The information in this post is for informational purposes only and does not substitute for the advice by a medical professional.

The 1 Exercise to Add for More Power

Exercise of the Day


Last week I wrote about the exercise you should stop. This week, let’s discuss an exercise you should add for an immediate increase in power.

If you want:

  • More distance from the tees
  • Better power in your stride
  • To get past the sticking point in your squat

Here is your exercise:

Kettlebell Swings

KB swing


  1. First, be sure you can do a proper hip hinge, and choose an appropriate weight (don’t go overboard, technique is important)
  2. This is not a squat, you must hinge at your hips and stick your butt back
  3. Address and grasp the KB
  4. The first movement is to swing under your legs
  5. Then explode through your hips driving the KB up into the swing, clinching your glutes at the end
  6. Do not use your arms, this is not a shoulder exercise

Try these in addition to your normal routine 2 sets of 20 reps

Muscles Used (According to Bret Contreras)


Here is Ann Wendel, PT, ATC, CMTPT with a great explanation.

The Kettlebell Swing

Good luck, enjoy.

The Hydration Equation

Nutrition, Pain

To Hydrate or Not to Hydrate?


So, I need 8 glasses of water at 8 ounces apiece and I am good, right?  Well, what if you are a coffee drinker?  What if you are an endurance athlete?  Is it different for a weight lifter?

For athletes and people on a low sodium diet, they can complain of cramps not from lack of hydration, but of hyponatremia or lack of sodium.  Muscles contract and relax using a system of gradients.  On one side is sodium and the other side is potassium. If your sodium level is depleted, the muscle will contract and spasm the same as you would with dehydration.

The Caffeine Myth:

In 1928 a study was published that showed caffeine was a diuretic.  Since, the prevailing advice has been to replace your cup of coffee or tea with a cup of water to offset the effects.  However, a study in 2014 showed that this was not accurate and that although caffeine is indeed a diuretic, 1-2 cups of coffee is equivalent to your water intake.

“Our research aimed to establish if regular coffee consumption, under normal living conditions, is detrimental to the drinker’s hydration status,” lead author Sophie Killer, a doctoral researcher, said in a statement. The study was published online today in the journal PLOS ONE.

Killer and her colleagues enrolled 50 men, all moderate coffee drinkers who didn’t take diuretics or caffeine-containing medication. Women weren’t included in the study because menstrual cycles may cause fluid balance fluctuations. In the study’s first phase, investigators randomly assigned the men to drink 4 cups of black coffee or an equal amount of water daily for 3 consecutive days. After a 10-day “wash-out” period, the groups switched. Coffee drinkers changed to water and vice versa.

The investigators analyzed hydration status with several established measures—body mass, total body water, and blood and urine tests. They found the hydration effects of coffee or water did not differ significantly. The study participants lost a small but significant amount of body mass each day during both study phases, 0.2%. Several factors may explain the body mass loss, the investigators wrote. One possibility is that the men simply didn’t drink enough fluids during the study. Even so, the men weren’t near the clinical dehydration level of 1% to 3% body mass loss, the investigators noted.

“Consumption of a moderate intake of coffee, 4 cups per day, in regular coffee-drinking males caused no significant difference across a wide range of hydration indicators compared to the consumption of equal amounts of water,” Killer said.

For athletes:

Proper hydration during training or competition will enhance performance, avoid ensuing thermal stress, maintain plasma volume, delay fatigue, and prevent injuries associated with dehydration and sweat loss. In contrast, hyperhydration or overdrinking before, during, and after endurance events may cause Na(+) depletion and may lead to hyponatremia. It is imperative that endurance athletes replace sweat loss via fluid intake containing about 4% to 8% of carbohydrate solution and electrolytes during training or competition. It is recommended that athletes drink about 500 mL of fluid solution 1 to 2 h before an event and continue to consume cool or cold drinks in regular intervals to replace fluid loss due to sweat. For intense prolonged exercise lasting longer than 1 h, athletes should consume between 30 and 60 g/h and drink between 600 and 1200 mL/h of a solution containing carbohydrate and Na(+) (0.5 to 0.7 g/L of fluid). Maintaining proper hydration before, during, and after training and competition will help reduce fluid loss, maintain performance, lower submaximal exercise heart rate, maintain plasma volume, and reduce heat stress, heat exhaustion, and possibly heat stroke.

The big takeaway from this study is that if you are an endurance athlete or your activity is higher level you could be flushing a much needed electrolyte, in this case Sodium out of your system.  General advice (always check with your MD for individual advice) is to drink regular water with food that has a little salt, otherwise include a little sodium into your water for regular consumption.  Trust in Kelly Starrett.


The Upper Body Exercise to Stop Right Now

Injury, Pain, Uncategorized

In the history of weight training there have been numerous examples of exercises that are fantastic: the squat, deadlift, lunge, pull-up, push-up. However, there are also exercises that make any anatomical professional cringe to the point of white-knuckling. Here are some examples:

I mean, really there is no explanation needed.

I mean, really there is no explanation needed.

Isolation:  Yes, from everyone around you who can't stand listening to your knees crack

Isolation: Yes, from everyone around you who can’t stand listening to your knees crack

Just, no.

Just, no.

The exercise I want you to throw away today, forever…no I mean it, FOREVER is the upright row.

The anatomy is simple:  The exercise is designed to target the traps.  However, to get the traps you have to put yourself into the position of shoulder impingement and the repetitive position that can lead to tennis elbow.


Yep, that's the one

Yep, that’s the one



With each of these exercises I know the argument:  “It isolates blah, blah, blah muscle.”  Well, the upright row isolates alright, it isolates the supraspinatus rotator cuff tendon right up under the acromion.  The only pump you’ll get from this exercise is a pump of corticosteroid the ortho doc will be giving you, unless surgery is the better option:



So, please….don’t do this exercise.  Your body will thank you.

Is the SI Joint Overrated or Underated?


One of the more controversial areas in the body is the sacroiliac joint. This area has either been identified as the key to back/lower extremity pain or called a non-factor. The literature points to a lack of specificity and sensitivity in diagnosing, treatment is mostly anecdotal, and the therapists who dare “treat” it are frauds.

However, did we throw the baby out with the bath water? Clinically, is there a correlation with symptom complaints, objective limitations, and the SI joint? In an attempt to “legitimize” our profession we have begun to scrutinize by yelling at the top of our lungs about the lack of research.

The question I ask is simple: Why do clients have unilateral pain at the SI area? Why does it limit their SLR? Why does an audible cavitation occur with a resisted hip adduction? Finally, why does this cavitation very often reduce the complaints of pain in the area?

80/20 Examination: Getting all of your objective information in just one movement


If you chose one movement to give you the most information about a client what would it be?

Tim Ferriss advocates the 80/20 concept in his New York Times Bestseller books like The Four-Hour Work Week. The 80/20 concept is all about value. Can I get a large return in value from a small investment in time? While as therapists we crave time to find movement patterns to address, we don’t always have the time we desire. In the changing world of reimbursement (Sorry, Jerry Durham) payment where pay for performance is king, treatment resulting in change will be paramount to an extensive examination.  Therefore, it is important to gather as much information as possible in the least amount of movements.

Enter the ground up squat:

Now, the only change is that you would try without the stick first.  However, you get ankle, knee, shoulder, lumbar, thoracic, and cervical ROM.  You also get trunk stability, shoulder stability overhead, and both upper and lower extremity stability.

Pretty big bang for your buck.

Top 5, or Maybe 3 Best Physical Therapy Moments on TV/Movies


Here is the follow-up to the Top 5 Worst Physical Therapy Moments on TV/Movies!

As you’ll see, I could only find 3 really positive TV/Movie moments that do not set our profession back.  We talk about “brand” all the time….this is at least part of the problem.


#3. Regarding Henry – Bradley

I told you he would be on both lists.  Whatever you think of his techniques (they certainly are not evidenced-based), he showed empathy and promoted functional improvement.


#2 -Tourniquet Training – Johnny Owens

Leave it to the Army to do something this cool.  It will be fun to watch this technique play out.  I don’t know that it will have much indication in most civilian therapy clinics, but it is interesting.

#1.  Kobe’s Secret Weapon – Jody Seto

A great story about PTs presence in sports and the ability to keep someone as demanding as Kobe at the top of his game for as long as he could be.

Top 5 Worst Physical Therapy Moments in TV/Movies


Although not well represented, Physical Therapy has had its place in pop culture.  Generally, PTs are in the background watching someone exercise or walking with them, but a few exceptions show the compassion and excellence that PT can provide.  However, there are some funny moments that probably set our profession back a decade. Here are 5 of the worst offending moments:

Honorable Mention:  Mike Reinold & Erson Religioso Too Funny.


Drum Roll, Please


#5.  Seinfeld – “It Moved”

Although, technically a massage therapy moment, it did happen in the confines of a PT practice.  A funny look at how uncomfortable it can be and the need for proper communication.

#4.  Regarding Henry – Bradley

Bradley is a tough one, because he may be included on the top 5 best also.  However, walking through the hall saying “I got to get me some of that” about nurses is probably a bad representation.

#3  Hard to Kill – Danny

I mean, come on…Gut from Stone Cold ?  First, a fanny pack?  Second, “I’m going to make you feel alright?”  Yikes, I am sure the folks at somasimple cringe at that.  The worst part:  Not listening to your patient, throw subjective report right out the window.  Lesson to any therapist: listen to your patient, and you may not be shot by goons of corrupt politicians.  “You can take that to the bank.” Sorry for the language

#2 – Seinfeld Again – Delicate Genius

$150 for a missed appointment….man those were the good ol’ days.  “No one can disturb the delicate genius”  Seinfeld put PT in the popular culture….but not the best type.  “You do have insurance don’t you?”

#1 (With a Bullet) – According to Jim – Physical Therapy

I don’t think I need to explain.


Stay tuned for the Top 5 Best Physical Therapy Moments in TV/Movies





What Should He Do?


Menisectomy vs Meniscal Repair

If you are a Bulls fan or Chicagoan in general the news of Derrick Rose’s recurring meniscal tear has already sent you into the first stage of grieving. So, now what? A lot of medical professionals and former athletes will be on the airwaves today comparing and contrasting injuries, surgical techniques, and prognoses. The main questions will be: 1. Repair vs removal and 2. Will Rose ever be the same?

The meniscus is a C-shaped cartilage that sits on the top of the tibia. Its primary responsibility is to provide a cushion between the femur and tibia. The meniscus is generally injured by a compression and twisting injury. When injured, people can feel pain, lost range of motion, popping, and occasionally locking of the knee.

A meniscal repair is an arthroscopic procedure where the surgeon will suture down the injured tissue to allow it to heal. This type of surgery only occurs if the tear is a clean longitudinal tear on the periphery of the tissue because this area has blood flow to allow healing. A menisectomy, on the other hand, is an arthroscopic procedure where 10% of the meniscus is removed.

Physical Therapy for either procedure includes improving range of motion, controlling swelling, increasing strength, and fixing any movement faults that could have predisposed the injury. In addition, physical therapy has been shown to be just as effective as surgery in patients with meniscal tears. A Functional Movement Screen should be used before returning any client to sports to decrease the chance of re-injury. In regards to if Rose will be doing this again, the injury itself and the general rehabilitation should be easy enough. However, the psychological hurdle will be the most difficult. Rose will need to again be explosive, with great jumping and landing mechanics, without hesitation. This is no simple feat, and as anyone who watched Rose at the first of the year knows, it was a work in progress.