Kettlebells for Knee Pain

According to a survey by the Center for Disease Control and Prevention, 30% of adults reported some type of joint pain during the last 30 days. Knee pain ranked as primary joint of complaint for this particular survey¹.

In the world of rehabilitation, scientific literature has been pointing to the muscles of the hip as a major player in knee pain². Strengthening the Hip Abductors (Gluteus Medius) and the Hip External Rotators have been specifically highlighted as a source of pain relief for the knee^{3, 4}. This stands to good reason when analyzing the functional mechanics of the knee; the orientation of the knee is controlled by the position of the femoral head. The position of the femoral head is controlled by the muscles of the hip. In other words, the hip dictates the orientation of the knee in space, and thus, acts as the guide-wire for the muscles of the knee. A good directional pull from the muscles of the knee encourages good movement at the knee joint itself. Good movement decreases stress forces which then can decrease wear and tear, and, ultimately offers pain relief.

To address knee pain by strengthening the hip, kettlebells can be used as a functional therapeutic exercise. Here are a couple kettlebell exercises which can target the muscles of the hip:

High Knees

The Hip Abductors are responsible for maintaining pelvic motion and femoral alignment during function. The High Knees are a great exercise for the Hip Abductors because it combines strengthening with balance. In this exercise, the lifting leg is the extremity which applies force. The stance limb is the side which is being strengthened. This exercise is performed by raising a kettlebell up by the foot until the knee of the lifting limb is at the height of hip – a “high knee”.  By lifting up the kettlebell using dorsiflexion and hip flexion, a sudden downward force is created on the side opposite to the stance limb. This force then requires the hip muscles of the stance limb to engage and prevent a sudden drop in pelvic height on the lifting side.  There are a couple compensatory movements to watch for including excessive leaning, lateral shifting, and forward flexion of the spine.  The forward flexion of the spine is caused because when lifting the kettlebell with the “high knee” technique, the lifting extremity utilizes the hip flexors which are connected to the lumbar spine. If one does not control posture and engage the muscles of the stance limb, then the body will want to flex forward.  If there is trouble with leaning or weight shifting, then a lighter weight should be used.

Side Swings

Resisting the motion of hip abduction and external rotation requires that a force is applied which encourages femoral internal rotation and adduction.  One of the best exercises to apply this force and thus strengthen the muscles of the hip for knee pain is the Side Swing.  By swinging the kettlebell on the side of the body, more weight is pulled over the lower extremity (and hip) you wish to strengthen. This same pull will also attempt to bring the knee and femur into a position of adduction and internal rotation. By side swinging in correct mechanics, we then resist the unwanted motion of hip internal rotation/adduction and therefore will strengthen the hip abductors and external rotators.

The Single Leg Deadlift: Golfer’s Lift Variation

This version of the Golfer’s Lift is a variation of the Single Leg Deadlift. The purpose of this exercise is to focus strengthening at the hip while limiting motion at the knee. Once again, we find ourselves in an exercise where the stance limb is the limb which is being strengthened. By moving into the combination of a deadlift and mini-lunge, the hip abductor must be activated to prevent changes in the horizontal position of the pelvis. By holding the kettlebell on the opposite side of the stance limb, additional muscle recruitment is forced upon the hip abductors. This exercise also requires that the individual is in good control of knee position; avoiding adduction and internal rotation is of key importance. Additionally, maintaining the single leg stance is an added challenge for control and balance. Do your best to limit the contact of the trailing limb. Finally, spinal posture must be preserved for safety during this exercise.

In the address of knee pain, training and strengthening the body in functional movement is always a desireable plus. Many of my patients and clients who used kettlebells for therapeutic exercise consistently remarked that the areas of complaint always felt better after kettlebell exercise. Despite the repetitive squatting motions of most swing based exercises in kettlebells, the population I encounter who most consistently express that their symptoms improve after a session with kettlebells are those who have knee problems. When the call for treating knee pain with exercise is made, I hope that kettlebells will be one of the therapies that will answer the call.

References:

1. Center for Disease Conrol and Prevention. http://www.cdc.gov/Features/dsJointPain/
2. Dolak et al. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011 Aug;41(8):560-70. Epub 2011 Jun 7.
3. Bolgla et al. Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. Int J Sports Phys Ther. 2011 Dec;6(4):285-96.
4. Khalil Khayambashi et al. The Effects of Isolated Hip Abductor and External Rotator Muscle Strengthening on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2012;42(1):22-29, Epub 25 October 2011. doi:10.2519/jospt.2012.3704 

The Rotater Review by Dr. Ben Fung

A little while back, I was asked by the people from The Rotater to take some time to review their product.  I want to first make the disclaimer that this review exclusively reflects my own thoughts and experiences, and, that the Rotator has neither offered nor provided incentive or financial gains from this review.

My first impression of the Rotater was actually through Twitter - a testament to the connective power of Social Media (a shout-out to #solvePT).  As I can be a skeptic and even cynic at times, it took several rounds of Twitter #FollowFriday #FF’s recommending the Rotater before I took a few minutes to check out their website. The first thing I saw was a picture of an individual stretching themselves into a rather generous range of shoulder external rotation.  To be honest, I was a little bit alarmed.  Most individuals do not have that level of flexibility, and, in certain contexts, such a level of flexibility can be counterproductive as one may be gaining range from the wrong regions of the body.

In any case, since I was going to write up a review, I put that impression aside to test the instrument with a clean slate; as with my Vibrams, I would first test it on myself.  The package came in the mail consisting of the Rotater, the Strong Arm Attachment, several sheets of instructions, and an instructional DVD.

Like most males, I immediately picked up the instrument and decided that I did not need or have use for instructions. I began poor attempts at properly utilizing the Rotater, fumbling it every which possible way. Finally, I took a look at the instructions for correct use. I performed several variations of shoulder stretching in rotational glenohumeral movement. Experiencing the comfortable stretch with a precisely isolated mechanic to the shoulder joint proper, I quickly popped in the DVD for more information.

Surveying the DVD menu, the BLOOPERS section caught my eye - I had to take a look. Sure enough, the instructor on film was fumbling around with the Rotater - just like me! Good! I wasn't the only one.  

Obviously, this simple tool came with higher levels of concept (much like kettlebells!).  Watching the entire DVD through, I was thoroughly impressed with the distinct advantage of self controlled shoulder orientation during stretching and strengthening. It is this ability to control glenohumeral orientation at various angles of shoulder flexion, extension, abduction, and/or adduction (and combinations thereof) that was the most appealing to me.  When utilizing therabands, resistance cables, or pulleys - it can often be a challenge to strengthen movements in precise orientations of the shoulder joint. With the Rotater, one can quickly transition between any shoulder angle without complex maneuvering or hassle with a contraption’s setting – this I liked... A LOT.

The second big advantage I found with the Rotater is that the instrument naturally isolates shoulder rotation and prevents very common compensatory movements for restricted shoulders. Not so with other methods of isolating shoulder rotation; the Rotater beats out any towel, ball, wedge, pillow, hand, fist, or belt.  The Rotater also has various set distances where one can apply the Wrist Strap for stretching, or, the Strong Arm Attachment for strengthening – a very nice feature for variations in arm length.

The tubing strength for the Strong Arm Attachment has generous strength and can be adjusted for length to create more or less tension for various levels of strength.  The Rotater also offers different levels of tensile strength for the Strong Arm Attachment to cater for different levels of ability.  However, for the Rotater to be used independently, one must have at least one healthy upper extremity to hold the handles of the Rotater.

I feel that the Rotater is ideal for athletic populations; for more acute or complex injuries, or, the geriatric population, using the Rotater independently can be a challenge.  But who says one must use the Rotater independently? When using the wrist straps, the Rotater is a great tool for Active Assisted Range of Motion in the clinical setting. Additionally, it can be used for manually resisted shoulder rotation as a mode of strengthening.

The Rotator is a great tool for improving shoulder rotational performance, however, I highly advise that one first receives proper instruction from a healthcare professional before using the Rotater. This point is supported by the people at the Rotater in that during several segments of the instructional DVD, reference to the expertise of Physical Therapists, Physicians, or Surgeons prior to the use of the Rotater were made.  This is very much appreciated as I’ve seen far too many instructional DVD’s leave individuals to explore the nuances of human movement without in-person-instruction - an exploration which commonly produces injury.

The Rotater instructions and DVD are clear and concise. The instrument is sturdy and conveniently light. The Rotater is a tool that can help fashion functional independence by empowering the individual to apply stretching and strengthening of controlled shoulder rotation. As a Physical Therapist, I am thoroughly enjoying the Rotater and will continue it's use in shoulder rehabilitation.

Preventive Therapy: Calf Stretches

Today’s Preventive Therapy tip is inspired by my “love” of high heeled footwear. In case you haven’t experienced my spiel about how terrible high heels are for your physical health, here is the Cliffs Notes version: Walking with heels cause the ankle to plantarflex downward creating excessive stress forces at the foot & ankle which causes compensatory muscle movements at the knee, hip, pelvis, and spine. Excessive stress forces are ALWAYS bad for the body and can cause long term changes to your body - bad changes. As a result, I’ve treated patients with foot pain, calf pain, headaches, back pain, neck pain, shoulder pain, and even jaw pain due to chronic use of high heeled footwear. Not to just seemingly pick on women’s footwear; ANY footwear with a raised heel can cause this problem when chronically worn - cowboy boots are culprits too!

However, high heels are an industry standard to certain lines of professionals and there is no avoiding them. If you must wear heels, then I highly suggest stretching these two muscles:

1)       The Gastrocnemius

2)       The Soleus 

Both of these stretches MUST include turning the foot and pointing the toes of the foot behind inward toward your opposite heel. Without turning your foot inward, you will not experience an effective stretch.  Also, do your best to keep your heel on the ground during this stretch.  Both of these stretches will affect the calf of the foot behind your body.

These two stretches can relieve ankle/foot/calf pains due to changed mechanics secondary to footwear.  These stretches will also prevent any adaptive changes which may make your body at higher risk of injury.  Try doing these stretches before lunch, after dinner, and before you go to bed.

Also, I'm sure you've noticed a new model in our images.  Please welcome and support Mr. Mike Rein, MS, BS - Exercise Physiologist, Exercise Specialist. Mr. Rein has been developing a blog called "Kettlebell Dynamics" - please take a look and support him!

Dr. Fung’s Five Fingers Experience

From a cursory glance on the web, social media, streaming channels, and on the running trail – one can quickly notice the growing trend of barefoot running and the minimalist shoe movement. Currently, the “Five Fingers” fascination is in relative infancy and predictably, as with any emergent phenomenon, is under initial skepticism and scrutiny which is well matched by fandom and craze.  Caution to new explosive trends is wise as many entities in the past have tried to pass their own version of the magic pill, secret serum, or superman exercise apparatus – each debunked over time. As time passes, controlled trials and repeated research will be combined to give the public a middle ground conclusion on the matter which will be revisited every decade or so with gentle sways in the valence of support or caution. Despite the science, there is a very human element that needs to be addressed in the world of human movement and physical health.

As a clinician, I hold myself to the standard that I will never ask my patients or clients to do anything I wouldn’t do myself or ask of my loved ones. Since the minimalist trend has piqued my interest, I’ve been looking for a way to satiate my curiosity of the “five fingers” experience. My interest in barefoot mechanics stems not only from clinical curiosity, but also from my early life experiences in martial arts and my background in surfing - both which are primarily done in barefoot or minimalist footwear. Additionally, there are a good number of high performance sports of which athletes participate or train barefooted, or, in minimalist footwear.

Thanks to a Twitter connection with @MoveFowardPT and Pacers Running Stores (@RunPacers), I was finally able to procure a pair of Vibram® Treksport and experience it for myself.

The first thing I did once I got my Vibram®’s was take a quick trot around the neighborhood. I noticed immediate differences in my gait and running mechanics. I then decided to test it for some prolonged ambulation. 6400 steps later (according to my pedometer), I noticed definitive activation of my foot instrinsics and that much of my weight bearing occurred in the forefoot. Additionally, I felt that my weight acceptance during each stride was much more evenly distributed over time; it felt as if was I walking “softer” and “smoother” – my family stated in jest that I was walking around like a ninja.

I followed this little experience with a basic pair of flat sneakers to compare the difference. While the only “strain” I noticed using the Vibram®’s was increased forefoot use, I noticed in less steps an unsettling experience in left hamstring/gluteal fatigue, poor eccentric control during heel strike, lazy posture, and bilateral medial arch & hindfoot soreness. I did not expect such a pronounced difference between the two types of footwear.

For high mileage bipedal travel, I typically wear running shoes and use a custom foot orthotic due to my generously flat medial arches. However, what tends to happen with orthotics is that my feet are simply supported by the device - much like a sling or a splint. The difference I specifically noticed with my “finger shoes” is that the device was able to work WITH my feet; the subtle tension when wearing my Vibram®’s gave me the perception of increased proprioceptive sensitivity.  This was a familiar sensation for me. It actually reminded me of when I train kettlebells, barefoot in the sand. I was compelled to mix the two to top off my Five Fingers Experience and find out for sure. Indeed, training kettlebells, using Vibram(R)’s allowed for a more sensitive proprioceptive experience during exercise. For those of you who haven't tried performing heavy snatches or windmills in the sand - try it! It will blow your mind.

It may be too early to make a definitive judgment of the Five Fingers Experience, however, I offer an analogous anecdote in my experience with kettlebells. It goes without saying that I highly support the use of kettlebell exercise as a mode for fitness, physical therapy, and corrective exercise. However, I do not prescribe kettlebell exercise to ALL patients or clients; only those who are appropriate and would benefit from the exercise receive instruction.  Similarly, my initial impressions of the Five Finger’s experience is that it certainly has its place in the world of fitness, health and wellness. For my own two feet, the Five Fingers experience was definitely a positive one; I traded out soreness at the medial-arch & hindfoot for increased use of my instrinsics and a slightly sore forefoot.

Only time will tell what the scientific literature makes of the barefoot movement - not to mention what prolonged use of the "finger shoes" will do to my body (you can be sure I will blog on that experience when it comes). If history is any measure, there will always be several trains of thought regarding the minimalist footwear experience. However, when it comes to application, it all comes down to matching this experience to the right person, in the right manner, for their best outcome.

Cyber PT collaboration with Kettlebell Therapy™

Cyber PT has been kind enough to publish one of Kettlebell Therapy's most popularly read articles, "Restoring Movement with Natural Physics" by Dr. Ben Fung, PT, DPT.

Kettlebell Therapy^TM: Restoring Movement with Natural Physics

As a Physical Therapist, I have used kettlebells to rehabilitate and promote health in individuals with low back pain, shoulder impingement, ankle sprains, medial knee pain, myocardial infarction, mitral valve replacement, and much more. Who would have thought that a cast iron ball would be so clinically effective and versatile?

Like most people, when I first saw a kettlebell, I was simultaneously confused and amused. My first exposure to kettlebells happened at a martial arts seminar in San Diego when one of the instructors lugged out a 53 pound iron-wrecking-ball with a handle fused to the top of it. He called the object a “kettlebell” – it looks like a tea kettle and it swings like a church bell. He began a demonstration and spoke on the benefits and martial arts applications of kettlebell exercise. I had little interest in new trends and was much less inclined to try it out myself – that is, until I saw one of the seminar leaders struggle with the most basic and foundational exercise, the ballistic kettlebell swing.

The rest of "Restoring Movement with Natural Physics" is available on Cyber PT at:
http://www.cyberpt.com/kettlebell_therapy.asp

Be sure to visit and support CyberPT.com!
Cyber PT is also available on Facebook & Twitter:

CyberPT on Facebook 

@CyberPT 

Swinging Away Back Pain

I'm pleased to present another Kettlebell Therapy™ article on the Physical Therapy Web Space titled "Swinging Away Back Pain".

There have been estimations stating that 80% of Americans will experience back pain some time in their life¹ (Web MD, Mayo Clinic). Choosing an appropriate therapeutic corrective exercise to address back pain can be quite the conundrum. One of the many goals in addressing back pain with movement is not only to modulate the pain, but to keep the pain at bay during functional activities. Of the many therapeutic exercises available to address back pain, preserving functionality can be a challenge. Correction during specific and isolated movements is more easily achieved than it is maintained during an actual functional performance.

As therapeutic relief and maintaining correct movement are central goals in movement based therapy, an ideal exercise for a back program would be that which both relieves pain and prevents further injury by fortifying functional spine mechanics. Kettlebells have recently garnished considerable attention in the world of Physical Rehabilitation. Despite the kettlebell being nothing more than a cast iron wrecking ball with a handle on top, there have been studies exploring kettlebell exercise for lower extremity sports rehabilitation², musculoskeletal health³, and cardiovascular exercise response^{4, 5}.

Read more at http://physicaltherapyweb.com/articles/kettlebell-back-pain.php

The Kettlebell Connection

Before I begin this post, I want to thank all of my readers, followers, friends, and of course my family, for the overwhelming love and support you’ve given during this time my wife and I have been dealing with our recent miscarriage. In our age, the social connections we make go far beyond that of physical presence; the willingness to bond across these new digital frontiers truly demonstrates the generous capacity to share the human experience in ways we are only beginning to understand. One thing is for sure: this experience can be shared at the deepest and kindest levels of sympathy.  Again, all my thanks to YOU!

Last week, I had the pleasure of sharing energizing hours of conversation & interaction across two separate days with Dr. Tim Olson, PT, DPT, CSCS.  Dr. Olson and I found in our discussions a common passion for functional movement, physical performance, and innovative systems for the Physical Therapy profession at large.  Of course, when talking with yours truly, you can hardly get away from the inevitable conversation about kettlebells. Naturally, the topics included the physical rehabilitative qualities of kettlebell exercise, the physics of the kettlebell tool itself, and the various treatment diagnoses of which kettlebells are of benefit.

During my time with Dr. Olson, I found him to be an exceptional expert of human movement and outside-the-box thinking.  From the stimulating discussion and several challenging questions, my eyes were opened to some expanded concepts of integrating kettlebells and Physical Therapy.

Three Lessons from the Kettlebell Connection with Dr. Olson:

• In addition to the Natural Physics of kettlebell exercise, kettlebells have an innate property to produce proper form during and after exercise. The kettlebell tool itself also acts as an ongoing source of biofeedback (visual and somatosensory) which can produce superior movement when other sources and techniques of facilitation and instruction have been exhausted.  This is most convincingly seen in exercises such as Bottoms Up activities and the Turkish Get-Up. Unlike dumbbells, barbells, cables or resistance bands, the distance between the handle and the center of kettlebell mass provide an additional kinetic chain where the gravitation pull on mass is off-center when grasped. This causes the body to continually adjust and re-adjust with every movement and acts upon the body in a manner which seems to serve as it own form of proprioceptive neuromuscular re-education. This discussion lead to lesson #2.

• Sometimes the simplest approach is the best approach (ie. K.I.S.S. – Keep It Simple, Stupid).  Many times, the threshold for over-thinking, over-repetition, and over-facilitation is far lower than one would otherwise anticipate. Many times, conscious body movement is its own greatest enemy when aspiring to improve functional performance. Training movement in simple, automatic terms rather than attempting to force the body in sequentially complex arrays often yields superior results in a time efficient manner.  That being said, the kettlebell is arguably one of the simplest exercise tools ever conceived. And yet, in an age of technological wonder, the breadth of potentials when using a simple kettlebell is plain impressive.  The simplicity of the kettlebell’s design and the numerous available applications pose an interesting question when faced with availability of advanced technological complexities: Could it be that the humble tools pave a clearer path to the serenity of human performance?

• Simplicity in design demands wealth in wisdom. Dr. Olson pointed out that many kettlebell exercises seem related if not overly similar when seen at a glance. In general, kettlebell exercises can be categorized by the emphasis on the focused attention or combination of: ballistics, power techniques, dynamic stability, core strengthening, mat based exercises, prone based exercises, sports specific, and tactical. Of these various categories, each branch holds a core familiarity of technique and form. An obvious example is how the dead lift progresses to the pre-swing which progresses to the swing, then the clean, then a high pull, then a snatch. I have always held the operational definition that “Wisdom is knowledge applied.”  The ballistic progression for kettlebells is a great example of how multiple principles of exercise science sublimely unite during application:

1. Overloading Principle: Kettlebells are dense heavy objects which tend to be heavier than objects manipulated in every day life. Additionally, the exercise techniques used with kettlebells are done in movements far more explosive and intense than that of normal every day life.
2. Individual Response Principle: Kettlebells must be customized to each individual per exercise and per progression. Kettlebells which are too light allow for individuals to “cheat” and “muscle” the kettlebell to mimic proper form. An easy way to check if a beginner is cheating on the swing is to add another kinetic link to the swing itself by looping a towel or rope around the handle of the kettlebell. If the beginner is indeed cheating, the bell will droop downward with gravity as the individual can no longer death grip the kettlebell into submission during the swing itself.  This principle holds true in the opposite extreme; kettlebells which are initially too heavy for beginners are simply dropped during exercise or self-limiting due to form.
3. Adaptation Principle: While many kettlebell exercises may seem similar at a glance, the intricate biophysics for each variation is highly different as experienced by the body.  With careful instruction, a small circuit of the various categories of kettlebell exercises can prove to be an extremely challenging feat even when performed by the most veteran of kettlebellers.
4. Specificity Principle: As discussed in my “Restoring Movement with Natural Physics” article, a major advantage of working with kettlebells is that we train our bodies in the same physics as the functional activities we strive to improve upon.  This training effect carries over for better performance during function and can be easily adapted for each specific sport, activity, tactical situation, functional movement, or activity of daily living.

My time with Dr. Olson was a refreshing and rejuvenating experience.  To strengthen oneself, one must sharpen iron with iron; being challenged is as important as being inspired. Many times, they are one in the same.  My interactions with Dr. Olson generated for me a deeper consciousness of human movement and functional performance. I express my sincere appreciation and humble thanks to Dr. Olson for his time, his thoughts, and his passionate dedication to his profession, his colleagues, and his patients.

Dr. Tim Olson, PT, DPT, CSCS provides a holistic Physical Therapy service through METROSPORT Personalized Physical Therapy. For more on Dr. Olson and his unique private practice, please visit: http://metrosportpt.com/ and follow Dr. Olson at @timolsonPT.

Spine Wellness, Physio-Style (Part 2)

Continued from my last post, Spine Wellness, Physio-Style (Part 1):

We’ve all felt it before... tight upper neck and shoulders, tender rhomboids between the shoulder blades, a sore & stiff low back… these can be normal signs of physical wear and tear from life in general. However, if the body begins to crumble under the physical stressors placed upon it, we come to a familiar experience of the "straw that broke the camels back."  When the last straw lands... our body is truly in trouble.  These warning signs, especially those feelings of TENSION and FATIGUE, are the body’s way of letting us know that something is not quite right. While it is likely that nothing is pathologically or medically emergent with your spine or associated tissues, however, they are not in the best of health.  Most of us are keenly aware of these warning signs, however, many of us delay... ignore… and eventually regret.

Choosing tissue tension as an initial point of focus for spine wellness was reinforced as people perceive tension as a widely common early expression of declining spine health.  Be the cause a variation, combination, or permutation of neurophysiological, biochemical, biomechanical, and/or psychosocial factors – many individuals agree that their concern of decline in their own spine health is made more aware when the uncomfortable sensation of tissue tension is experienced.

This is when the Physio-Style wellness approach shines in comparison to the “Sick Care” interventive approach. Reflecting on the current “Sick Care” reactionary interventive health approach versus a wellness approach of prevention and proactive pursuit of optimal health, I realized that there is a need and a large public demand for “Physio-Style” wellness services to improve spine health. The public at large is quickly growing impatient with a reactionary, nearly spastic approach of putting out fires as they happen.  Rather, the favor is trending toward the prudent foresight, regular health screenings, wellness treatments, and injury prevention.

Spinal Tension Release Therapy aims to alleviate the compounding and repetitive stress & strain which commonly expresses itself as uncomfortable tissue tension BEFORE the stress becomes damaging.  As these physical stressors pile up, tender trigger points, pain, headaches, muscular stiffness/tightness, decreased physical capacity, poor biomechanics, etc. become the next tier of the worsening signs and symptoms of poor spine health.

The composed systematic approach of Spinal Tension Release Therapy are as follows in the below components:

• Spinal Mobilization/Manipulation: acts as a catalyst in the process of normalizing tissue to normal resting state. This is important as repetitive physical stress causes tissues to be in a chronic state of irritation. Spinal mobilization/manipulation also manually releases joint & tissue tension and allows for an endorphin release which interrupts pain-spasm-pain cycle. Additionally, it is noteworthy to point out that this technique also causes a “down-regulation of inflammatory-type responses” (Teodorczyk-lnjeyan et al 2006) which aides the body in combating irritation to quickly restore a normal resting state.  The evidence for spinal mobilization supported by: Cross et al 2011, Puentedura et al 2011, Bishop et al 2011, Cochrane Review 2010, and much more.

• Soft Tissue Therapy, Massage, Manipulation:  relaxes tissues to a natural resting state (versus the chronically irritated and tense tissue state). Soft tissue techniques also allows for optimal circulatory flow which is crucial for cellular replenishment and tissue restoration. This technique can also modulate/manage painful areas and allow for encourages normal movement and tissue function (Poitras et al 2007, Furlan et al 2002, Cherkin et al 2003.)  One of my favorite applications of soft tissue therapy is with the use of instruments (IASTM), particularly, the EDGE Tool.

• Therapeutic Stretching: releases and lengthens tightened tissue (Sihawong et al 2011, Poitras et al 2007, Vladimir Janda, MD approach) which can allow for unrestricted tissue movement. Additionally, stretching optimizes the Length-Tension relationship of muscle & connective tissue for optimal function from a biomechanical perspective. Stretching can also reflexively enable weak counterparts to create muscular balance during static and dynamic states.

• Neuromuscular Corrective Exercise: strengthens and controls weak tissue which are not operating in ideal biomechanics during function.  This can creates muscular balance between antagonistic and synergistic muscle groups to create optimal postures, mechanics, and health (Janda approach, McGill & Karpowicz 2009, McGill et al 2009, Smith et al 2008) and retrains habitual patterns of movement for ideal function which naturally yields prevention (an example: the Functional Wall Squat).

• Preventive Ergonomic Body Awareness: the training of mind-body awareness to the static and dynamic orientation and position over time for the purpose of minimizing internal and external stress forces from the environment. Developing health habits of ergonomics and good biomechanics during movement & function naturally decreases the physical stress & strain in our daily life preventing the over-competition of stress forces to our body’s natural restorative processes.

In most scenarios, our body responds to excessive stress with natural and fairly expedient healing.  However, sometimes we simply need the therapeutic catalyst to avert the vicious cycle of overwhelming stress & strain. The therapy to our bodies allows for the natural process of daily restoration to win-out instead of waiting for the “last straw” to cause damage.

I want to reiterate that the concept of Spinal Tension Release Therapy was simply a way for me to personally and systematically organize therapeutic theory, scientific research, and clinical application for the benefit of my patients, clients, and public at large.  The above concepts are shared by many clinicians of various disciplines (though the perspectives and preferences may differ).  I have been able to utilize this particular method to help many individuals with complaints of chronic trigger points, muscular pain, head aches, sinus pressure, low back pain/soreness after work, etc.  Many of these individuals consulted physicians who did not feel that their experiences were at a medically pathological state necessitating intervention.  However, each individual was keen to express the need for something to be done from a perspective of prevention and wellness prior to an impending critical incident.

Health and Wellness is still a developing concept as our society and our healthcare system as a whole has yet to determine and agree upon a standard operational understanding of the two. Nevertheless, I would venture to surmise that all Physical Therapists/Physiotherapists aim to better the health & wellness of the public at large through our combined clinical expertise, public influence, and personal examples.

However, whenever the lines get hazy, I refocus myself with the combined wisdom in the quotes drawn in my previous post (Spine Wellness, Physio-Style Part 1):

Health is: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity…” achieved through “a proactive, preventive approach designed to achieve optimum levels of health, social and emotional functioning.”

To our best health!

   -Dr. Ben Fung, PT, DPT
    PhysioTherapist
    Doctor of Physical Therapy

Spine Wellness, Physio-Style (Part 1)

Recently, I gave a public service lecture on spine health at the Cushman Wellness Center located in the Outpatient Pavilion at Sharp Memorial Hospital in San Diego.  My topic: Spinal Tension Release Therapy – A Physiotherapy Wellness Approach to Spine Health.  There was a great turn out, but, I know many of you wanted to attend and were unable to. Thus, I am posting the content over the next several posts.  Enjoy!

The World Health Organization defines health as: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."  However, using “well-being” to define “health”, one must define “well-being” or “wellness".

Searching throughout the all powerful INTERNET, I conveniently found a nice compact definition from DefinitionOfWellness.com which I happen to agree with: “Wellness is not the mere absence of disease. It is a proactive, preventive approach designed to achieve optimum levels of health, social and emotional functioning.”

Combining the two definitions in its application to the spine, I came up with the following:  “Spine Health is the optimal state of physical, mental, and social well-being as affected by the spine achieved through proactive, preventive measures.”

This is distinctly different from the reactionary and interventive approach of most healthcare systems.  While most healthcare systems align with taking action only after physiological and/or pathological insult to the body, the approach of wellness not only prevents decline, it actively pursues measures which brings one’s health to the farthest point from illness and dysfunction to optimal health and functional performance.

Spine health & wellness generally revolves around postural awareness, core strength, muscle control, biomechanics, tissue integrity, tissue recovery, nutrition, lifestyle, and global life stressors. However, achieving and maintaining a Well-Spine isn’t always easy.  Normally, our body experiences wear & tear and responds to this daily damage with precise systems of function to repair, replenish, recuperate, and recover. This process of tissue restoration is active at the molecular level, the biochemical level, the tissue level, and ultimately the body and mind as a whole. However, there are times when the proverbial “straw breaks the camel’s back.”  Just about everyone has experienced that one “time” when compounding stress & strain add up to a critical point beyond the capacity of our body.  This is when the trouble starts. When physical stressors out-compete & overwhelm the body’s natural process of restoration, this over-competition of stress, strain, & tension can create a chronically impaired system of function. For those of you who have suffered through or currently experience chronic pain, you know that the impairment is both mental and physical.

A decline in the health & wellness of the spine can present in and is not limited to variations and combinations of the following manners:

• Joint and muscle stiffness/restriction in movement
• Joint and muscle soreness/pain/aches (even headaches!)
• Muscular tenderness and trigger points
• Impaired movement patterns
• Impaired functional capacity
• Decreased tolerance to activities
• Weight gain due to decreased activity
• Painful and limiting postural deviations
• Decreased tissue integrity, fracture, strain, sprain
• Inefficient and dangerous biomechanics which lead to a high risk of injury

So how do we achieve a well-spine and maintain that high level of health?  My suggestion is to explore approaching spine wellness from a physiotherapeutic perspective.   Physiotherapy is an ideal modality to achieving optimal spine health as many of the symptoms of poor spine health are rooted in the neuromusculoskeletal impairments.  These impairments tend to be a combination of pain, poor movement, and decline in function of which Physiotherapists are expert in correcting and resolving.

As the body is comprised of living tissues, we know that everything that moves within the body must have circulation (the movement of fluid, proteins, particles, cells, etc.)  Circulation allows for tissues to heal and regenerate; therefore, it can be said that physiological health is founded in MOVEMENT. "Moving Well Is Living Well."

But to truly understand Spine Wellness, "Physio Style", we must discuss the major practice patterns of which Physiotherapists are "practitioner of choice", and, how it relates to the wellness of the human body.  Physiotherapy address four interrelated practice patterns which are integrated to rehabilitate, promote, and maintain physiological health and well-being:

• The Musculoskeletal system: The muscles, bones, and connective tissue which are responsible for gross body movement by use of mechanical levers throughout the joints of our body.
• The Neuromuscular system: The brain, nerves, and connections which are responsible for activating, terminating, and controlling the movement of the musculoskeletal system.
• The Cardiopulmonary system: The heart, lungs, and blood vessels which supply oxygen, energy, and nutrients to the neuromuscular system which controls the musculoskeletal system.
• The Integumentary system: The skin - the largest organ of our body - which acts as a barrier and protective armor for the cardiopulmonary system; protecting it from injury, insult, and infection. However, the integumentary system yet is still controlled & limited by the architecture and physical structure of the musculoskeletal system.

In essence, Physiotherapy approaches wellness from a comprehensive and integrated consideration of the physiological tissues of the whole body as it applies to movement, function, health and wellness. Well... this is all good but how exactly we achieve a Well Spine, "Physio-Style"?  After contemplating on the concepts above as well as some of the scientific literature regarding therapeutic treatment of the spine, I wanted to systematize for my own edification - a reliable order of operations of which I personally could address the spine from a perspective of wellness. Eventually, this systematic approach became what I composed as Spinal Tension Release Therapy.

Coming Up: Spine Wellness, Physio-Style (Part 2). In my next post, I will continue to highlight key points of my lecture on spine health and expand on how I came to the idea of Spinal Tension Release Therapy.

Lecture on Spinal Tension Release Therapy

I will be giving a lecture & demonstration on a Physiotherapeutic approach to Spine Health at the Cushman Wellness Center at Sharp Memorial Hospital – Outpatient Pavilion this coming Friday, February 10^th, 2012 from 12noon – 1pm.  No registration required, AND, FREE TO PUBLIC!

The address to the Cushman Wellness Center is as follows:

Sharp Memorial Outpatient Pavilion
Cushman Wellness Center, Main Floor
3075 Health Center Drive
San Diego, CA 92123

Remember... this one is FREE! See you there!

-Dr. Fung

Resolution Reality Check: Simple, Logical, Effective (Part 2)

Last post, we discussed the components of a successful Health-Fitness New Year’s Resolution.  Three components are must-haves to attain success; the resolution must be “simple, logical, effective.”  We also discussed the logic and science behind kettlebell exercise as a solid tool in achieving success.

To close out our “reality check” on the New Year’s Fitness Resolution, I am introducing a workout routine which fulfills those requirements.  One of the many advantages of kettlebell exercise is that it addresses the whole body.  Instead of isolating body parts which are meant to work together, kettlebells train the body to integrate – the “Five Star” Kettlebell Routine is a workout which does just that.

The Five Star is comprised of five kettlebell exercises done in sequence and switched from side-to-side.  The exercises are as follows:

1. One Handed Swing – The foundational kettlebell ballistic exercise which trains lower quarter power, core stability, and corrective functional biomechanics.
2. Clean and Press – Good explosive functional power along with upper quarter strengthening and shoulder girdle stability.
3. High Pull – Explosive dynamic reversal along with core stability and balance.
4. Snatch – Intense muscular explosivity and cardiovascular demand.
5. Windmill (and switch swing to other hand) – Dynamic control of upper quarter, shoulder girdle, core, and balance.

The Five Star Kettlebell Routine is a workout which is quick and efficient for the busy day.  These five exercises cover all regions of the body dynamically, functionally, combined with strength and endurance. Finishing a one repetition cycle of this five exercise sequence usually takes 15-25 seconds.  On average, hammering out ten repetitions on both sides will take approximately 6-8 minutes resulting in a quick and efficient full body workout.

Finally, I want to thank all of you for support Kettlebell Therapy™ as we’ve continued to develop our site and resources. We've added to our sidebar several links and classes I highly recommend.

For those of you in San Diego looking for an award winning kettlebell class, Sharp Healthcare now holds "Kettlebell and PhysioKinetic Fitness" on Tuesdays and Thursdays from 5:00pm - 6:15pm as well as 7:30am - 8:45am.  These classes are ongoing and can be joined & renewed at any time! Register Here!

Finally, I would like to make special acknowledgements to Dr. Erson Religioso at The Manual Therapist, and, to The Physical Therapy Web Space for their support and collaboration during the early launching & development of Kettlebell Therapy™.

My best to you all!

-Dr. Ben Fung

Resolution Reality Check: Simple, Logical, Effective (Part 1)

It’s nearing the end of January 2012 and it is time for a Resolution Reality Check!

One of the most common New Year's resolutions involves a goal for fitness and physical health.  Many individuals head to gyms, boot camps, special programs, running, diets, yoga, pilates, lifting, support/self-help resources, social exercise groups, etc… each with their own benefits, styles, and results.  However, more often than not, the New Year’s health-fitness resolution tends to fail in some degree. We all know this intimately as many of us re-make this particular resolution every year. Most of the time, fitness resolutions result in failure due to poor planning and choosing the wrong type of exercise to pursue your goals. To avoid failure and achieve success, we need to break down the resolution with a reality check.

Whatever components your health-fitness resolution may have, success is more likely to occur when strategized. Sometimes, a spirit of determination can only get you so far… sometimes you must find ways to set yourself up for success.

The successful health-fitness resolution holds within it three crucial components; it MUST be:

1. Simple
2. Logical
3. Effective

Simple:  The modern day lifestyle is busy enough as it is to squeeze in 90-120 minutes of additional commitment several days a week.  While it IS possible to do so, most of us would get only a handful of hours of sleep a day if we were to commit to such routines.  Sometimes, the simplest solution is the best solution – and after all, a kettlebell is a cast iron ball with a handle on top from which you can achieve a fine workout in just 15 minutes. Simple enough.

Logical: First off, the health-fitness resolution must hold logical water. Unrealistic goals are unrealistic – period. Also, the resolution and the path to achieve it must make sense. We must take into consideration the science of human movement as all forms of exercise require human movement. The body moves as integrated kinetic chains where multiple muscle groups and areas of the body work together. The logical approach during exercise is to improve the functional performance of the body as a whole, thus, we should include routines which train in functional arrays rather than isolative movements.

Effective: It isn’t enough to engage in exercises because they look & sound good. We need to choose an exercise because it has been proven to work. According to research, high intensity kettlebell exercise can burn up to 20 Calories a minute... that's more than 1000 Calories per hour during exercise! While strict aerobic exercise typically burns only 80-110 Calories per mile, kettlebell exercise burns far more Calories per hour, and, addresses both cardiorespiratory endurance and lean muscle strength training at the same time (Fung 2010). The lean muscle building yields a high metabolic demand for adipose calories which only results in a healthy & leaner body composition.

If your New Year’s Fitness Resolution includes things like weight loss, body composition fat loss, toning up, and getting stronger – then add some kettlebell swings to your day!

Kettlebells are simple, logical, and effective – a solid tool for success!

Coming Up: Resolution Reality Check: Simple, Logical, Effective (Part 2).  In my next post I will introduce my “Five Star Kettlebell Routine” – a quick and effective workout for the busy day.

A Christmas Case Report

About 6 months back, I had a co-worker of mine (Female, 50's, generally sedentary, office work) approach me regarding intense headaches stretching from the base of her skull to the sides of her upper scalp. This was accompanied by the usual office space muscle tenderness, stiffness, soreness, and discomfort of the body as a whole.  Additionally, she had noted pain in her upper thoracic spine which she noticed were associated with her headaches. At the time, she was very stressed with work and expressed she carries all of her stress in her upper shoulders and neck.

I made time to evaluate her. In the end we decided to go a manual route along with postural awareness and corrective exercise.  Since we work on opposite sides of campus, we were only able to meet up once for a single treatment after hours.  We went with approach of Spinal Tension Release Therapy.

After treatment, she felt immediate relief of thoracic pain, cervical neck stiffness, elimination of trigger points, and finally - NO HEADACHES!

I've kept up with my co-worker every couple of weeks just to see how she is and to remind her of her Home Exercise Program.  She has proudly reported each time that since treatment 6 months ago, she has been pain free, headache free, moving with ease, and much more aware of her ergonomics during stress.

As Dr. Erson Religioso states in a related topic, thoracic pain should be properly resolved in just a couple visits. This is a similar case that demonstrates that the patient, the science, and the clinician can achieve that ideal result when it all comes together in an integrated and properly applied fashion.

Have a Very Merry Christmas & Happy Holidays!

Sincerely,

-Dr. Fung

Coming Up in the New Year: Optimizing the Fung Protocol. Metabolically optimize the Fung protocol for maximal physiological effectiveness. Learn the science behind how Dr. Fung personally lost 2 inches of waist in less than 6 weeks!

The Root of Therapy

Reflecting on this time of year & the spirit of Christmas & the Holiday Season, I recently rediscovered that the English word “Therapy” is rooted in the Greek word “Therapeia”.

Of the various translated definitions of this word, two caught my eye:

1. A Treatment for Healing, Curing (of the sick, aka. "to make well")
2. A Service done to the sick

I remember a while back, a motivational speaker referred to the Greek word “Therapeia” to confer a cultural meaning of healing, restoration, and improvement of one’s well-being. It is now widely accepted that health is not just the absence of disease but is a comprehensive state of well-being.

Contemplating on these thoughts, I reminded myself that there are many doctors in the world who care for many people in the scopes of their respective professions. There are allopathic physicians, osteopathic physicians, philosophy doctors, pharmacists, physical therapists, psychologists, optometrists, dentists, podiatrists, acupuncturists, chiropractors, naturopathic physicians, oriental medicine physicians, ayurvedic medicine physicians, family therapists… the list goes on and on.

I, myself, as a Doctor of Physical Therapy am ultimately a “therapeutic doctor” – a therapist; my services and skills must hold true to the root purpose of “therapeia” - healing, restoration, ... to make well. As a Physical Therapist, a compassionate understanding of the human experience is pivotal in being not only an effective clinician, but a welcome expert in the eyes of my patients & clients.

I encourage all to reflect on “Therapeia” – what it means to you – as a patient, client, or clinician, AND, what you are doing about it.

Season's Best To All,

-Dr. Fung

The Fung Protocol

My thanks again to all of you who supported, organized, and helped prepare for the very successful 2011 National Speaking of Women’s Health Conference via Sharp Healthcare in San Diego.

First things first: I’ve received numerous e-mails asking for information on my kettlebell classes held through Sharp Healthcare. Click here for the link to registration.

Also, I also know cost effectiveness is always a concern and that many who attended Sharp’s Women’s Conference wish for additional affordable class times (ie. day time classes, weekend classes, etc.), and, additional locations (ie. East County - San Diego).  If you wish to pitch in your vote, please e-mail me: Contact@DrBenFung.com and let me know your ideal class time/location.

Onto the new post! What is the Fung Protocol?

The approach of Kettlebell Therapy is 100% based on research evidence and clinical science. One of the founding pieces is the 2010 Fung Protocol as published by American College of Sports Medicine. The Fung Protocol is defined as a repeating 30 seconds “on” (exercise) – 30 seconds “off” (active recovery) routine which cycles 3 times between the following 6 exercises:

-          Left Handed Snatch

-          Right Handed Snatch

-          Left Handed Clean & Press

-          Right Handed Clean & Press

-          Left Hand leading Switch Swings (switch on every 5th swing)

-          Right Hand leading Switch Swings (switch on every 5th swing)

This cycle of 6 exercises is repeated 3 times making a total of 18 minutes of exercise following the 30:30 on/off repetition.  Of the many results of my doctoral work, this particular protocol demonstrated an exercise response of 90% of age predicted maximum heart rate (HR Max) and was shown to metabolically utilize aerobic and anaerobic systems simultaneously during kettlebell exercise as measured by VO₂ & VCO₂.  Additionally, this protocol and the amazing response to exertion allowed for participants to safely exercise at these levels with a wide range of baseline activity levels from semi-sedentary to former college athlete. In fact, I have successfully applied the Fung Protocol to senior clients with no complication or injury.  That’s the power of science!

Thanks again to all my followers, supporters, clients, and patients. With the loving support of my family and friends, YOU make the high quality education and expertise of Kettlebell Therapy possible.

Season’s Best!

-Dr. Fung

You may also enjoy reading: Optimizing the Fung Protocol

National Speaking of Women's Health Conference

Thank you all who came out on Saturday to Sharp Healthcare's Speaking of Women's Health Conference in San Diego, 2011!  It was a fantastic conference filled with dynamic speakers, a great expo hall, and motivated women striving for best health.

For those of you who missed my lectures, these are my top 10 take away points:

1. Resting metabolism accounts for about 60% to 75% of the calories you burn every day. – Mayo Clinic

2. Lean muscle mass is responsible for the majority of calories burnt on a daily basis.

3. Fat supplies 60% of the body's ongoing energy needs at rest primarily from muscle metabolism.

4. The secret to melting fat is engaging in exercise that simultaneously builds lean muscle mass and addresses the cardiovascular system with aerobic exercise.

5. Kettlebell exercise is a resistance exercise which increases muscle mass by strengthening your body with functional movements and correct body mechanics.

6. Kettlebell exercise also allows for semi-sedentary individuals to safely exercise at nearly 90% of their Age Predicted Maximum Heart Rate during a 15 minute protocol (Fung 2010).

7. Aerobically, kettlebell exercise is equivalent to a brisk job as measured by the actual oxygen consumption during exercise.

8. Unlike traditional resistance/lifting exercises or running, the foundational techniques in kettlebell exercise use physics that are joint sparing rather than joint crushing/shearing.

9. To maintain kettlebell exercise strictly in the aerobic domain: kettlebell weight should be limited to < 13% of body weight (Fung 2010).

10. Recommended starting weight classes for women range from 15-26 lbs.

Thanks again to all who came out and supported us!

Season's Best to All!

-Dr. Fung

Preventing Knee Injury with Kettlebell Therapy

As I have received a lot of questions regarding knee health in the past months, I felt that addressing a couple basic screening tools and a corrective exercise to begin the path of achieving knee health would be a great topic for Kettlebell Therapy.

The knee joint is the unlucky cousin of the ankle/foot and hip.  The muscles of the hip act as a controlling guide-wire to the orientation of the femur itself.  In stance, the muscles in the ankle/foot control the orientation of the tibia. Therefore, the movement of the knee is dependent on the control at the ankle/foot as well as the strength in the hip girdle.

As discussed in the Functional Wall Squat posts, the proper mechanics of the knee in normal ambulation or squatting is that of having the knee itself follow the path of the toes, free of any knock kneed or bow legged postures.  However, it is within the window of normality to see some amounts knock kneed and/or bow legged postures in a healthy individual.  It is when these postures are accompanied with functional deviations that we then become at higher risk for injury.

Here are two screening tools for the knee:

Thessaly’s Test

This special orthopedic test is typically used by Physical Therapists and Orthopedic Surgeons to screen out meniscal tears of the knee. It is a very sensitive and specific test when done in 20 degrees of knee flexion and is quite reliable for screening out tears. Any catch or reproduction in pain is a positive test. If this is indeed positive, a medical referral may be recommended prior to further exercise.

The Drop Vertical Jump

Functionally, the knee can be stressed in several dimensions during activity.  The Drop Vertical Jump is a clever way to screen for weak hip external rotators and weak hip abductors during landing (eccentric squatting) which is basically asking for an ACL tear sometime in the future. A positive screening would be a landing with internally rotated and adducted (knock kneed) femurs. This can also screen for weakness at the ankle/foot which would result in excessive pronation during landing.

Here is how to do it:  Have person jump off of a box and land, controlling their descent. While there are variations at various performance levels, the analysis is largely the same.  The important data is checking for dynamic control at the knee which informs us of the strength and coordination at the hip and ankle/foot.

 Genu Valgum Deviation

Pronation Deviation

If this screening tests out positive, the “High Knees” exercise is a great place to start as a corrective measure. To learn more about “High Knees”, take a look at our article as published by the Physical Therapy Web Space under the section “To address hip abduction: High Knees”

Something that I constantly stress to my patients, clients, and students is that our bodies are perpetual victims of earthbound gravity. As the human body mostly functions in a bipedal mode, it is important for us to see our functional movements from a ground up perspective. For the knee, this means we must give special attention to the mechanics at the ankle/foot as it is the primary point of contact and foundation for our function in stance.

Coming up: Blasting Abs With Kettlebells. In my next post, I will introduce some foundational aspects of combining mat exercises with kettlebells.