(upbeat electronic music)
- Welcome, my friends, to the Bob and Brad Podcast,
produced by Bob and Brad,
the two most famous physical therapists on the internet.
I am Bob.
I'm exactly one half of the Bob-Brad team,
and today, my guest host is.
- Mike, physical therapist assistant.
- And Mike is gonna help me interview Rick Olderman,
and we're gonna talk about back pain, knee and hip pain,
shoulder pain, and foot and ankle pain.
So stick around.
- 'Cause you're gonna realize everything's connected.
- Right.
- Now we're gonna move onto the book
titled Fixing You: Hip and Knee Pain.
Is it called Hip and Knee Pain?
It says both?
Oh, it does have both.
So who in particular would benefit from this book?
- Again, anyone with chronic hip or knee pain.
(Rick laughs)
- That makes sense.
- Because if you're having chronic problems,
again, it's not because you're broken.
It's because the way people have been approaching you
is from this component standpoint,
which is our training as medical professionals,
to look at things, "oh, you've got a knee pain?
"So I'm gonna solve everything in the knee."
But what about the foot and the hip, right?
What about the back?
You know, all sorts of things.
So what about how they're walking?
What about how you're sitting?
What about how you're standing?
What about how you're exercising?
Once you understand things from a systems standpoint,
all of those other questions make sense.
And this is what I believe is missing in physical therapy,
is that we're going more towards manipulations to solve
a component problem, but I believe we're
getting away from truly how the body works in this way.
We're relying on something passive to solve pain.
And if you're listening out there and you have some idea
and you believe that, oh yeah, I bet how I'm using my body
has something to do with my pain,
then this systems approach is your solution,
because it's all about how you're using your body, right?
So yeah, that's who would benefit.
- Sounds good.
- So in the book, you say there are three common problems
that happen with hip and knee pain.
You talk about poor performance,
tight muscles, and poor movement habits.
Would you mind elaborating on each of those?
- Yes.
Yeah, so I'm gonna, I may geek out just a little bit here,
but stick with me.
I'll try not to.
So here's the thigh bone.
It starts at the pelvic, at the hip joint here,
and it goes to the knee, the knee joint.
So the thigh bone is half of the knee joint.
If we don't pay attention to how this thing is controlled,
then we're missing half of the control of the knee joint.
There's precious little in the knee joint
that's actually controlling the knee joint muscularly.
So the big players up in the pelvis,
in the hip, are the butt muscles,
the gluteus maximus and the gluteus medius.
The gluteus maximus is that big, bulbous butt muscle,
the bigger one that you see in,
especially runners have big butts, right?
And so, that thing has many different functions.
I describe it like a hand muscle.
It's a hand muscle that has lots of different uses.
It controls this thigh bone in particular ways.
So making sure that thing is working properly
is critical to controlling how the thigh bone is corrected.
Now, the gluteus medius is smaller.
It has a more precise type of function for the hip.
So that has a lesser role
in controlling the femur, but it does.
So that's the upper half of the knee,
which is controlled from the hip and pelvis.
So the glutes are the big powerhouses.
Those are the movers and shakers of controlling this.
But you can do all the strengthening in the world,
and if you're not walking correctly to use the glutes,
'cause that's their whole purpose, is to help us walk.
If you're not changing how you're walking to turn on
the butt muscles, then all the strengthening or stretching
or whatever you're doing is gonna be for naught,
because you're not applying it
to how you're using your body.
Does that make sense? - Absolutely.
- And gait is the biggest thing.
I mean, it's the thing that we do most of,
and if we're not walking correctly,
then that is actually turning off these muscles.
You can do a thousand lunges, squats, deadlifts,
whatever you wanna do, but if you're not walking
and using it, what's the purpose?
It's not doing anything.
So that's the upper half of the knee joint.
The lower half is then controlled
by the foot, calf, and soleus muscles,
and the calf muscles attach above the knee joint here.
So if your calf muscles, usually the problem with calves
are that they're too tight.
So what they're doing is pulling the knee
back into a locked position, and they're not allowing
the ankle to move the way it should move.
So you have to solve the calf and soleus tightness
and function issue for the other half of the knee joint.
Now, the third thing, there's only one muscle in the knee
that controls the knee joint, the popliteus muscle.
That runs from the inside of the knee
to the outside, like this.
And it crosses the knee joint in a diagonal.
Well, if you look at the architecture
of the way the knee is built,
you see how one lobe is angled differently than the other.
So rotation is built into the knee joint.
It rotates with all movement.
The popliteus, because it runs from the inside
to the outside and crosses the knee joint,
helps control that rotation.
So when you have knee pain,
what is often happening is that the popliteus is in spasm,
and it's locking the knee into the rotated position.
And so, by simply massaging the popliteus muscle,
it unlocks the knee, and almost all the knee pain
will go away almost immediately.
I had a woman come in with a tibial plateau fracture,
which is a fracture of the top of the lower leg bone here.
She came in with a tibial plateau fracture,
in incredible pain.
All I did was massage her popliteus.
She walked out with probably 95% less pain.
I didn't change the fracture.
I changed the stresses that were acting on the fracture,
and that's what this systems approach
does to things, for the body.
- Is that popliteus painful?
- Oh, yeah, it'll be painful, because A,
it's a tiny, deep muscle.
So when you massage it, you can't attack.
You've gotta be gentle and kind of sneak your way in
and give it some love, instead of attacking it.
'Cause people will jump off your table
when you touch this thing.
You'll find, any of you out there who have knee pain
or practitioners listening who are treating people
with stubborn knee pain, even post-surgical,
especially post-surgical.
I had a guy who had an ACL, a whole reconstruction
of his knee, meniscus, ACL, everything,
and he could not straighten or bend his knee.
He was in so much pain after surgery.
All I did our first session
was massage his popliteus muscle.
He gained 20 degrees of knee flexion right there
and went into full knee extension.
And it's because that little tiny muscle
is locking the knee into a rotated position
and causing all sorts of havoc in there.
But again, the question has to be,
but why is the popliteus in spasm?
That's where the gait pattern comes in.
That's where the calf, soleus, and hip muscles come in,
because things aren't working here correctly.
That's why this little guy
is doing too much and going into spasm.
- This is fascinating.
- So if poor walking mechanics is the major cause
of your glute max not firing properly,
what do you recommend to people to fix their gait?
I know we've looked into more like, minimal
or less supportive shoes to help with that,
but what's your opinion on it?
- Yeah, you know, orthotics and shoe wear
are the last things I look at.
So really, the big problem that almost everyone
is running into, no pun intended, with gait issues,
is that their knees are locking.
And what is happening is that, because our shoe wear
typically has a thick sole, and especially the heel portion,
you look at your shoes,
you'll see the heel portion's super thick, right?
Well, that allows us to strike that heel
stronger than we would naturally do that.
And what that does is it allows us to put that foot
further out in front of us than it needs to be,
'cause we can hit that heel as hard as we possibly want to,
because we have all that padding right there.
If you just compare how you walk without your shoes on
to how you walk with your shoes on,
you'll notice that you walk slightly differently,
and it's because you can't get away with striking that heel
so hard when you're walking without those shoes on.
That is closer to how you should be walking.
And the biggest difference that you'll see there
is that when you're walking without your shoes on,
you'll notice that your knee unlocks.
It is more prone to unlock.
With your shoes on, your knee is more prone to lock.
- Makes sense.
- And that's what's turning off the butt muscles.
That's what's spasming the popliteus muscle.
- So how do you get the glute muscles to fire?
- Yeah, so that takes a little bit of guidance on my part,
but in my programs, I teach people how to do this.
So the simplest way is, well, first of all, you have
to prove to yourself that your glutes aren't working.
So the test I would give to your listeners is this:
put your fingers on your butt muscles.
Pinch 'em together and you'll feel that.
There's your maximum contraction,
and you should feel it nice and firm and hard
when you pinch 'em together like that.
Keep your fingers there.
Now relax completely your butt muscles,
and they should feel flabby again.
Now, keep your fingers on both butt muscles
while you walk five or 10 steps,
and you'll notice, gosh, they're not really firing.
That's your test to say, to show you
that the butt is not working when you're walking,
which is when it's needed the most.
I don't know, have you guys ever like,
turned around and immediately run into a doorway
or a table or something like that,
and you didn't realize it was right there?
I do that periodically.
(Rick laughs)
What always amazes me is the amount of force
that my body has generated with just a half of a step.
Just a half step, and it's like I just got hit
by a linebacker, right?
So that glute is helping control all of that force
that you're generating in your walking.
And so, if it is not turning on with walking,
all that force is being translated into smaller tissues
and joints, and that's where the breakdown is happening.
So to solve that, an easy way would be to,
if you get up on your tippy-toes,
and you keep your hands on your butt muscles,
and you walk around on your tippy-toes,
you'll notice that you start to feel
some contraction in your butt muscle naturally.
You should never turn on your butt,
you should never turn it on consciously,
because what happens when you see a squirrel?
Then your butt turns off.
What we want to do
is fix your walking pattern so it never turns off,
no matter if you're seeing a squirrel running from a car
or whatever you're noticing during your walk.
If you fix your walk, you can think about
all sorts of other things other than contracting your butt.
So if you walk around on your tippy-toes, you'll notice
that your butt now is starting to turn on, why?
Because you'll notice that your body is aligned differently
over your foot at foot strike when you're doing this.
And so, what you do is you slowly lower your heels back down
to introduce the heels back into striking,
and you'll notice that your butt continues to turn on.
- Oh, that's great.
- And the reason it's turning on,
the reason it's continuing to turn on
is because it's sticking with that new gait pattern
that you just taught it with the tip-toe walking.
It's not so much the foot strike pattern.
It's about your whole body moving over the foot
at foot strike. - Gotcha.
- So in your book, you also talk about, the big-time
hip flexors, in your opinion, are the tensor fascia lata,
the sartorius, and the rectus femoris.
Why do you those versus like, what Bob and I
probably learned in school, was your iliopsoas?
- Well, one of the things is because whenever I focus
on the iliopsoas, I never saw results in my patients.
- Makes sense.
- And so, look at the lever arm.
Look at the lever arm of the sartorius,
the rectus, and the tensor fascia lata.
Huge lever arms acting to flex that hip, right?
Enormous muscles, huge bulk.
Look at the iliopsoas.
It's just barely crossing the hip joint, and it's tiny.
And it's very close to the hip joint itself.
All those other muscles, by virtue of the fact that
they start at the ASIS on the pelvis, are much further away
from the joint, so they have
tremendous hip flexion leverage to flex that hip.
The iliopsoas is just a helper.
The problem is in the big guys, not that little tiny guy.
That little tiny guy may be irritated,
but it may be irritated for different reasons,
and that irritation may not directly be impacting
whatever you're trying to solve
by addressing the psoas. - Makes sense.
- But I was gonna say, a lot of this approach
to understanding how we work as a system
involves rethinking the significance of our anatomy.
It's not enough to know that the iliopsoas starts at your L1
through five and then inserts into the top of the hip bone.
It not enough to know that
we have these other hip flexors here.
You have to understand the meaning
and the significance of the architecture of our bodies.
That's what I've been rethinking for these last 20 years,
and that's how I've put all this stuff together.
You know all these things, all of this anatomical stuff.
You know this.
But we're taught to think about it in a different way
than what could be more useful in our clinical experience.
- Do you even want me to ask this last question?
- No, that's fine.
(Mike laughs)
- I think we'll switch something.
(Rick laughs)
Well, it was like, one exercise for knee pain,
but we realize it's a whole systematic thing.
- It's a whole system, and ultimately,
I'll tell you, no one gets out of our clinic.
If you come in with back, sciatic,
SI, hip, pelvic, knee, foot,
no one gets, I'm sorry, can you guys hear that dinging?
Sorry about that. - Nope.
- But no one leaves our clinic with any of those diagnoses
without learning how to walk again better,
'cause walking is where the rubber hits the road.
That's how we're supposed to be using our bodies.
So ultimately, whatever you do,
you have the other fix your walking pattern,
or else it will keep breaking down your body.
- I'm a big believer.
I had hamstring problems and anterior hip pain,
and it all went away with adjusting my walking.
(upbeat electronic music)