Tutorial #2982

Working with Knees

25 min - Tutorial
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Knee problems are common for many people. In this tutorial, Amy Taylor Alpers shares how you can work with knees in general, whether they are healthy, damaged, or recovering from surgery. She works with Martha, who has meniscus tears, torn cartilage, and arthritis, on the Wunda Chair, but also shares how you can work on other pieces of equipment.
What You'll Need: Wunda Chair

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Apr 16, 2017
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Hi everyone. I'm Amy Taylor, outbursts from the Pilati Center in Boulder, Colorado. And I am here with Martha and we're going to do a little tutorial on how to work with knees, knees in general needs that are damaged knees that are pre possible surgery needs that are post-surgery. We see a ton of it. It's really rampant. Martha is a pre-surgery and we're hoping to maybe stave that off forever even. Um, but she's got some meniscus tears.

She's got some torn cartilage. She's got a little arthritis in her left knee, old car accident, but also really fit healthy skier yoga, all kinds of movement, ex dancer, Claudia's person. So healthy and easy to work with. I know your clients aren't always like that, but it's always a blessing when they are. Um, so one of the things come around. We're going to start, we're going to do mostly on the chair today, but I'll talk a little bit about, let's have a state and we'll start with some footwork. We'll talk about, um, where else you might see similar movements or get similar effects from other exercises you can do in [inaudible]. Okay. So we're gonna Start, if you can, and I know from experience, you can't always do this, especially with need people, but uh, particularly with, um, slightly older people maybe who really just don't have the control in their feet or the range needed. If you can start with on the ball of the foot. So we'll come to the ball. The foot will come to our Palladio's V if we can. Again, sometimes you have to work in parallel and that's totally fine. Um, but one of the things I want to talk about, which I find to be primarily the issue is this powerful, powerful quad that has a sense of being a little bit over the knee here and then that the Shin is a little bit tucked away and on footwork.

That's quite a challenge to work with, but also a really great place to work on it. So what I want to do is get the heels a little higher so the knees a little more open and then stand on your little toes a little bit more and bring your heels together. So you're going to put a little more weight on your little toes. Actually, really a challenging movement for people so that we're not getting this line if you see it right, but we're going to get more weight on that little toe, right? So that the line through the foot is more direct in the knees not being torqued. And then we can say right off the bat, you know how we might say the choreography is just push this pedal down or straighten the knee. Right? So that's, that might explain the choreography, but what it does is trigger that the knee actually pushes the spring down.

And what we want to do is actually have the foot push the spring down. Yes. Nice job. And press the cath forward and that's why you want the heel a little bit so the calf can be forward. And then when you come up, if you have to help, that's fine. Guide that quad back over that knee and keep bringing this quad, this calf forward on to the foot. Right?

So that as she comes up now there's a sense that the chin is lifting the femur versus folding back under the femur. Then we'll leave and get better hip flection and then the calf pushes forward into the foot so that we're working the arch of the foot. Similar to kind of what I talk about in my other tutorial on the Pedo Pole. Right? How's that feel, Martha? Do you feel that hard, right? Yeah. So it's quite a different pattern than we're used to because primarily, and then you can see how I'm kind of wanting to support her kneecap right there, which tends to be for her, one of the most tricky spots and that I've got my finger behind her fibula and I'm pulling that fibula forward so that I can get that kneecap to go this way up the quad. Nice job.

Okay. Yes. And then let's go ahead and come to bird on a perch, but you keep working the same thing. So if you couldn't do, you know on the toes first, then you would go to burn on a perch. So go to the arches. There you go. And this one can be a little bit easier, but also it doesn't quite put the knee in the same position. So if you have to start here, you do though. This one tends to be a little bit easier for people. So again, just this idea, I'm pressing her calf, both Tibia and fibula forward.

I'm supporting up through the side of the knee, especially the outer side where her issue is, but not an uncommon place and reminding her that this Shin needs to stay in front of her knee a little bit more and that will actually cause the hip to flex in a slightly different way as well. So maybe scoot your heels back a little bit and then start trying to find your actual Yab bird on a perch. Deep heels, you're reaching the heel. Well, nice job. And when you reach the heel then the timing of this whole sequence is a little different, right? So if she in fact try one where you don't reach the heel so much, then the knee kind of doesn't quite know so much what to do. And part of the problem often is that we're very tight in the ankles for a lot of people. Right. But if in fact she reaches her heel down, that picks the knee up. Beautiful job. Beautiful job.

And then you try to keep doing that. It's harder on the way up, but that's our goal. Yeah. Nice. Do One more. So go down. So knee quad can come up and then you try to keep that and flex your ankle and your hip war. The goal being basically, let's say if we could take more work in the foot, ankle, more work in the hip and a little less in the knee and that by doing so we actually changed the timing of the knee a little bit too. Then we get the whole package. Okay, so now let's try on your heels. Same thing. So I work a lot. I'm just trying to get ankles to do more work, right?

If they need to be stretched or they need to be strengthened in their flection. Right. So that if she goes down again, she's going to think I pushed the heel now. But I try to lift the toes. Excellent job. And then on the way up, I try to keep the heel down a little longer and lift the toes. And not only, Huh? It's hard to see it. I know, but wow. She's working incredibly hard. Um, it goes deep to your Psoas, so it's gonna also change your lumbar spine and the way you breathe too, so, right. So as the heels go down, you can feel this space happen and that'll be an inhale actually. That'll be your inhale. And then the exhale really helps. Yeah. To reorganize the whole thing. One more, Martha. Beautiful. So heels down, big lungs. Really light here. Yes.

And I can sort of feel how this one's light, but this one's having more trouble. Right. And then, oh, beautiful job. Beautiful job. That was awesome. Okay. I know that much work though, to change the organization, to change the timing, the coordination of the way the muscles work around the knee and keep that femur from kind of gliding forward over your Shin too much. Right? So it's kind of a standard problem and it's because I things, my belief system anyway is that we sit a lot, even even for those of us who don't sit as much as as pretty common today, the the standard path of getting up out of a chair just puts a lot of forward thrust into the femur. And so the Femur is constantly being sort of sheared forward off the shin.

And then we come to standing and it's not in a very good position there. So we ended up in a hyperextension. And what, what would happen, let's say if we were squatting, would be a really nice standard path that would keep the ankle free, the knee free, the hip free of the lumbar spine free, and teach the femur to be in a different relationship to the Shin so that when we rose up, we'd be just right on top instead of slightly forward. So this kind of constant shearing of the femur off the knee and then you do some yoga or you could even do plots by sharing the knee all the time. That happens really commonly. And then we're exacerbating it. Right. And certainly if you're ski skiing in a way might not be the worst because you know, you put some pressure on the front of your boot. Right.

And so we see that a lot in Colorado, but still, once you've hurt the injury, once you've got the injury, then you know it's hard to hard to reclaim it basically. Okay. So now we're going back to the balls of the feet. And we're going to do two movements here. So we're gonna bring the thighs down until they're parallel to the ground. And then we're going to point and flex and keep your knees a little lower and then push down from there. Yeah.

So you don't let it backtrack at you at all. And your goal, once again is the same idea, right? So you're going to see if you can move the pedal more than your knees. So you're going to push the pedal down yes. And Flex back up again. And so the pedal will rise a little bit more. Yes.

And then you're going to push it down and you can think I'm pushing it all the way from my spine in a way. And then having awareness here that you're not holding your leg so much with your quad, but you're holding the pedal with your feet and you're determining the spring down there with your feet more than just kind of lock in your thigh out. Right. And then go ahead and point, keep the pedal still, but from the foot again. Yeah. And Lower and less so that it's not just ice water, everything, which we do. It's really that I actually learned to use everything below my knee to do all the work that's supposed to happen below my knee. Right?

So you point and can that go a little lower and then you flex, you got it and you point and you use your arches, your ankles and your calves. And at the same time these muscles are working to stabilize the femur. But in relationship to the work that's happening here instead of vice versa, where she'd just be holding this and then moving her foot. Very nice job. Go ahead. And then just let your pedal rise really, really nice. So, so we're just changing that relationship where this slides that way all the time as we get out of a chair kind of a thing. And we're learning to stand more on the foot and make decisions at the knee and hip based more on the foot than on the knee.

And thus doing so you might find you really want to use your foot correct or a lot you really want to do your standing foot exercises. And then even when you're doing foot work exercises like here on reformer that you want to feel like the foot is doing the work more than the quad. So this is a big, huge issue in life. But big, big one in [inaudible] we can just pump everything with our quads are really good at it. So we're going to just try to see if we can't change our a little bit about that. So come on up and let's do foot ankle. So you're going to turn and face the other way. And we're on a medium spring, depending on your chair, a high, low, maybe even a medium low.

And then also like on center line, we'd probably do it on a two too. So play a little bit strong, healthy, but knee problem can go up a little bit. Obviously we have people who are gonna even work on lighter sprays than that because they don't have the strength or the control yet. Okay. So let's just do your left one. So we're going to put your foot there, your left foot, their hands go on the chair. Even as you push down. Think about this Martha, instead of even pushing now with a flexed ankle.

So your quad would lever at all point your foot and push the foot down to put your knee where you want. And then you put the knee just below the kneecap. Exactly right. Checking even here cause you see it. Here's a perfect example of, yeah, go ahead and let it happen for a moment if you don't mind. Like into your standard hyper extension where we're holding a tremendous amount of pressure right here. And we would like to have that relax a little bit and put that weight right here and let the weight come from the shinbone to the tailless even a little more forward. And then it'll bridge out into the ball of the foot.

And if we can feel that on the standing foot, I would even like to feel like there's a little less work right here and perhaps a little more work in here. Yeah, like if you were skiing down hill and you had to dig in a little bit, that's the way, right? So that we're not stretching this all the time. That's really a standard. So we would like to not even have quite so much pressure there, but a little more in the front of the heel so that then when she works her other foot, she's thinking the same idea a little bit. Right? So let's get you a little more square. So we'd just like to see that even, and on one leg, often we're not. And then as she's standing here, again, we're kind of hanging in our Achilles tendon and what I want you to do is put your weight on the ball of your foot and Citi your heel. Yep. Yes. And then push this up.

You did higher push this forward, right. So we're getting that Shin under the femur again correctly and then keep it there to flex and your flection is going to happen here instead of here so that you have to keep holding the work in your foot and then push again with your foot. Nice job. Very nice job. And keeping the calf forward. Yeah. And then maybe a little more little toe side of your foot. Yes. To get that outer line. Nice Job Martha. Even a little more little toe.

Yeah. So that the weight comes through the ankle and goes evenly to both sides of the foot rise. We get the big toe and the little toe and not just the big toe, which is really common, which obviously torques the knee a little bit. Very, very nice job. And then one more time and she's doing a really nice job of making the work go throughout the whole foot and coming back up. Actually do one more just so I can say this last thing and that is again that we're trying to get the femur up here and the quads hold the femur here so that the push could be forward from here as opposed to forward here. Nice. Let's go ahead and do the other leg.

Do the other leg anyway because she's going to work on her left even when she's standing on it. Now that she's done it. All right. So she's got a better awareness of what's going on here. I just come up, obviously touch things a lot to make sure I can feel where the tension is and we just want less tension here. Yep. And more work here. Right? So that this is not pulling on the knee at all. Right. And then she might even just feel that outer side of her foot just a little bit more even on the left. Yeah. And I'd even relaxed that a little bit more. Right. So you could dig into the foot a bit, right? Yes. Beautiful.

And as she digs into the foot, that's what connects up into the soul, has a little bit more. So we get an automatic whole body out of that. And then the Psoas of course goes right up into the diaphragm. So we get a nice inhale as we push and exhale. And you think of getting the weight onto the ball of the foot more of both feet. So it's a little less yeah, in the Achilles tendon and it's a little more on the shin.

Yes. And into the toes. Right. And then as she pushes knee cap, femur slide up. So calf is free. Nice job. And she mentioned earlier, but it's not uncommon that you would have an oppositional hip issues. So we'll see often for instance, that somebody has already a right hip replacement.

And then the next thing that happens is the left knee really common. So we want to make sure that the hips and feet on either side of the knee and on both sides of the body are doing a really good job. You got it. Really Nice. So then she's very much in control. She's not letting the spring or the pedal stretch her. She's working her foot up into her calf to provide like the up support for the knee from below that's often missing.

And then shifting that energy that wants to hang in the quad up into the, so as a little bit more great and then come to standing and then let's do something, not simple but a little differently. That's not just me and do just to standing pushed down from the front, but stand really beautifully on your feet. So I would soften the knee a little bit just so the weight is not held in the calf, but again, it's down in the ankle. Right. And then distributed to heel, big toe, little toe. And we'll slowly work on figuring out how to straighten the knee by pulling a kneecap up versus pushing a calf back. Okay.

Does that make sense? So if she were to straighten her knee right now, she might just push her calf back, right. And then the knee is kind of unsupported. What we would like is that the tripod of the foot is solid and the kneecap would pull up into so as, but it wouldn't create a shift back in the shin. You can almost think like we talked about a little bit earlier in that other one tibia forwarded femur back, but not so much ever calf back. Right. And then when she goes to push, then the push is going to be in her. So as, and I'm just gonna move your chair slightly forward.

Yeah, soften the elbows and put your weight on your hands. So again, we're on our feet hands the spine gets a little freer. We can breathe. Oops, sorry. And then come back up and you stay on your hands and feet. You don't to have to tense your back. You might even soften a little bit more to make sure you're really on them. That's the way so that deep.

So as could come back up and then go on down and do three pumps where you bend and straighten your elbows. Very narrow and see if you could feel that for footedness like an animal, right. Release tension here. Put all the work in your feet and hands and your lungs. Good job. Beautiful. Inhale, exhale and exhale venture. I was in one more time. Inhale, big lungs and exhale. And then last time, straight in the elbows. Inhale and just stay on your hands and feet and roll.

Roll Up. Exhale. Dominoes, work. So as works, you stay powerfully planted on your feet and then you have to pull your belly up. Yeah. Nice job to come to standing. Right? So that we would be standing even here, a little less than the quad calf and a little bit more in the hamstring Shin. Not that you feel your hamstrings work, but that your femur is a little further back here and your shins a little further forward. So this weight isn't here, but it's right here. And that can take a while. And then we figure out from there how to straighten knee up without doing the shin shove again. Okay. And you'll see it. It's rampant everywhere.

And because in Pele's we put people on their back a lot, right? So right away for foot work, then gravity even enables that. Right? So in foot work right away, you've got to feel that the arch of the foot, like you were doing in your foot, ankle is actually holding the whole leg and that the leg isn't just hanging off the foot and then the quad has to grab, right? So if the arch of the foot and the muscles that come up the back of the Shin that hold the Shin forward and actually do more work for us, the knee does less and the knees in a better positioned as well for finding its uplift. And I think that's one of the beauties of the first footwork position is that when the heel is high and the arch is lifted, the knee has to learn again that actually it's supposed to go this way instead of down. Right. So, but we have to teach that because we could still do that no matter what cause we're just really creative that way.

So basically you're just working on that pattern in every exercise, on every piece of equipment, at whatever level you're doing it. Standing foot or exercises are obviously amazing if we teach them to reorganize that pattern. I think it's there like beautifully designed for that and you know, and just the longer you teach bodies and more, you realize that some of that simple stuff that he created is just brilliant. Right. And then foot corrector, toe corrector, anything else? They don't answer the question but they could if you see the pattern and make sure right that you're always reorganizing that a little bit.

And it does vary. There are, some people have very flexible ankles and they have a slightly different issue where they need to build a little more strength around that range. But the pattern should come out the same in the end, whether you're working at it from a tighter or more flexible thing, you're trying to come to this middle ground where the arch of the foot holds you. The Shin comes down into the tailors and distributes up the arch, and then the Femur is supported up into the, so as an inter, the lungs hope, hope that helped you hope that you can explore that and have a really good time and see how many people you can can work with and help them not only heal some neat knee injuries, but prevent a lot of knee injuries. And then certainly after surgery, help them get back into a pattern that's not just going to wear up their new fake parts either. Okay. So thanks.

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Comments

2 people like this.
Excellent learning tool once again. Amy I am wondering about clients who are heavy, causing any disc cushioning to gone, and needing a brace. Do you try these same exercises?
3 people like this.
Amazing intuitive knowledge of knee mechanics!
I will be rethinking your information forever, as an active lifestyle requires longevity of our knees.
2 people like this.
Thank you, thank you, Amy. So many of my clients have knee issues exacerbated by cobblestones. You have given me new eyes to see with. Always gracias!!
2 people like this.
This was really helpful to me Amy! I will implement these tomorrow. I am working with two different clients, one who has had a knee replacement (20 months new), with slight drop foot, and another who has nerve damage from a car accident from her hip and knee affecting nerves to the foot. She has extreme drop foot and dorsiflexion at the ankle is non existent, however I have been able to discover minimal toe dorsiflexion. She is very thin and little muscle strength. Any suggestions you would have are greatly appreciated.
2 people like this.
Thank you Amy, great reminders and details of the hip, knee, ankle, foot mechanics. Makes me inspired to hear your voice explain this in such detail again.
2 people like this.
Thank you so much Amy! Very good explanation!
2 people like this.
Amy! I see you many times a week and I am ever inspired and excited by your ability to convey what you see inhibiting a body and how to use Pilates to return to life! Off to my studio to do the work newly invigorated ❤️❤️❤️
1 person likes this.
Hi Amy! I've been working with this all week: With myself as well as clients. My knee was actually really acting up and was having trouble with stairs. All good now as are my knee clients
As always, your tutorials are very important and informative!:))
1 person likes this.
Thank you for this invaluable information. I look forward to working on this myself tomorrow and then on to my clients.
1 person likes this.
I blew out my knee 13 years ago and used Pilates to rehab....spent 6 months on crutches unable to walk ..now it is better than ever so I can really appreciate the fine tuning....
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