Runner's Knee

Patelleo-Femoral Pain Syndrome / Runner's Knee Treatment in Adelaide

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

Is The Resilient Knee Program right for you?

Start a conversation with our new Chat Bot HERE

What is Runners Knee (Patellofemoral Pain PFP)?

Patellofemoral pain (PFP) is a common condition where pain is felt on the front of the knee, either around or behind the patella.

It occurs in up to 20% of the population (1).

The patellofemoral joint is made of the kneecap (patella) sitting on the front of the thigh bone.

The patellofemoral joint functions as a pulley system to help the quadriceps muscles straighten the knee most efficiently.

There are around 20 muscles that hold the patella centred and aligned.

Pain often results when there is excessive compression on the patella or a muscle imbalance around the patella causes misalignment of the patella.

Over time, this causes rubbing of the joint surfaces, creating inflammation and pain.

What are the most common symptoms of PFP?

• general ache/pain in the front of the knee

• pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)

• pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre.

• some people also hear and feel a grinding / clicking around the knee with mild swelling

An x-ray or MRI is not usually necessary to diagnose PFP.

Patello-femoral pain is often mis-diagnosed as knee osteo-arthritis in young people, due to the deep ache that is often felt. 

An assessment by a Physiotherapist will help to clarify your diagnosis.

Who is most likely to be affected by PFP?

The main risk factor for developing PFP is recent spike in training load. 

PFP is common in:

• runners

• cyclists

• triathletes

• cross fitters

• football, basketball, jumping sports

• hikers (especially going downhill)

Biomechanical issues that can predispose to PFP include:

• weakness in glutes, quads (VMO), core, calves

• tight ITB, TFL, quads (outer), hamstrings, calves

• stiffness in ankles (e.g. post ankle sprain)

• stiffness in the hip joints / hip flexors

• runners with who predominantly heel strike

 White et al (2009) showed that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls.

What is the most effective treatment?

There is strong evidence to support a tailored physiotherapy (including exercise, education, taping), compared to placebo in the short (six weeks) and long-term (one year).

Evidence shows a personalised exercise program (combination of stretching and strengthening) gives the best long term outcomes. 

Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment. 

How long until I feel better?

As our understanding has grown, it has become clear that PFP is not necessarily something that will disappear on its own, and some people can have episodes on and off for many years.

As such, in order to have the best chance of recovering from your PFP and reducing the likelihood of it recurring, it is important to understand your condition, your individual contributing factors and what you can do.

For many people, a program of ongoing and progressive exercise (as prescribed by your physiotherapist) is necessary to build and maintain muscle strength, and good movement coordination.

Additionally, there is evidence suggesting that people with PFP may have an increased risk of going on to develop patellofemoral osteoarthritis (OA). Therefore, seeing an experienced physiotherapist for a management program will help you keep your patellofemoral joints functioning as well as possible, and keep you as active as you’d like to be now and into the future.

What can I do?

• avoid aggravating activities

• ice your knee to eliminate the inflammation (15 mins x 2 day for 2 weeks)

• home exercises - foam rolling (see below) and strengthening

For Runners:

• avoid hills

• cut back on your running mileage

• increase your cadence by 5-10%

• check your shoes - time for a new pair?

• focus on cross training - swimming, pilates, yoga e.t.c.

Some of the common foam roller exercises we prescribe:

Calf

Hamstring

ITB

Quads

How can a Physiotherapist assist with recovery?

1.  Assessment and Diagnosis

A Physio Assessment early on  in your journey pays big dividends in terms of identifying relevant contributing factors and helping you get on the fast track to healing. 

We spend a lot of time in the beginning educating you so you know what to expect in terms of recovery and what you need to do, to manage your recovery successfully.

2.  Dry Needling / Massage and Taping

Generally a short burst of targeted hands manual therapy over 3-4 sessions will help re-set your tissues, balance the muscles around the knee and get you into a position where you can confidently self-manage. 

Muscles that are commonly tight and affecting your knee include:

• ITB

• TFL

• hamstrings

• quads and calves

Foam rolling and spiky ball massage are effective at maintaining flexibility, but dry needling has the ability to get to the deeper part of the muscle and get a more effective release. 

Find out more about dry needling here.

We can also show you how to tape your knee to provide relief in the short-term.

3.  Guidance on load management

We will give you advice on how to gradually re-load your tissues to safely protect your knee from future flare-ups.  We work with your coach or trainer to manage your return to doing what you love. 

4.  Building a personalised home exercise program

You are the most important part of the healing process and what you do is the most important part getting you better. 

We use the convenient Physitrack App to build your personalised home program with videos delivered to your smart phone.

5.  Movement Re-Training

Once your pain is under control we then watch how you move and optimise your movement patterning to decrease the chances of the knee pain returning.

People with patello-femoral pain are often hip flexor and quadricep dominant and need to learn how to activate the glutes and hamstrings.

We have some specific exercises to show you to help you fast track this process.

Is Knee Pain or Injury keeping you from being as active and healthy as you want?

Don't delay your treatment...

The occasional ache or pain may be nothing to worry about, but failing to pay attention to strong pain may end up causing you a lot of problems in the future. If knee pain is reducing your ability to take part in the activities your normally do, then it is time to get it looked at. In general, chronic knee pain or clicking that is affecting your life is a sign that something is wrong.

A serious problem will not correct itself, and left untreated, can result in more pain and irreversible damage. 

Bookings:

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

References:

1.  Boling M, Padua D, Marshall S, et al. Gender differ- ences in the incidence and prevalence of patellofe- moral pain syndrome. Scand J Med Sci Sports 2010;20(5):725–30.

2. 

Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: A review of routine general practice morbidity recording. Prim Health Care Res Dev 2011;12(2):157–64.

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Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 15 years with (over 20,000 patient consults). He is passionate about helping people to move better, feel better and get back to doing what they love.

Other blogs to help with your knee pain and get your performing at your best:

How To Make Friends With Your Hamstrings

The hamstrings have a long history of being the 'enemy' of good movement.

Tight, painful, cramping and all around bad guy, the poor old hammy cops a lot of negative press.

In this blog post, I wanted to share my thoughts with you about how to make friends with the hamstrings so you can all get on well together. 

What are the hamstrings?

The hamstrings are made up of three muscles - the inside two are called the semimembranous and semitendinosus and the large outside hamstring is known as the biceps femoris. 

The back of a right leg from hip to knee

In a bigger contex:

The Superficial Back Line, from Thomas Myers Anatomy Trains

The hamstrings are part of the Superficial Back Line - which is a myofascial line of tissue that incorporates the muscles and fascia from the bottom of the foot up to the back of the head. 

When one area isn't functionally overly well, there will be compensations up or down the chain.  Ever heard of hamstring issues affecting your lower back? 

Tight hamstrings means that the instead of stretch and movement occurring through the back of the leg, the lower back gets compressed, especially when sitting or bending forwards. 

That is one of the reasons we take a holistic view of your body and movement when you come in for an assessment.  We leave no stone unturned in our quest to get to the source of your problem. 

It doesn't matter where you feel your symptoms, we don't chase pain.  We focus on finding the weak link/primary source and then allow your (powerful healing) body to do the rest.

"Where you think it is, it ain't" - Ida Rolf

What is the role of the hamstrings?

The primary role of the hamstrings in walking and running is to eccentrically control the landing of the foot.  The hamstring complex undergoes a substantial eccentric contraction during the late swing phase (Yu et al, 2008) of gait.

Eccentric refers to a type of contraction where a muscle lengthens while contracting vs a concentric contraction where the muscle in contracting and shortening (e.g. doing a bicep curl). 

As you can see, just before your foot lands, your knee is going from a bent position to an extended straight position and the hamstrings job is to allow for a controlled, smooth landing.

Whilst it is important to have adequate flexibility, the actual more important job of the hamstring to have enough strength and capacity to walk and run properly.

If a muscle doesn't have much capacity to contract when needed, it will most likely get overloaded.  When it gets overloaded, it's muscle fibers contract and knot up, limiting flexibility.

For a runner, strength and stability trumps flexibility everyday of the week.

Trigger points in the hamstrings can refer pain to the upper thigh, buttock and around the knee

3 Steps To Making Friends With Your Hamstrings:

1.  Stop stretching them. 

Never again do a standing hamstring stretch.  I don't mean avoid it for a few weeks or months.

I mean NEVER* do this stretch whilst you are alive on this planet! 

Like an addict, you gotta give it up cold turkey. 

Yes, you can still do yoga and downward dog and continue to move through functional range of movements but no mindless, static stretching. 

Stretching in this position, you are actually making the hamstring weaker

Hang on a sec...I thought stretching was a good thing!?

Stretching the hamstring in this position, you are actually making the hamstring weaker and sending confusing mixed messages to the brain about what the function of the muscle is. 

Anytime your brain is confused, it's going straight into fight-flight mode and will want to tighten everything up to protect it.

Intuitively stretching feels good and it often does give some short term relief. 

But in the long run, with continued stretching, the hamstring becomes weaker and more likely to become overloaded and tight.  Then you've got yourself into a real pickle. 

The hamstring, once locked down, becomes an inefficient blob that hampers everything you try and do.

Our first step in making friends with the hamstring is to stop pissing it off, so no more stretching. 

By the way, as an added bonus, your lower back pain and sciatica will thank you as the standing hamstring stretch has a good way of irritating it.

*If you desperately feel the need to stretch, then you can apply heat packs or use the foam roller/spiky ball directly on the muscle. 

2.  Reset.

To reset the hamstrings, I recommend first releasing the muscle with 3-4 sessions of deep tissue dry needling and myo-fascial release massage.  This is like pushing re-set on your muscle tone and creating a fresh slate to work with.  After a few sessions, the muscle will release and then we can move onto the final step.

It's important to get a twitch response that stimulates the blood flow and releases the chemicals in the muscle that have been holding it tight. 

Be prepared for some significant post-treatment soreness for a 1-2 days.  Months/years/decades of tightness ain't going down without a fight!

Check out more about dry needling here and see how it can get your healing on the fast track. 

3.  Build 'Em Back Up.

The biggest issue around the hamstring is it's near universal lack of strength. 

When was the last time you did a specific hamstring strengthening exercise? 

Most of us tend towards an excessive quads/hip flexors vs hamstrings ratio due to excess sitting, walking and running. 

Quads are strong, hammies weak.

This imbalance is perceived by the hamstrings as threatening. 

Powerfully contracting the quads during the running and kicking motion could potentially damage the hamstring. 

How does the brain / muscle respond to threat? 

You guessed - it tightens up.

Graduated Strengthening Program For Hamstrings:

The best long term strategy to make friends with your hamstrings is to build capacity so they can perform their job of eccentrically controlling the foot in landing.

If the hamstrings can happily do their job, they'll most likely start to feel safe, protected and will naturally start to release all on their very own. 

Trust me, I'm a Physiotherapist!

It will take time (3-6 months) to build strength, so listen to your body and take it easy at the start.  If you can only manage 2-3 reps in the beginning, that is fine.  No rushing!

The goal is to push the hamstring to fatigue (feeling some hamstring soreness the following day is a good sign) and then allow it to adapt, recover and get stronger. 

Make sure you create the right environment for healing via eating well (protein + vegies), drink plenty of water and get enough sleep.

Aim to do these strengthening exercises twice per week.

How many reps? 

If you figure every 10k your run is approximately 5,000 steps on each side, then the hamstring needs a fair amount of endurance capacity.  I would keep gradually increasing the reps until you are not feeling any pain on your walks and runs.

Quick note: avoid the hamstring curl machine at the gym.  This exercise strengthens and shortens the hamstring, which is what you don't want.

Step 1: Bridge

Try 3 x 30 sec holds.  Relax your lower back and squeeze your glutes. 

Tuck your pelvis so you feel the opening of the front of the hips. 

Keep the bridge high as you extend one leg in front. 

Hold for one breath and then switch sides.  When you can repeat x 10 each side, move to step 2.

Step 2: Bridge on Foam Roller

Make sure the roller isn't too far away from you, otherwise the hamstrings will cramp.  

The goal is to gradually build up the strength in the hamstrings.  It may take 3-6 months so no rushing. 

If you push too hard, then you most likely will lock the muscle down and you'll have to start over.

When you can complete 3 x 10 reps on each side, move onto step 3.

Step 3: Hamstring Curls on Swiss Ball

The perfect Eccentric Hamstring Exercise: Strengthening AND lengthening.

Quickly pull the ball in towards you and then SLOWLY (slow as you can) lower the ball away from you. 

Count to as least 5 seconds as you do this. 

Repeat until fatigue. and then do another x 2 rounds. 

If you can do x 30 reps pretty easily, try one legged.

Practicing this movement will have a direct improvement on your hamstring problems, especially for runners.

Step Four: Single Leg Deadlift

Hold a dumbbell in each hand and stand on your right leg, lifting your left leg a few inches behind you (a). Keeping your back straight, lean forward from your hips until your body is almost parallel to the floor, the weights in line with your shoulders (b). Return to start.  Do 12, then switch legs.

Bonus Tip:

Don't forget to strengthen the glutes, lower back and calf muscles above and below the hamstring.  Often if these muscles have reduced capacity, the hamstring can become overloaded and then lock down. 

So there you have it.

Have a go and please write in the comments how you get on.

I'd really appreciate your feedback :-)

References:

Hamstring muscle kinematics and activation during overground sprinting.

Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE. J Biomech. 2008 Nov 14;41(15):3121-6

3 Tips To Running Without Knee Pain

Knee pain is really common among runners (about 40% will experience in a given year). 

So...rather than ignoring it and hope its goes away...here are 3 simple tips to help you keep your knees tracking smoothly and efficiently :

1.  Increase your cadence

Research suggest a small increase in your cadence (increasing step frequency by 5%) leads to a decrease in ground reaction force. 

Essentially, shortening your stride takes the stress off your legs and taps into your 'spring system' that is more efficient and less impact on your knees. 

The average runner's cadence is approx 160 steps per minute, and the research shows increasing to 170-180 can make a big difference.

Be warned though, this style of running will put a greater load on your cardio-vascular system - so you may need to keep an eye on your heart rate and take breaks as needed.

Download free Metronome App here

Some GPS watches track your cadence.

Otherwise you can download a free metronome to help you.  I like to use the metronome for a few minutes at the start of a run to help get my rhythm in place...starting at 170bmp and then up to 180bmp for a few minutes.

2.  Strengthen your glutes

"Strong glutes makes everything better" - Perry Nickelston

The glutes are the main protectors of the knee.  When they become weak or inhibited they allow excess pressure on the knee joint and the muscles that surround it such as the ITB. 

When running, the glutes should take most of the load.   The gluteus maximus is the biggest and most powerful muscle in the body.  But in the presence of pain, injury or excessive sitting it 'switches off' and other muscles are forced to compensate.

Here are some of our favourite exercises to get your glutes back online and functioning:

• clam

• bridge

• single leg bridge

• reverse lunge

• squats

• split squats

If you think your glutes might need some work...then you should join our weekly Pilates class...click here to reserve your place (spots are limited). 

Bridge:  Tuck the pelvis under lift your hips - look for a straight line between knees, hip and shoulders.  Breathe and relax the shoulders.  Hold for 1 minute x 3 sets.

3.  Foam roll AFTER you run

The muscles in your legs have to work pretty damn hard during a run - absorbing up to three times your body weight every time you land. 

Muscles such as the outer quads, ITB, calf, hamstrings and adductors can get tight and knotted up and have a lot of trouble relaxing back to 'normal' after a hard run. 

This tightness can lead to increased pressure on the patella (knee cap) and cause ongoing tracking issues with the knee. 

A quick full body tune-up can be completed in less than 90 seconds (see video below) and help iron out tight spots around the knee.  

Of course, if you are tight in a particular area, you should spend longer working out the knots.

Is Pain or Injury keeping you from being as active and healthy as you want?

Why Knee Pain Gets Worse With Lunges And How To Ease It

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

Is The Resilient Knee Program right for you?

Start a conversation with our new Chat Bot HERE

Why knee pain gets worse with lunges and how to ease it

Knee pain while performing lunges is very common and every day in the clinic I hear people say that performing lunges aggravates their knees. 

I find my patients either:

1. Push through the pain and keep going with them, ending up with an injury or

2. Stop doing them altogether and miss out on the many benefits lunges can bring.

In this post, I will show you how performing lunges can place excessive stress on the knee and a give you a simple way to avoid this from happening. 

What happens during a typical lunge?

See the picture above where the front knee travels along way forward past the ankle.

This is not a problem if you don't have knee pain. 

BUT, if you do have knee issues, there is a high chance this movement will aggravate your pain.

Doing a forward lunge in this manner plays into a common muscle imbalance that many of us suffer from - over-active quadriceps and hip flexors at the expense of the gluteals. 

Walking lunges are particularly bad at encouraging this quads dominance, as the center of gravity is traveling in forwards direction.

Quick anatomy review:

The hip flexors (left) that attach the lower back to the hip and the quads (right) that attach the hip to the knee. 

The effect of over-loaded quads:

Due to the fact that we are sitting, driving and walking a lot, our quads and hip flexors are naturally prone to tightness and overuse. 

Adding further stress in the form of lunges can push them over the edge.

When a muscle is repeatedly contracted in a shortened position, eventually this will lead to development of knots or trigger points in the muscles fibers. 

This reduces the flexibility in the muscle and also gives rise to referred pain, that often is felt in the knee.

Referral pattern of the quads:

When the quads develop trigger points (knots in the muscle fibers) they have a characteristic referral pattern. 

See below:

So....instead of the forwards lunge, try this simple but powerful change:

The Reverse Lunge

To obtain the benefits of a lunge, without putting your knees at risk, follow these 3 steps:

Step 1:

Maintain a neutral spine (think gently tucking the pelvis under and activating the core muscles) and then taking a big step back. 

You should feel a gentle stretch in the front of the leg that steps back (upper quads and hip flexors). 

Tip > you can use a foam roller to counter balance the backwards motion.

Step 2:

The key to the reverse lunge is maintaining a vertical tibia in the front leg.

At the bottom of your reverse lunge, take a quick look at your tibia bone (lower leg from knee to ankle) and it should be in a vertical position i.e. perpendicular to the ground. 

Keep your center of gravity back and over your hips. 

In this position, your glutes should be activating strongly.  The quads should also be working, but not excessively. 

The nice thing about the reverse lunge is that if you push back to far, you will only work the glutes harder, which is never a bad thing.

Progression: Reverse Lunge with medicine ball

Step 3:

Push yourself back up to the start position using your glutes to lift yourself forwards.

If you can do ten on each side without much trouble, adding some weight in the form of a medicine ball or kettlebell is a great idea. 

Aim to complete three rounds.

Between sets you can do some bridges or step ups which will also target the gluteal muscles.

If you're sore in the glutes the next day, you know that you're on the right track!

Please have a go and let me know how you get on in the comments below.

Download the The Healthy Knees E-Book - now on special !!

Is Knee Pain or Injury keeping you from being as active and healthy as you want?

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Get To Know Your Muscles - TFL (Tensor Fasciae Latae)

Author: Daniel O'Grady is a Physiotherapist in Adelaide, Australia.

Most people know about their ITB (Ilio Tibial Band)  that runs on the outside of the thigh; but not as many are familiar with the strip of muscle that joins the upper part of the ITB to the pelvis. 

This small muscle is known as the TFL (Tensor Fasica Latae). 

“If you’ve ever had problems with your knee, hip, lower back, calf or achilles, chances are you have some unresolved tightness in your TFL.”

QUICK ANATOMY REVIEW:

As you can see in the picture, the ITB has upper attachments to both the gluteals and the TFL.  Any dysfucntion/weakness in the glutes means that the TFL needs to work proportionally harder.  Gluteal inhibition is common - especially if you spend a lot of time sitting.

PALPATE THE TFL ON YOURSELF:

To feel the TFL, place your finger on your front of your pelvic bone.  Slowly move down and to the outside of the thigh until you feel a ropey muscle that is the the width a finger.  It may be tender to touch.

FUNCTION:

The TFL is a hip flexor, abductor and internal rotator.  It works in conjunction with the gluteus medius and gluteus maximus to stabilise the leg during the stance phase of walking and running.  The TFL anteriorly rotates your pelvis.  Functionally, the TFL is part of the Lateral Line and the Spiral line, according to Thomas Myers in his book Anatomy Trains.

The Lateral Line

The Spiral Line

SYMPTOMS:

Overload of the TFL can lead to pain and tightness in the front of the hip.  Very common is also pain and tightness in the outer part of the knee and into the ITB.  This is most noticeable when walking or up and down stairs/hills. 

Other symptoms:

• knee and hip pain (especially outside)

• the lower back and SIJ

• upper back

• calf and achilles

As the TFL pulls the head of the femur bone forwards, chronic increased tone is one of the prime causes of hip osteoarthritis and degeneration. 

HOW THE TFL BECOMES OVERLOADED:

The TFL becomes overloaded with repeated use in the following situations:

• excessive sitting, driving, kicking

• walking and running (especially uphill and downhill)

• cycling, swimming, kayak/canoe

• meditating crossed legged in lotus position

• sleeping in the fetal position

• standing with a swayed back and wearing high heels too often

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your TFL issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building gluteal and core strength is critical to prevent a relapse. ”

TRIGGER POINT DRY NEEDLING:

Tightness and shortening of the TFL responds well to dry needling, which can de-activate the trigger points (knots in the muscle) that can form in chronic cases.  The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms.  Dry needling is certainly an unusual feeling, but definitely beats 15 minutes of deep painful massage in that area.

SELF-CARE TIPS:

• apply heat to the front of your hip 10 minutes each day

• avoid sitting cross legged

• avoid walking and jogging uphills and on sloped surfaces in the short-term

• ensure your shoes are not overly worn

• sleep on stomach or side with pillow between knees

• when running - avoid over-striding and endure proper warm up and cool down

• use cruise control on long car trips to stretch the legs

GRADED EXERCISE PROGRAM TO ADDRESS TFL OVERLOAD:

PART 1 STRETCHES:

FOAM ROLLER ITB

Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER QUADS

Go harder along the quads. Keep breathing!

HIP FLEXOR STRETCH

Feel the stretch in the front of your hip as you tuck the pelvis under gently

FOAM ROLLER TFL

Angle your body across the TFL and roll it with medium to light pressure

PRONE EXTENSION COBRA DECOMPRESSION

Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PART 2 STRENGTHENING:

The goal is to strengthen and support the muscles around the TFL

BRIDGE

Feel a stretch in the front of your hips while your glutes activate in the back of the hips

CLAM SHELL

Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

SINGLE-LEG BRIDGE

Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

PUSH-UP TO SIDE-PLANK

Activate the obliques as you twist into side plank. Try x3 on each side.

PLANK

Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

PART 3: POSTURE / NEW MOVEMENT PATTERNS

“For many people, the TFL becomes the muscle that is always switched on and over-active.

Try these movements, focusing on keeping your core and gluteals engaged. ”

STANDING PELVIC-TILTS

Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING HAMSTRING CURLS

Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

REVERSE LUNGE

Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

SIT TO STAND SQUATS

Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

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