We discuss in this interview:
- An exciting case study brought by coach Carl Reader, about re-gaining movement and overcoming knees swelling
- Using functional movement for the knees
- The “rock and roll” maneuver
- Building a progression schedule
- Overcoming anxiety about movement
- Avoiding overcompensation in case of imbalance between legs
Clint – Thanks for joining me again today. I’ve got a guest, Carl Reader, who has been on the podcast a lot. He’s a really integral part of our support group inside Rheumatoid Support, where he’s one of the coaches and members are able to ask him direct questions about particularly their needs, but also other aspects of the physical challenges with inflammatory arthritis. Now, Carl’s with us today, he’s got new things to share. Another case study, I believe. Carl, welcome back. What do you have for us today?
Carl Reader – Hi, Clint. Thanks for having me again. Yeah, another exciting case study to share with you and your listeners today. So I’d like to just introduce you to a lady who’s 65 years old, and she lives out in New Zealand. And as she describes, she has RA in both knees and swelling, and a lot of pain. Couldn’t walk, couldn’t get out of a chair, and her words to me where she just was broken and hopeless and it really like I felt just the pain that I could see that she was in. She told me she had listened to the last podcast that we’d done together on pain reduction and swelling in the knees and she thought she would give it a go. When I saw her, I could see that she was struggling and it was really getting her down. I just said to her, just the power of functional movements and basically, we’re going to start very slowly with her. We’re not going to do anything hectic movements because she could barely move in this chair. So she went from basically not being able to get out of a chair, walk or drive in three weeks, get out of the chair comfortably, drive and walk. She just sent me an SMS the other day saying she’s on 5000 steps, it’s just a remarkable turnaround. And I think she’s probably sent me about like 20 texts saying, thank you, thank you, thank you, thank you. And I keep saying, it’s not really me it’s the work, it’s the body and the human body. But it’s a wonderful case study so, we can unpack that and just go through what I did with her and just share what I want to call out, that key move that really made all the difference.
Clint – How good does that make you feel? Because I feel great as well, just knowing that I’ve introduced her to you via the online support group that we have, and then she’s reached out from there to expand her help and gotten one on one private video calls with you on a weekly basis. I feel so happy for her. I mean, no wonder she sent you 20 odd texts, because when your knees are like that, and I can talk from personal experience like life is a nightmare. So let’s have you tell us as much as you can about what you did with her. And I believe she also is doing our Paddison Program diet as well.
Carl Reader – Yeah, absolutely. I mean, it’s why we do what we do or why I do what I do. I mean, it’s just so rewarding to help people, even just small changes and that’s exactly what we do. But getting back to your question for me, the simple thing was just getting out of the chair was going back to what I call the rock and roll maneuver, where we position her in the chair where she can use that momentum of where you like sort of sit back and you do a few rock and roll from the pelvis and generate power. I really want to expand on this because it’s so important for listeners to understand this. Where she would lean forward and get a center of gravity forward and then push through her heels and use the big muscles. So the glutes, the buttocks muscles and a core muscles to get her out where she was using her knees to get out of the chair, it just was just agonizing. And what I’m discovering as I work with clients and as I just grow through my own experience, is that the body is like it’s not just its momentum, but it’s generating energy and power. So you’ve got to look at it as like battery packs. When you use your buttocks and your hip flexors and your core, they’re like the big main battery packs. And that sort of backwards and forwards movement is like you kind of charging a cell phone, you’re generating current, you’re generating electricity to sort of power you up out of the chair and. It was like one fish, and she got back to me and said, I can totally get out of the chair without any pain, that made such a remarkable difference. And I kept going back to and saying, you should just do that simple rock and roll, I’ve never been taught that maneuver, and it’s just changed my life. And so and the week before, I had another client say to me, that little thing you taught me about rocking and rolling, getting out, it’s changed my life. So it seems to be such a key thing that I take it for granted, I can get out of a chair without any pain. But for people who are really struggling, this maneuver is so, so powerful.
Clint – Well, for those people who are watching, maybe you could demonstrate it from side on, I’ve put you on the spot there. We haven’t talked about this or given that the majority of people listening to the podcast, potentially talk us through it as well. I know you’ve got your headphones on if need be, you can take those off, but just see what you can do here in terms of demonstrating and also talking whilst connected with your earbuds.
Carl Reader – Yeah, absolutely. So I think the key thing is that when people generally get out of the chair, they want to like stand straight up, like vertically up. So you’ll see them gravitate towards their hands and they want to push themselves up using their elbows. And so when you go straight up out of the chair, you use your knees to get up, and that’s where the pain comes because you get that compression. What you want to essentially do is get your center of gravity like over your knees, so you want to bring the body forward, but it must hinge from the pelvis. And a lot of people hinge from the mid back and lower back. So they get lower back pain or they’re not quite sure where to get that hinge problem has got to happen at the level of the hips. What I often do is get them to put their hands on the front hip bones, like right in the front of their body. And those bones have to literally sort of move down towards the floor. And as they move down, I can see my whole body is shifting forward. And that’s shifting of the weight, it’s got to do with the centre of gravity. It sort of brings it over your knees, you take the load from the knees and you shift it into the hips, which is where the power comes from. And that activates the buttocks and the glutes, the glutes and the hamstrings.
Clint – And at that point, as we have, we get a feeling for it after a rock or two, we can then apply the downward pressure. And the important point, I think, is that it goes down through the heels.
Carl Reader – Correct? Well, that just stimulates or activates we call the posterior chain muscle. So in other words, the back muscles and the back of your body. That’ll be a hamstring calf, glutes, and that’s the power of muscles you want to use. Now, you’re obviously going to use some thigh muscles up your quadriceps, but it’s the power has really been generated from the hips in this exercise. And that’s it’s a shifting of the load from the knees to the hips, which does the pain reduction. And the rock and roll is basically if you have your hands on your hips, you kind of you can just see in the video, I’m kind of just sort of like getting ready to launch. And it’s this sort of feeling of like you’re using that momentum to generate that power that you go sort of one, two, three, and then you stand up and you push up.
Clint – A couple of comments around that. First of all, I taught my mum this ten years ago after she’d had two knee arthroscopy. So she’s 79, should be 80, and on December 24th. I learnt the sort of weight in the heels thing through doing nearly 1000 Bikram yoga postures, Bikram yoga classes. Where the sort of the first of the squat exercises, it’s weight in the heels, 100% of your weight in the heels, but don’t take your toes off the ground. So I’ve always sort of known this way before you and I met and Mum came to visit us the other day, my son turned four. And don’t you know, in the morning before breakfast there she is. I told her every day do 20 of those before you get up before anything else. And then she was doing those 20 things. I said, how are your knees? She said, perfect. And she didn’t even want to talk about they were perfect. I mean, it’s just it’s fascinating, isn’t it? Just this very simple movement. She doesn’t have to rock anymore, which is tremendous. She just comes straight up. She doesn’t have rheumatoid. She just had some wear and tear arthritis in the knees. So. Okay, what sort of schedule have you now got this person on that you’re working with and what’s the progression or what is the scale from that? Where do you go from there?
Carl Reader – That’s a great question. Firstly, she’s doing those exercises three times a day and she’s doing about 2 to 3 sets of them of about seven repetitions. Now, I didn’t even think she could do that. She kind of like we were discussing a program and she said, no, she wants to do more, and I said if you want to do more and you feel that’s fine. So that’s what she’s doing. We then went to getting out of the chair with a weight to the seated sort of like a seated squat where she would hold a little like a 2lbs or 3lbs weight. The other thing I got at doing, which is very interesting, is using the arms to generate power of the legs. So I’ve got to do a lot of upper body like arm swings, walking like many punches, we’ve talked about that before, the punches. And then I get it on the chair and then we go for the lower body. So we’re using the upper body to essentially charge the lower body. And she always says, my knees feel so soft or it feels easier. So that’s also been very interesting for people struggling with the lower body is to start with the upper body exercises and then go to your lower body. I’m even using that now for elite triathletes who struggle with muscle imbalances and I get them to first do the arm stuff first, then go to legs and there’s a huge difference.
Clint – Okay, great. And so with that, do you have her seated for this? And do you also have the elite athletes seated or it’s just because of her limited ability that you had her seated for the upper body?
Carl Reader – She started seated, but now I’ve got a standing. So the progression is from sitting, obviously standing. So do all the exercises she does standing, whether it’s with the weights, whether it’s elastic bands, or resistance bands that she’s using to pull. We started with stair climbing, but that’s still her one-year left side and knees still quite not so much pain but restricted. So we’re working on that balancing out that strength because, you know, there are compensations. But, you know, as you said, you’re going from no sitting and standing and driving to walking. I’ve felt that progression has been incredible. But now we’re working on getting that left side of your body stronger.
Clint – Did you mention to me before we started or after we recorded that she’s now done like a thousand steps or something?
Carl Reader – 5000 steps last week? Yeah. I mean, it’s unbelievable.
Clint – 5000 steps. And she couldn’t get out of the chair before?
Carl Reader – Yeah, she just said, I mean notes to me here where I was weak was broken, hopeless, and every time I sat down, I just had this panic. Not a panic attack, but anxiety would follow because she said, I don’t know how I’m going to get up. I don’t know how I’m going to get off the toilet so it’s such a big thing. And I think as well, like we’ve talked about this before for listeners, but like any sort of anxiety or fear about movements is something that they really have to work through because as you know, it’s such a handbrake to movements. And just knowing you can get up without that, that horrible pain, it’s just that alone is so positive on the mind.
Clint – So let’s say that someone just wants to implement whatever you’ve just talked about today, and they just want to give this a go at home. Correct anything that I’ve said that’s wrong here. But it would be along the lines of, when you’re in the chair, get your two feet flat on the floor, maybe shoulder width apart, I’m guessing.
Carl Reader – That’s great.
Clint – Then basically getting the zone, start moving the body forward and back from the hips. So your upper body is quite a straight line.
Carl Reader – Correct.
Clint – And then as you come forward on maybe the third go, push down through the heels, use the momentum to come u. Once we get a few of those under our belt, then treat them, I guess like squats and do like if you’re your client, maybe three sets of seven, three times a day would be a great place to get to in a couple of weeks. And then if we’re feeling beyond that, then do the upper body and then do those workouts as well. I wouldn’t imagine if the upper body is like heavy resistance. You wouldn’t want to do that three times a day.
Carl Reader – No, absolutely. No, no. That’s more like a little warmup, not with weights or anything just very simple. It’s very simple like walking arms. It depends, every client is different. So some have shoulder problems and you’ve got you can’t do that. There’s a lot of clients look straight ahead when they want to get up. And when you look straight ahead, you have this tendency to kind of arch your lower back or you push up, which then switches off the core muscles. So you actually want to look facing 45 degrees down in front of you that keeps you connected through the chain, and it’s one of the first things I correct. I often get my clients to say, where are you looking? What are you looking at? And that’s the sort of positions them naturally with the eyes, which is very powerful. The other thing is to put slightly turned out as well, that also helps with the knee, especially when you’re sitting down.
Clint – Yeah. Okay. Fantastic. If someone has an imbalance on one leg to the other, let’s say one knee is swollen, the other one is okay. What would you recommend in terms of trying to avoid overcompensation and using only the good leg? Or do you have a strategy for how we can restore that the balance there?
Carl Reader – Yeah. So what we do, and especially when I used to rehab knee replacements, is you just put the sore leg slightly in front. So in other words, you move it about an inch forwards and that already shifts the load. So you’re not getting, it’s not like you’re putting that leg right behind that all the leg, left leg. It’s not like your right leg is doing 100% of the work. When you put your sore leg one inch in front, you’re getting like about a 60 to 40% ratio. So the further forward the leg goes, the saw leg, the more the right leg is going to do the work. But clients we play with that online as part of the coaching, so we play around with how far that leg needs to go. It’s a great technique to bring load into that leg without straining it. So it’s a good question.
Clint – Yes, that is good. So that we’re controlling the exposure of the load to the leg to the load has the weakness. Yeah.
Carl Reader – And remember when you go one leg, especially in standing, that’s you’ll see that with a lot of hip patients like you got 4X, we say 4X the body weight. So it’s 4 times the load is on the hip when if you’re standing on one leg. Like climbing up the stairs, for example, you’ve got all your weights on one surface area of the hip, it’s four times the load. So that’s when you make small changes, it’s all got to do with loads. It makes me talk about it as well. Small little changes make a big difference on the loading of a joint.
Clint – Well that’s really I think what we wanted to cover today. Nice quick one just to give this tip and to talk about this wonderful results in your case study for your client. And share that good news and that simple strategy for people with really serious knee issues at the moment. Carl, did we miss anything?
Carl Reader – No, I think that’s that covers it. I’m sure there are things in the program where guys can go and have a look and see for that technique and practice that at home. With that technique, it helps you with, as you say, progressing into squats and everyday bending. It’s something I teach from elite athletes right through to people who’ve just come out of hospital. So if you can learn this and get it done, it’s a key step in the right direction.
Clint – Yeah. Awesome. And going back to my mum, talking about her 20 a day, I do the same thing. I practice what I taught her as well. And so I do 20 squats before breakfast because Arnold Schwarzenegger said you shouldn’t be able to eat food unless you deserve it by doing a workout beforehand. So I just do 20 squats before, and I do 20 again right before bed because I like to think that I want to lubricate those knee joints and get blood flow and activity to my legs before they then are stationary for another 8 hours or so.
Carl Reader – Sorry. There’s just one thing I think it’s important if listeners do try this and they do get pain. So that’s part of where the coaching comes in because often is handbrakes we have to work through to help you squat. So some of the stuff that we’re doing is releasing back tension or we are mobilizing ankles or doing deep breathing. We’re trying to just sort of release handbrakes because it’s a lot of stuff sort of has to be in a chord or function semi optimally to get out of the chair. That’s also a big thing we do with her as well. That’s just trying to activate muscles and just take it through like a little thing like that because, you know, it involves multiple joints getting out of a chair, you know, your ankle joint, knee joint, hip joint and back joints and neck joints. So there’s a lot going on there, you have to sort of communicate and be happy.
Clint – Yes. In terms of that coaching, one of our much loved members and administrators of our support group, Ellen, she is singing your praises as well. She’s been working one on one with you for some time. And she says not only has he made me feel better, but he’s also funny and he makes me laugh.
Carl Reader – So maybe it’s the laughing that’s doing all the work. I don’t know.
Clint – Not sure. But she’s happy and I’m happy because you come on and share some great tips and help people. So thanks very much, Karl. If you want to go and book a session with Carl directly, it’s www.CarlReaderCoaching.com. Otherwise, come over and join us in www.RheumatoidSupport.com and you can contact Carl that way as well. Thanks very much, my friend.
Carl Reader – Thank you, Clint talk to you soon.