Rheumatoid Arthritis In The Knee Exercises. Functional movement coach Carl Reader shows us some exercises to improve our knees.
We discuss in this episode:
- Isometric exercises for the knees
- Squats for the knees
- Advice for RA patients
- Body awareness
Clint – If you’ve got problems with your knees, then today’s episode is going to be super helpful. I’ve got Carl Reader, a functional movement coach, and my best South African friend, with me today to walk us through three important stages of knee improvement. He’s going to give us the exact exercises that we need to improve our knees, good day Carl.
Carl – Hey, Clint. Thanks for having me back again.
Clint – Yes, you’ve been tremendous to our members inside our coaching platform where you provide this service on an ongoing basis to our members who have problems with not just their knees, but other body parts. It’s just that you happen to be a specialist now with knees. Having worked with so many rheumatoid arthritis patients for the last couple of years. So let’s go through this, let’s get straight into it. What’s a good first starting exercise that we can do with bad knees and even maybe a step back earlier than that? Should we do lots of reps or should we keep it just low reps and stationary or isometric? So talk us through that first.
Carl – Yeah, brilliant. You know, you mentioned I’ve spent a lot of time on knees, and obviously in anything where you spend time, you learn new things all the time. And for those who’ve been working on doing exercises, we focus so much on glutes and hamstrings. Even my teaching is glutes and hamstrings and quads, but I’ve really just been spending a lot of time on the inner groin, they’re called adductor muscles. And if you go into the anatomy textbook, you’ll see that they’re actually almost bigger than the quads. They’re a large mass of there for big, big, large group muscles that we often stretch but don’t really give much attention to strengthening. And they are they are the major stabilizers of the knee. And it’s something that I the last six months have been really just digging into and getting great results. So these exercises are going to start actually to target those muscles and we’re going to use isometrics to get started with these. So for those of you who are not familiar with that, we have three types of different muscle contractions. We have concentric where we are shortening muscles, we have eccentric where muscles are working as a lengthening. It’s basically the best way to think of it as a breaking. So when you’re doing fast activities running, you need to have a breaking force that’s eccentric. And then isometric just simply means not changing the length of the muscle, so it’s working statically. But what we see and as we’ve grown our science, we see that when we do a lot of functional movements, isometrics plays a major role in most things we do to bring stability to the back, the knee, the elbow. So that’s just a brief introduction to what we’re doing.
Clint – Yeah. Great. And to put this into some context that’s familiar to everyone, if you go and do a yoga class and you find that you’re holding a posture for ten, 15 seconds and and the teacher counts down will hold this for five, four, three, two, one. You’re doing isometric exercises there. You can walk out of a vinyasa class and your heart is beating. You’ve had a really solid workout, especially if it’s heated and you have just done a great workout, almost completely isometric except getting in and out of postures. And so it is a tremendous approach for rheumatoid arthritis, where often with heavily compromised joints, they don’t like being put through as many repetitions because they don’t have the supporting muscle mass or there’s inflammation.
Carl – You just said it beautifully so the whole idea of isometric is the word supporting and stabilizing. And so often we want to get straight into strengthening and we forget about those supporting muscles. So the first exercise I want to introduce to the listeners is called a sumo squat, in ballet they call it the plie. I’m not going to teach ballet on the show, but it’s where we stand wider, wider stance so wider than than normal shoulder width stance. And what’s important for the listeners here is you need to when you’re doing isometrics, you’ve got to be comfortable. So you’ve got to find that stance where it could be even like a quarter of an inch, one centimetre wide or shorter, where you feel comfortable to stand in. Because if I say to you, stand exactly in this position, that might not feel comfortable. But by simply moving like a tiny, tiny fraction can take away the pain. The whole idea is to strengthen these muscles in a pain-free or relatively comfortable position because you’re going to be holding it for five, ten, 15 20 seconds.
Carl – So we want to stand in a nice, comfortable position. But I would say not as wide as you possibly can, but wider than shoulder width to start with. And then you will build that width open and then you want to have your feet slightly turned out. And again, you can stand with the feet like straight turned out. But if you’re not comfortable even more turned out, you’ve got to find that position on the knees where you’re comfortable and then you’re going to simply sit down almost vertically. There will be a slight forward leaning from the pelvis. So it’s not like a regular squat where you’re leaning way forward. But this is just sitting down about 6 to 10in. And then you’re going to hold that position. And what you’ll notice is the inner groin, inner thigh muscles will have a lot of tension through them, and that’s the isometric work. And you’ll notice that the top of the muscles and the knees will be working a lot.
Clint – Yeah, love it. And what I really like about this particular posture, is it something that you can do with very little warmup? It’s something that I often do when I get out of bed and like the very first exercise I do in the day because you can get into it fairly easily, it doesn’t require much skill or experience with exercise. Get the legs wide apart, get down into it as far as you can go. And because it’s a big muscle that’s being engaged, mostly you’re not going into any area of danger of tweaking a tendon or anything. It’s very safe and something you can do first thing in the morning.
Carl – Absolutely. And it’s why it’s the number one, it is the easiest exercise to get into. And you can adjust it, which is nice. So a lot of the clients, many of your guests or your members, they often tweak it and they say, right, I’m in the right position and I’m like, let’s go. And so it can be modified easily as well. And the important thing is you want to try to get to 3 to 4 reps of like start at five seconds, then you build it up to like 10 seconds and just being constantly aware of your other joints. So be aware of your back, be aware of your hip. It’s a fantastic hip opening exercise. The ability that it frees up the hip flexors and has it has so many benefits, it’s a simple exercise.
Carl – Then from there we can transition. So we can transition into what I call the assisted squats. So this is now doing a normal squat technique where you can either have this hip width apart or slightly wider shoulder width apart with your squats. But what we’ve got here is we are raising the heels off the ground with either a folded up mat. Sometimes if you’re comfortable, you can use a slant board if you’ve seen those on Amazon or you can buy those. And again, you can vary the angle of the the degree of the slant. But by raising the heels, it takes tension out the back, what we call the posterior muscles. So you’re able to basically squat down much lower and more effortlessly than if you didn’t have the heels raise. And therefore it allows you to get into a comfortable squat position and hold it again isometrically without really struggling with this tension and other muscles.
Clint – When I first started squatting and I’ve never been, like, a really frequent squatter at the gym, it’s not something I really ever enjoyed or became really competent at. But I noticed that a lot of people were elevating their heels when squatting at the gym 20 years ago. You don’t see it as much now at the gym, but you still see the odd person raising their heels at the gym. And I was always told whenever I would inquire that it’s better for the knees. And so putting aside gym and loading and barbells and stuff, I would say based on what I’ve learned from you and my own research is I don’t know if it’s better for the knees, but it allows more freedom almost for the knees because of potential sort of limitations on the underside of the leg.
Carl – 100%. I mean, like even for me, like and so a lot of people are concerned about the shortening of the Achilles tendon. We’re talking about doing 2 to 3 reps here. We’re not saying stay there the whole day, you know, or like have a heel raise in your shoe. It’s a tool to help you get into the knees, you’re able to bend much further. And obviously, if you’ve got arthritis and it’s stiff, it also allows you to safely increase the range of motion in the knee without like having to be stuck and fighting all these other muscles that are tight. So I find it very effective.
Clint – All right. Let’s go on to the third and final recommendation today. And this is actually my personal favorite. So let’s talk about the Bulgarian split squat. I’ll bring it up on the screen here.
Carl – Yeah, Brilliant. So all these exercises are designed to progress you to this. And this is a great picture here, Clint, of you doing this here. And as an exercise the functional movement coach, your technique or form is spot on. So I’m glad that the listeners can see that it’s a great. But here you can see, you know, Clint is maintaining just for the viewers, they’re watching this on YouTube, wherever he’s right and he’s not actually on the ground. It’s about a millimeter or a quarter inch off the ground. And you’ve got a wonderful hip hip opening stretch on the right side, hip flexor stretch, which is great. And then you’ve got the isometric work on the left leg working nicely there. And what I want to really draw attention to the listeners here is this is not just a quad exercise. This is a hamstrings, buttocks, quad, and what we refer to the inner thigh muscles, groin exercise. Even a calf exercise, the back of the knees working there. So it’s a fantastic exercise. Isometrically as well.
Clint – Yes. And it looks dangerous in terms of from a balancing point of view. But when you’re in it, you get a surprising amount of stability from the back foot against the bolster at the back. And so you’re not only trying to balance with the front leg, but there, as I said, to repeat myself, you get a surprising amount of feeling of security and safety on that back leg. And what I do is if I do sometimes start to feel a little bit unstable, if you put your arms out like wings, you then get that feeling of stability because you can find that subtlety in your balance using your arms outstretched. So I’ve never had an accident in this posture and I have done this hundreds of times. So from that point of view, don’t be concerned with giving it a go. Carl Let’s talk about the depth. Um, uh, now obviously I’m in this at, I want to say probably a moderate level. Let’s talk what would be a beginner level.
Carl – Yeah. So you’d want to be you may even start off without even, you know, having the, having the leg on up on the, on the thing. You might just start off with the leg behind you trailing. So you’re supported on your tippy toes. In other words, you basically still have the hip flexor stretch, but you’re not as bent as you are there because some people’s knees, as you know, the rheumatoid can be really stiff. They can’t actually bend it like that, so they’re going to struggle to. But this is again, is more advanced as well. But that would be a thing. Then you’d want to get that 90 degree angle on the front leg is a good position not to be too far forward to start off with. And then as you get as you get stronger, you can slowly moving that forward and deeper. So the thing about this Bulgarian split stance is so many progressions and they can all be done safely, which is which what I like about it.
Clint – I’m going to share now the progression that’s regular. This is the progression, and you can see that now we’ve got oh, interesting that we just spoke about raising the heel to get that forward knee into a deeper and more acute angle. You actually have to raise the heel off the ground. And so when I watch my wife, who did dance for the first 20 years of her life when she and she has outstanding flexibility and movement through her entire body. She’ll easily get into complete squats, like right down to sort of bum on heels and then back up again when she just wants to go down to talk to the children and come back up again. It’s like it’s effortless for her. And I’ve watched her closely over the years, her heels always come up off the ground as she goes into the deep squat about halfway down the hill start to rise. And if you watch footballers who squat down in between breaks on their during their soccer games, the heels always come up into these deep squats. And so it’s sort of the body’s natural movement. And so I deliberately raise my heel as I try and get that knee forward. Now, I’m hoping to get it as far forward as possible based on the guidelines of sort of the knees-over-toes kind of information online. So this is what it looks like as we go deeper isn’t it?
Carl – You make a great observation. And in fact, what you can do is you can actually put a little towel or a little folded mat under the heel so that you don’t have to hold it up. So it takes strain off and then it will actually give you more, you’ll be able to then focus more on the knee because at the moment you’re trying to work a lot through the ankle there to keep the balance. So just a step before you go into this you could actually put a little towel under them. You know, it’s interesting with this, if we draw a line, if we draw a line parallel to your, your lower limb, your tibia fibula and your basically your lower limb, and then you bring that parallel line to the toes, you’re still not past the toes, you see. So this on the camera, someone looking at this right now, I’ll be saying, well, the knee is way, way past the toes. Well, if you look at the angle, can you see that? Yeah. Can you see that if you draw? No, I’m trying to go the go from the heel to the knee. If you draw your night, your night sign is on your shoe and you go up to the if you drew a line from the knee to the Nike sign and you drew a parallel line, your knee is still behind the toe in a sense, even though you look forward. Yeah, Can you see that?
Clint – I don’t, actually. But that’s okay. Look, I can tell you.
Carl – If you if you were to take the if you take the angle from the knee where you see your muscle there that you’re pointing on there on the screen and you come straight down to the Nike sign. And you would make a parallel line, you would see from the toe up on the same parallel. You’re actually still. Yeah. From there. Yeah, exactly. So you still technically, if you look at the angle, you’re not way past the toe.
Clint – No. And for those people who are like their minds are blowing and saying, hang on, this looks dangerous, this looks bad. This is a knee that hasn’t got rheumatoid arthritis in it. Let’s first of all, establish that as number one. And number two, this is a knee that I have been working on for a very long time. Okay, So that’s number two. Number three, the knees over toes information online which is Ben Patrick, you can follow him online. He’s another great coach for knees. Very, very well known. He, he shares a lot of the science around this, and so this is following science. This isn’t just some crazy guy doing his own thing here. All right? So, um. Yeah, and my knee feels tremendous doing this, I’m trying to get it deeper and deeper and deeper, but I’ve done this very steadily for the last 12 months, and I’ve done this posture most days. And so, um, yeah, I’m looking forward. I hope that with time it’ll continue to progress and I’ll get my heel onto my bum in this position or I might have to get the back leg off onto the ground. Yeah, but, um, but yeah, that’s the goal, so. All right, Carl, well, we’ve got our three there. Why don’t we recap what we’ve learned today?
Carl – Well, I just think its progression is, you know, all these exercises you can be you can progress and it’s important that as we get back to before we go into those more advanced that you build those stabilizers that you build those initial baseline strength that you get, that isometric strength. And one of the things that is very helpful to help illustrate, but just an example is if we think about a battery, it has to hold a charge. If you think about something like it has to hold a load. And so when you when you balancing on one leg, like going knees, other toes or going into those Bulgarian split stance, you need the muscles to hold that charge for five, ten, 15, 2 seconds. And when it drops that charge, in other words, when you’re weak, that’s where the injuries come and the tweaks come. So you’re essentially seeing the muscles, which I believe they are, these little muscle battery packs. The body actually is electric in a sense, it’s electric. It has electric fields and it’s it holds charges. And so for those of you when you are holding these positions and you start feeling these burns, it’s also important that you take the muscle to that point where it starts to feel fatigued and burning but never sprain or strain in the actual joints. So you have to differentiate between my muscles are burning or my knees are actually killing me. So that body awareness is very important but be encouraged to go to that point of almost fatigue burn any comments?
Clint – No, I love it. I’m glad you said that, because we don’t get much return on our time and effort investment if we don’t get to a point where we’re like, Oh, okay, I really want to come out of that now. If we’re always a little bit, a little bit back from that, we might not see much change. And whilst we’re not looking for pain, we are looking to kind of get to that point where that muscle is getting pretty darn tired, I want to come out of this now. So that’s the point we want to get to. I like for a guideline for ra people and I follow this myself, is to work out the areas that need attention every day in a way that we have enough in the tank to repeat it again the next day. So we’re not trying to absolute exhaust the tank. We’re trying to find that balance between giving everything a good workout, but being able to show up again the next day without thinking, oh, no, not this again.
Carl – Yeah. No, that’s. That’s brilliant. And these, these postures that we’ve just discussed, these three different exercises also build core strength. You’ll notice when you hold that Bulgarian squat, it requires a lot of core strength. And that’s like my passion it’s the whole functional movement. You’ve got the whole body working, so this is so beneficial on so many levels.
Clint – Okay. Fantastic, mate. Now you help people in two sorts of capacities. One inside rheumatoid support. If you’re interested in watching this and you think I’d really like to connect with Carl, you get Carl for free as part of a membership inside one of our platforms. Okay, so it’s called Rheumatoid Support. You can reach out to us if you’d like to find out more about that and I can connect you into that via our Help desk. Carl you also do one-on-ones, talk about your website.
Carl – Yeah. So it’s www.CarlReaderCoaching.com and that’s Carl with a C or you can email me at email@example.com. And especially for the members, we work with a lot of members and this whole guiding them through this whole process. Sometimes it helps to have someone watch you, make sure your form is correct and just to motivate them but yeah, especially when you start getting into those more advanced postures to really just have someone to have an eye for movement and be there to make sure that everything’s firing before you progress. And if you do have pain, the clients often say, I’m feeling this or I’m feeling that, then we modify and change it so it works really well. And even just if you’re having one session or you need you want personal training sessions twice, three times a week, even just those, it depends on what you need. So there are various options available.
Clint – Yes. And Carl, your pricing with your one-on-ones is extremely reasonable. So don’t hesitate, everyone, if you’re interested in getting some help to learn how to do these exercises or just to learn how to begin movement again after it’s been a very long time, reach out to Carl. He’s fantastic. Okay, Thanks, Carl. This has been super punchy, helpful, and really appreciate your time once again.
Carl – Pleasure, Clint. Thanks for having me. Talk to you soon.