The Best Glute Exercises to Fix Knee Pain For Good

Hey everybody, it's Dr. David here from El Paso Manual Physical Therapy. Welcome to our live stream. Today we're going to be talking about the best glute exercises to fix knee pain for good.

Um, if you've never met me before, my name is Dr. David. I'm a manual physical therapist and I help people avoid unnecessary surgeries, injections, and medications and get back to being healthy, active, and mobile again. And uh I tend to talk a lot about knee pain because one of my favorite topics is knee osteoarthritis. But I also help people with meniscus tears in their knee, condraatial patella, patellophoral pain syndrome, berscitis, tenonitis, ACL tears, all kinds of knee problems. I I especially love um but I I I love helping people in general when it comes to avoiding surgery and unnecessary unnecessary surgery, medications, and injections.

Um, guys, tell me where you're from. If you're here with us live right now, um, I see 89 people are with us live at this time. Um, if you're following us on on Facebook or YouTube, I can see your comments right here. So, you might see me looking this way because I'm looking at comments. Um, and then we're live on Instagram as well, but I can't see your comments from Instagram. So, so sorry if you're if you're watching Instagram, you're going to you're going to be a um, no comments right now. Oh, we got some coming in already. Sue from from the UK, London. I have now been diagnosed with an ACL tear. Oh, I'm so sorry, Sue. Um, hopefully we can help you out here today on this live stream.

Um, just to let you guys know, too, we're going to be doing a helpline later on, so you'll be able to call in. Uh, when it's time, I'll show you the phone number here on the screen, and then I'll be able to um get your phone call here. One of my staff will be taking the phone call and then when we're ready, we'll we'll bring you on live here so that you can ask us a question so that you're not stuck with fixing whatever problem it is. Ideally, if it's a need problem, we'd love to take your call today.

All right, who else is here? We have uh Oh, we have a new member on YouTube. T I can't read that. Ted Patet, somebody's subscribed to our YouTube channel. So, just so you guys know, if you're on YouTube and you're following us, there's an option for you to to become a channel member, which means we'll get to your comment much faster because we have people asking comments uh asking questions in our comments on YouTube all the time. you know, they they want to um a ask a specific question about their condition and we do our best to try to get back to everybody as best as possible. Um and lately we've been on it. We we have sta staff myself on on there sometimes as well, but we try to get to people as fast as possible. But if you're a channel member, we'll get to you even faster.

Julie Parker is in Sydney, Australia. Hey, Julie, welcome back. I remember you, Julie. Thanks for joining us. Kimberly is here. Hey, Kimberly. Oh, she's wishing me a happy birthday. Thank you. My birthday was a couple days ago. I appreciate it, Kimberly. Who else have we got on here? Uh Nancy says, "Happy birthday." We have Barbara in Hartford, Connecticut. Um thanks for joining us, guys. I appreciate it. Canada's here. We have Ferdinand. Yep, Ferdinand is in Canada. And then we have Lori Wilson. Hey, Lori. Uh happy birthday, Dr. David. Thank you. Um Karen is in Florida. Welcome. Welcome in from sunny Florida. Hopefully, it's sunny right now. Nancy is in Fort Worth. Hey, Nancy, fellow Texan. Great. We have the Menon 49 says, "Happy birthday." Thank you so much. I appreciate all the birthday wishes, guys. Um Aquarius NY uh says, "They're in Washington DC. I have severe hip arthritis. It's killing me now. My lord, I'm so sorry." Um let's let's ask questions. We'll we'll get to it here real soon. and I want to be able to help you out with your hip arthritis problem or or if it's a knee arthritis problem or an ACL tear. Those are all things I can talk about with you guys here. Romania is here. Awesome. We have Europe in the house. We already had some UK people. Another UK another Londoner. There we go. I I missed the name. We have Rita as well. She's saying, "Where are you located?"

I am in El Paso, Texas. That is on the western most tip of Texas or right on the border of Mexico as well. Literally, I can step outside of our office and we can see Mexico. Um, beautiful part of the country, the desert, so it's mostly hot and dry. Um, but I love here. Our hometown. This is my hometown. And, um, I love I love the people here, the culture, all that. So, if you guys ever get the chance to visit, um, please reach out. We'd love to to point you in the right direction around town. Uh, Estakata, Oregon, outside of Portland. That's where Carrie Karen Oh, I'm not sure how to how to pronounce your name here. U she's from Oregon. Fantastic. We have Pauline Bernie from Mole, Scotland, the aisle of Mole, Scotland, and with birthday wishes. Thank you, Pauline. I appreciate it so much. Um Becky says, "Hi from California." Awesome. I have peasant serereine berscitis and distal hamstring tendinosis. I hyperextended my knee when I walk. I have been living like this for two years. Oh, hyperextending the knee is usually a sign of overdominant quads and weak glutes because it's your quads that make you fully extend your knee. So, if you're hyperextending, that means you're you're probably overusing your your quads. Hopefully, we can answer more questions about that later on.

Then, we have um Lane Lanes Majovitz says, "Hello from St. Petersburg, St. Pete uh beach in Florida. Happy belated birthday. Thank you guys. I appreciate all the birthday wishes. Cornwall, UK. Awesome. Knees are giving me hell. 68. I'm so sorry. Let's help you out. Joan CLmans from Omaha, Nebraska. Wow. All over the US. All over the world. Crawford, Texas. That's where Louis Mitchell is from. Fantastic. We have Lisa Nelson. She says, "I got a cortisone shot one week ago for a flare up for my knee arthritis and it hasn't helped yet." Oh no, it's probably not going to help. I mean, if it usually takes like a day or two, maybe three at most to to help you out. And if it didn't have the effect, either they missed or you have a different kind of problem, the cortisol is not going to help. And usually it's a nerve problem.

All right, guys. Thank you so much for all those comments. Keep asking questions here and we'll do our best to help you out. Let's get to my list here. I have I got some sections written up for you guys here. I'm going to demonstrate a lot of exercises today as well. So, what are the best glute exercises to fix knee pain for good? And what I'm going to just get through my list here and show you as I'm going along because um what I what I just want to make sure I say now before I get too far into the list is that this is not an all-in-one thing. In other words, you you don't do all these exercises in one day or even in one week. you progress through them over time depending on where you're currently at. And so I'll I'll I'll drop more about that as I go through the list, but let's get into the first one.

We have glute sets. What this is, it's it's very simple but poorly done very often in people that have knee arthritis because a glute set is just tightening your butt muscles, your glutes. For those of you guys who don't know, glutes is short for glutius maximus or glutius muscles because you have maximus minimus. There's a bunch of other muscles in there. But basically the muscles on the back of your hips, the butt muscles, those are what I what I'm referring to when I say glutes. And the reason for this whole talk is because I have a strong belief that glute muscle exercises can directly heal a ton of knee problems, including all those that I've mentioned so far. knee arthritis, meniscus tears, u kneecap problems, condril patella, patellopformal pain syndrome. So we need to focus on glutes and this exercise here, glute sets is foundational. You should not progress to anything else on this list if you can't do a glute set. And for many of you guys watching right now, you're going to try this glute set with me. And if you get stuck here, if you if you struggle and you don't have it down 100% with confidence, then you could pretty much stop the video after this and just work on that for a week to a month before moving on to number two or anything else. Even if you're a runner or you've been walking all your life or you you exercise a lot, but if if you can't figure out a glute set, you have no business doing any of these other more complicated exercises, more challenging exercises. You have to get a glute set done. I have people that can pick up weights, you know, bodybuilders, powerlifters, very strong people, marathon runners, long distance um athletes that can't do a glute set. So, it doesn't matter if you're very active, you might not be able to do a glute set, which is going to set you up for serious knee pain later on. So, let's get the glute set right.

Here's how it works. You can do this in standing, sitting, or lying down. in standing. Can I come over here next? If we look at doing it in standing, all you're going to be doing is shifting your body weight evenly between both legs and then you're tightening up the glutes and holding it for a 10-second count until you get to 10. Once you get to 10, then you can let it go and relax for a moment and then do it again. And you're just tightening your glutes and letting it go. Hold it for 10 seconds. every time we tighten it up. You got to be able to do this in seated too though and in lying down. And the reason why I think it's so important to be able to do it in standing, seated, and lying down is because this exercise often requires so much repetition in people because they can't do it well. You just have to get yourself to do it a lot throughout the day. This is an exercise that I tell people to do hourly. So, if you're sitting, say you're sitting in a chair, you're driving somewhere, you're at a restaurant, anywhere you might sit, at home, in the public, wherever you are, what you ideally should be doing if you're working on this exercise is right here, tighten up the glutes. See how my body just goes up an inch? Because my my glute muscles literally thicken when they contract, when they when they flex, and so it it thickens under me, which pushes me up a bit. That's what should happen.

What I haven't said so far that is critical. Pay attention right here. When you go to tighten your glutes, whether standing or sitting, I'll show you lying down in a moment. Hold it for 10 seconds and really concentrate. Close your eyes. Pay attention to where you feel the muscles burn because what you should feel is burning right in the glute. It could be lower glute, upper glute, outer glute, inner glute, anywhere, right in the middle. As long as you feel it in the glute. Don't split hairs at this point over was it the glutius maximus? Is it the minimus? Is it the paraphformis? Cuz there's all these muscles. Don't even worry about the names of the muscles. Just call them glutes for now. But as long as you feel the burn happen here when you intend to fire the glutes, then you're doing a glute set correctly. The mistake people run into is they'll intend to fire their glutes. They're trying to do a glute set and these muscles right here, the thigh muscles, the quads are the ones that are actually burning. And you can see it because watch, if you can see my legs here, you can at least see my knees. Yeah, I can tighten my glutes here. And my legs kind of they kind of rotate out this way. But if you're heavy on firing your thigh muscles, what'll happen is people will straighten out their legs. Their their knees will kind of start to to move out like this. That means that you're using your quads a lot because in order to straighten out your legs, you have to use this muscle. And if the focus is on tightening the glutes and your foot's coming up, you're using your quads. You're using your thighs. Not good. That means your body's rewired itself over the years to compensate with using these thigh muscles when you should be using your glutes. And because you're using these thigh muscles so much, it's putting all this extra pressure on your knee joints. And that's probably what's setting up your knee pain. This is why this exercise is so foundational because if you can't figure out whether you're a bodybuilder, a distance runner, you've worked out all your life because we have people like that that they're almost they're too proud. They're too prideful and they'll say, "I I don't have a glute problem." I once talked to a a bodybuilder and I had to tell him that he had weak glutes and he got offended, stood up like as if he wanted to fight me. And you know, I was I kept my professionalism and I said, "Sir, if you don't believe me, please go work with another healthcare professional." It gets to that point with some people where they almost get they they literally get offended that I tell them they have weak glutes. But what you have to realize is it's a it's a relative weakness because you might have very strong glutes for your for your gender, for your age, for your lifestyle, whatever it is, but you have a relative weakness to the thighs. And if your thighs want to take over all the time, you have a relative glute weakness, and that's setting you up for too much pressure in your knee joint. That's probably why you have knee pain. So, glute set right here. Tighten up those glutes. Hold it for 10 seconds. Make sure that you feel it in the glutes, not in the thighs. After that, you can let it go. And then repeat. And you could do this casually while you're watching a movie, having a meal, on the road, driving. You know, be safe. Ideally, as a passenger, you should be tight tightening your glutes. If you're driving, manage your safety. And then you have to do this in lying down. So, in lying down, you could be on your back like so. And then just tighten up the glutes. This is a great one to kind of start the day, you know, when you wake up in the morning when you're conscious, you you wake up from your sleep. And especially if you have like knee arthritis and you know your first steps are going to be stiff getting out of bed to kind of wake up the glutes and not overuse the quads, start to tighten up those glutes right here. Just hold it for 10 seconds. Concentrate. Think. This is more of a thinking exercise for a lot of people more than an actual exercise where you burn the muscles. And that's okay. That's good actually because you have to go through that. Then you can also do this lying face down. You know, if you tend to be a stomach sleeper or you you just choose to be on your stomach and you can tighten up the glutes from here. Hold it for 10 seconds. Make sure you're firing the glutes. They're burning there and not the thighs. And then relax. And just repeat that. And you should feel your glutes working. You need to become very masterful, very deliberate, very conscious about using your glutes because if you can do that, then you can move on into the next exercises.

And and just to if I if I haven't already communicated enough how important this is in our knee arthritis recovery program in our other knee programs because we have a meniscus tear program we have an ACL tear program we have a patella pain recovery program for condroal patella and berscitis and tenonitis in the knee. In all of those programs, you cannot move on into later phases of the program until you can fire your glutes. It's that important. Let me show you what I mean because I have I have the poster here. This is for a knee arthritis recovery program. And we have phase one, two, three, and four. And the bottommost criteria right here is if you cannot tighten your glutes without other muscles firing, you should not move on from phase one. Even if you don't have any pain, if you don't have any swelling in your knee, you don't have any pain anywhere else. All of these are are like pain at night, pain, you can be on your feet as long as you want. um pain during the pain during the day, swelling. If you have no pain, no swelling, you can walk miles and hours, but your glutes cannot activate, you should I tell people stay in phase one. And you know what they're doing in there? Glute sets, exactly what I'm showing you here. And and you cannot progress to phase two until you can get those glute sets down. And it's it's a similar situation for all our other knee programs. miniscus tears, ACL tears, all of those problems. Hopefully I've driven this home to you guys.

Um, hey guys, just want to let you know our helpline is available right now. The the phone number is right here. There we go. Helpline. So, if you have a question, um, it's 915, that's the area code, 200 and then 4159. Um, I'd love to talk to you over the phone and help you out. So, call call the line right now, especially if you have knee pain. Um, please, let's not be stuck and let me help you out. All right, so glute sets, 10 second holds. The holds are important, guys. And I like to tell people, do it 10 times and do it hourly. So, you should be doing 100 seconds every hour until you feel super confident that you can fire your glutes on command without your thighs also working.

All right, let's go to number two here. Bridges. Classic glute exercise. And what I see is way too many people start doing bridges before they have glute activation from the glute sets. We have way too many people that do that. So assuming you can fire your glutes on command because you've been doing glute sets or you you've already you've already been able to do it because you can skip glute sets. If you're like, "Okay, I can fire my glutes just fine. I can even fire the right one independently from the left one." That's next level. You you need that by the way for other activities later on. But right now, if you can just fire your glutes and then fire them apart from your thighs, big big win to be able to do bridges. So let's check out bridges over here next.

Here's how I recommend you do a bridge. lie down on the floor on your bed, wherever you feel comfortable, knees bent like so. And then what I do recommend is that you open your feet a bit more. You don't want them close together. And you even angle your toes out just a little bit, a comfortable amount. You don't have to go an extreme amount. Just whatever is comfortable. That's kind of the starting position. This isn't a hard and fast rule. This is just a basic starting point that you can adjust if needed. Then what you need to do next is tighten those glutes. See that? I tighten my glutes and then let them go. And what you want to make sure is that before you even lift, because a bridge motion is you're going to be lifting up like this. You need to make sure that your glutes are the main exercise. I'm sorry, the main muscle that's working when you're going to come up right here. So, tighten the glutes, hold it for 10 seconds, and then begin to come up. Clear a little bit of space between your your bottom and the the surface that you're on. Like, see, I'm rubbing my hands down here just to show you that I have space there. And now I'm thinking hard about tighting my glutes and not letting thigh muscles on the front or the back take over. The tendency here is to use a lot of hamstrings, the back of the thighs. Hold the glute, hold the bridge for 10 seconds. After 10 seconds, you can come down. Let everything relax. Then repeat. Tighten the glutes first, then come up. And you're okay to come up higher, but only to the point where you feel your glutes are still the main muscle being used. This is the problem is some people, they they they think, "I'm going to go do bridges." And right away, they'll think, "I'm going to go as high as I possibly can and then come right back down." And they're doing reps like that without thinking through which muscles they're using. And inadvertently, they're using their hamstrings or even their back muscles up here because you kind of have to arch your back to get even higher. And if you're not used to using your glutes and you don't slow down to consciously bring them into the exercise, then you'll skip them potentially and do a bunch of bridges without using the glutes. And the focus here is to use the glutes. So make sure that you bring those glutes involved. And and I like the holds because it promotes the muscle uh being focused on. So 10 seconds. I'll tell you more about that here in a second. 10 second holds like this. 10 times. And I this is another exercise that I would look to do hourly. I know it's not realistic unless you're home all day, but you know, you probably have a life and you leave your home or you're busy at home doing things that this might not work well with. So, um, as best as you can, what I encourage people to do is 100 reps in a day. That's another option. And you could do more than 10 sets at a time. You know, 10 reps at a time. You could do 50 reps at a time. But take your time. Go slow and work up to it. Because if you've not done these exercises before and you're starting to do them, it might be tough to do 50 reps all at once. You might you might have the goal of just getting 30 reps in today or even 10 reps in today and then working your way up from there.

All right. Um I got a call from Lisa in Illinois who has a cortisone shot in her knee and she's got a question about that. So I'm going to take that call here next. Thank you. Let's make sure we're all set up. Hi, Lisa. Are you there?

>> Hi. Yes, I am.

>> Hi, Lisa. It's nice to meet you. This is Dr. David.

>> Oh, great. Nice to meet you, too. Yes.

>> Welcome. How can I help you?

>> Yeah. So, um you happen to read my um chat thing and so I had a I had a cortisone shot a week ago and it's not helping yet. and you said, "Well, it might be nerve related and so I don't know where do I go? What do I do? Do I go to a doctor or my orthopedic surgeon? What do I do?"

>> Yeah, great question. Well, tell me a little bit more um just so so that I can best help you out. The cortisone shot was in the knee. Is that right?

>> Yes.

>> Okay. And what was it for? What was the intent to help you with? Did they give you a diagnosis like knee arthritis or a meniscus problem?

>> Yeah. A flare up of my knee arthritis. Yes.

>> Okay. Got it. Got it. Is this the first cortisone shot you've had?

>> Yes.

>> Okay. And how long have you been dealing with knee arthritis?

>> Well, um, for a long time. Um, the X-rays showed actually that it's pretty much the same condition as as it was about three years ago, but for some reason I I think it was over the holidays by, you know, very active and everything that had to get done.

>> Yeah.

>> Um, it's it's flared up. So,

>> Okay, got it.

>> And then, um, where exactly on your knee does it hurt? Is there a spot like like on the inside of the knee, on the front of the knee, on the back, or is it all of those or is it just general pain like it kind of hurts all over the knee?

>> Um, sort of like inside, but then at times I thought that I had the uh the berscitis, the pez as

>> pezans bcitis. Yeah, it's a tough one.

>> Yeah. And yeah, but um they told me that it was probably referred pain

>> um that I was getting down there from the arthritis and that it was really the arthritis, not the PEZ stuff. So

>> yeah, peas answering.

>> Yeah.

>> Got it. Okay. And so so just to clarify, you have pain on the inner part of your knee like where like um which knee is it? The right or the left?

>> My right knee. I mean, when I walk, you can hear the bones kind of rubbing together.

>> Oh, no.

>> You know, you can hear

>> Yeah.

>> And it's so it's on the inside part of your right knee.

>> The pain is Yeah. towards the inner right part. Yeah. The inner part of the knee. Yeah.

>> Got it. Got it. And then is the today like these It's January right now. So this month since the holidays, has this pain been getting worse, getting better overall or staying the same?

>> So I would say that, you know, a little bit better.

>> Um, what's what's curious to me is that I thought with arthritis when you get up, you're stiff and it hurts and then you walk and it feels better.

>> But when I rest in bed and get up in the morning, it's like that's when it feels better. And then as I walk it gets worse.

>> Interesting. Interesting.

>> Yeah. So, doesn't seem to be right for arthritis, does it?

>> No, ma'am. It doesn't. That sounds a bit like a nerve problem.

>> Okay. And this is Yeah, this is tough because you have the crunching you said when you walk and then potentially you probably had an X-ray. Am I Am I right? That where they diagnosed knee arthritis.

>> Yeah.

>> Okay. Yeah. So, this happens sometimes where you have arthritis on the X-ray and so the doctor, you know, did their job and they told you that you had arthritis on the X-ray. However, they may not have a clear understanding of of how to tie the symptoms in like you're saying, like you don't have stiffness in the morning. That's very common with knee arthritis to have that stiffness or like if you've been sitting for a long time, like if you go to the theater or you sit and have a long meal and then you get up, those first steps are typically killer for people. they're just stiff and painful. Um, if you don't have that, then it's way more likely that that you have the arthritis in the knee is not the source of pain, even though you have it on the X-ray. The source of pain is probably the saphinous nerve which runs down the front of your thigh from the hip into the front of the thigh and on the inner part of the knee and then even runs down past the knee into the inner ankle inner foot area like the arch of the foot area. Um but it's very common for people to get pain at the knee because there's a branch that wraps around the front of the knee.

>> Okay. What you would do is I would treat the injection because you had the injection for the knee pain from arthritis in hopes of relieving the knee pain, but you're but it sounds like it didn't have any effect, right?

>> Well, not yet. They said it could take 14 days, but

>> typically it's within two or three days. You you you have pain from the injection site from being poked with a needle, but that usually resolves in a day or two and then you start to get relief from pain. Right.

>> So, so if you didn't get that then then my thought is they miss the joint which is hard to do in the knee because it's a big joint

>> that or it's a nerve problem. The saffinus nerve saffinus with a PH and um what you would do to fix that is you need to get better glute strength. It's actually the same treatment as fixing knee arthritis. So that's kind of the good news because you probably have arthritis as well. We know that. But

>> yeah,

>> what you're running into here is the expectation of getting relief from the injection, but it didn't work out.

>> Okay.

>> But it's because your knee joint is probably not currently the problem. It's the the the nerve.

>> Okay. So,

>> so it's the Okay. Wow.

>> Yeah. Yeah.

>> So, it's the exercises that you're teaching about,

>> correct? Yeah. the saphinous nerve because of its pathway. When when you have weak glutes, your knee wants it tends to move inwards a little bit too much and that because of the the nerve wraps from the front onto the inside of the knee, you can tension that nerve. You can put a little too much stretch through it inadvertently because of the weak glutes. But as you get the glute stronger, you tend to position your leg a little more outwards, which takes tension off the nerve. It puts slack on the nerve which decreases its irritation level.

>> Okay.

>> I hope that makes sense.

>> Yes. Okay. Well, at least you're telling me what I need to do.

>> Yeah. Yeah. And it it's a good thing because you're going to knock out two birds of one stone. You know, as the old saying goes, you're go by strengthening your glutes, you're going to take pressure off the the nerve, and then you're also going to be beginning the work to fix the long-term knee arthritis problem.

>> Okay. All right.

>> Hope that helps, Lisa.

>> Very good. Yes. Thank you so much. I appreciate it.

>> Yep. You're welcome. Have a wonderful day, Lisa. It was nice to talk to you.

>> Yeah. Good to talk. Bye-bye.

>> Bye-bye.

So good. That's a um that's a common problem that people with knee arthritis and other knee problems too like meniscus tears um ACL tears the the condal patella the patella problems and kneecap problems um it's a common problem that people face that goes undiagnosed unseen unnoticed by health care professionals and what you have to realize is when it comes to getting a cortisone injection a cortisone injection helps with anti- with inflammation it's an anti-inflammatory drug and pain, but it best affects non- nerve tissue. So, like your your ligaments, tendons, cartilage, bones, muscles. Cortisone helps with all of that really, really well. But nerves are different. And so if you had a cortisone injection and you're still in pain, it's either they missed the spot that you had pain in or they hit the spot but it's actually a nerve problem today that's irritating you and it's not tendon, cartilage, ligament, muscle or bone that's hurting you. So just keep that in mind. That's something that health care professionals generally don't think about and it can be very frustrating because you're doing everything you're supposed to do. you're getting the treatment that they're recommending and you you might very often people with a saphinous nerve problem kind of get looked at like with you know with a cocked head by their doctor saying well why didn't this work on you this works on everybody else you're one of those weird ones that didn't respond to my injection and I I'm pretty good at injections that's kind of what the doctor's often thinking and then they're thinking well maybe it's more serious than maybe we're beyond injections didn't work maybe we should move on to surgery and it might not be the right thing to do might be unnecessary surgery at that point. So, hope that helps, guys.

Let's answer some comments here. Next, we got Lenora Kenneth. Good. She says, "How do you correct a prrated ankle, pronated ankle, um, and knee alignment causing my left foot to turn outwards?" Um, hi homie. I'm from El Paso, Austin High School, living in Auburn, Alabama. Oh, awesome. You're you I'm in the neighborhood actually. That's that's where we are. We we're in Five Points if you if you uh know where I'm talking about. So, we're just south of El Paso High and Austin High School. Um so, thank you for joining us. To answer your question, uh pronated ankle means that you're falling down like a flat arch, which that's going to cause the the knee joint to want to cave in and it's possible for the foot to kind of compensate by turning out because if if this is your left foot and your arch falls down, it may want to make your your foot kind of turn outwards a little bit. So, um, the way the first thing that I would look at is your toe flex, your strength. So, how good your toes can curl. And what I would do first is have your like curl your toes without a shoe on just so the shoe isn't stopping you. And make sure that you can I show it real quick. Actually, that that'd be better. Like I'm describing it too much here. So, if you can just if you can curl your toes all the way down like that and see how I'm holding it and I'm okay. People that have very weak toe flexors, they begin to curl their toes AND THEY GO, "AH, I'M GETTING A CRAMP." AH, that's a sign that your toe flexes are probably very weak. So, be careful when you go flex your toes because you might set off a cramp. Don't do it too hard. But what you want to do if that's if that was you, if you felt like you were going to cramp or you actually did cramp is now you found the weakness and you need to work on it. So, curl your toes as much as you can comfortably. Hold it. The holds are important. I'll talk more about the holds like for the glutes and the feet. 10 seconds and then after 10 seconds you can let it go and this is what you need to be working on Lenora for weeks probably at least days if not if not several weeks the better part of a month and getting better at that and then once you're good at curling your toes and you can curl maximally 100% without your foot cramping then you've developed better strength and you're going to be able to hold the arch of your foot up better so that the the knee alignment improves and that's going help the the entire alignment of the the foot, the ankle, and the knee. It sets up the ideal forces in the joint. And it helps your glutes because if your glutes are weak, are you able to get my my hips and feet from here? Just Well, I'll take off the shoe so you can see. If your if your arch falls down and the knee wants to cave in like that because the arch falls down, the ankle moves down, foot wants to move out, then you need support from the glutes back here because the glutes when they tighten up, they make your leg want to turn out and they work with your foot muscle to get better knee alignment. So, it's really glutes up here and foot muscles, the toe flexors that work together to support the knee best. So, in your case, Lenora, work on those foot muscles first because that you said you have the the pronated foot. That pronated means it's falling down. Um, and then also work on the glutes. Cool. Hope that helps. And um hope you're having a good time in in Alabama.

Oh, we have a super chat. Fantastic. This is from GK NTRN um TR Y 2 220. says, "Hi, I had a broken patella 5 years ago. Today, my quads and other muscles are so weak. I'm so sorry. I have atrophy and I have knee pain. I am lucky that I have no extra weight. What do you suggest? Glutes or quads first?" Oh, no brainer. 100% quad uh glutes. I'm sorry. You need to work on your glutes. And here's the thing. I think what you're what you're probably thinking of that you're not saying here in this comment is that you have that if you work on your glutes that you're not working on your quads. And if you work on your quads, you're not working on your glutes. And in reality, the muscles will work together. I want you to do glute sets first to make sure your glutes are working. And then once you can do the glute sets properly, then as you move into bridges, you're using more muscles because you're not only activating your glutes. takes other muscles to pick up your hips. The thing is, when you pick up your hips to do the bridge, you still want to focus on using the glutes, but you're going to use a little bit of calf muscle. You're going to use a little bit of hamstring muscle. And then as we move into other exercises, you'll see here, you're inevitably going to have to use your quads. But what I would like for you is to be glute dominant because our society, our world today just kind of drives us towards being quad dominant. And that's what sets up knee problems. So, focus on the glutes first and then the quads will come. If you focus on the quads first, you're going to set up bad pressures in the knee and a compensation pattern where when you want to fire your glutes, you're just going to want to fire your quads more. And that's that's what tends to take people towards things like patellophal pain syndrome, conjella. It's not a good pathway that way. You start to hurt your knee. Again, would hate for you to do to do that. I think it's possible for you to move on from this injury and forget about it. Even, you know, years past and you're like, "Oh yeah, years ago I did have that fracture on my kneecap. I forgot which knee was it, the left or the right?" Doesn't even matter anymore because I can do everything that I want because my glutes are solid. So, hope that helps her.

Shirley says, "I have storm menisc torn meniscus at the root. Any suggestions?" Oh, that's a tough one. Let me see my knee model. So, what Shirley's talking about is um here's the meniscus right there. That's that this thing that I'm wiggling. You have two parts to it. Um an inner meniscus and an outer meniscus out here. And the meniscus is mostly floating and movable. You can see how I can wiggle it right here. That's how it's supposed to be because it kind of adjusts position as your knee bends and straightens because it moves with the with the thigh bone above. It's the the thigh bone is round right here. Con convex and then the meniscus is is uh concave. It kind of fits with the thigh bone on top. A root tear means the connection point where the meniscus does attach to the top of the shin bone here, the tibia, that's torn. In that case, for your situation here, Shirley, I would still give it a good go, working on fixing your glute strength because you're going to normalize the pressures in your knee. I would be offloading as much as you need you need to. In our meniscus tear recovery program, I talk all about offloading and how important it is. Same thing in the knee arthritis program, but for you specifically since you're since we're talking meniscus here, I would be offloading because then you'll give that root a chance to reattach or if it's if it's partially torn and and there's a it's already attached, you need to fully attach it and give it a chance to fully heal. I think it's very possible for you to heal completely without surgery. However, if you do all the right things, you're following like what I have in my meniscus tear recovery program, the plan there. You can look at our free videos on YouTube as well. There's a lot of helpful information there, and I've talked about root tears as well. Um, you you might need to go get a surgery for this. This is the one. There's two two situations with meniscus tears. It's a root tear and then if if you have a specific type of tear, like a a flap tear on a meniscus, forgot the exact name. there's a b there's like a dozen meniscus tears you can get um and it and it doesn't reattach and your knee is locking then it might be time to have a surgery but I would give it a good go first I would get on crutches I would make sure that you're tracking improvements I get the glutes to be active make sure your quads aren't super active and that should push you in the right direction to heal I think most cases will heal just fine without surgery so hopefully that helps Shirley

next up we have Renee MNA 5658. She says, "Uh, from Dearbornne Heights, Michigan. You saved me from surgery a few years ago." Yay. That's awesome, Renee. So glad. I also took your name miniscus program and had Zoom calls with Raul. You're the best. Oh, that's awesome. I'll have to pass this over to Ro. Coach Coach R is one of our um recovery coaches who is uh he works with our clients one-on-one and in group coaching calls. We work together all the time and he helps our clients out with situations like this with a miniscus tear. So, thank you for that. I appreciate Renee that you you giving us an update that you're feel feeling better.

We have a call on wait. Um Kimberly is in Minnesota. Let's come on over here to take the call. Let's see. Kimberly, are you there? This is Dr. David.

>> Oh, I am Dr. David.

>> Hi, Kimberly. It's nice to meet you.

>> Oh, so finally nice to meet you, too. absolutely love your show.

>> Oh, thank you so much. I appreciate the kind words. Well, how can I help you?

>> Okay. Well, um my story is a little um complicated or different. Um keep in mind about 23ish years ago,

>> I had a had an ACL surgery. So, not everything's going to be on my left leg.

>> Okay. Left side.

>> So, I had an a Yep. ACL surgery on my left knee.

>> Okay. And then and then about a year ago, it'll be two years in April, I fell and broke my hip. So, I have a plate and five screws.

>> Okay.

>> So, in that time, you know, I couldn't I wasn't allowed to put any weight on it. And Okay. And uh

>> as as those weeks went on, my leg got very very weak. My knee was not happy. It kind of just blew up and was inflamed and very angry. And

>> wow.

>> come to shove or whatever. I had the um visco shots in my knee which did help but it didn't didn't help you know with so much muscle loss

>> and I eventually had a a total knee replacement on the same leg which was a year a year ago.

>> Okay.

>> Um now all of a sudden my leg is like an inch longer at least than the other leg. Mhm.

>> I I still can't put weight on my left leg. Like if my knee is bent,

>> I'll fall to the ground. My body can't support my weight. It can't if it's straight because it's all stacked up. Where's it going to go? You know what I mean?

>> Yeah. Maybe lock the joint.

>> So, yeah. So, it's that's the only way I I I can do it. But my problem now is is my IT band is and this happened after my knee replacement

>> is is very is very angry and when I would bend it for starting to bend my knee at the time it would snap over the fibula head.

>> Yeah.

>> And that was that was extremely painful.

>> Okay. Well, that has gone gone away, but still I have um so much IT band pain. It like snaps or pops or whatever on the lateral side of the knee and I can feel it on like the side of my my leg. But

>> for me, my question is what kind of exercises can I do because I I can't be full weightbearing like a bridge. M

>> um but it's like my my feet never seem to be like parallel to to to lift up to to be able to do what you know I can do. So

>> Mhm.

>> Yeah.

>> Okay. Wow. So just to clarify, you had a broken hip and and surgery with the plate installed two years ago and then of course you had the ACL tear. This is all on the left side. ACL tear in the knee and then you ended up having the knee replacement um a year and a half ago and

Then you you've been dealing with the IT band problem since then, and that's the biggest issue for you. You want to know what exercises to help the IT band issue?

Yes, pretty much. My left leg still doesn't have a lot of strength to it, and I'm still in therapy. Yeah, my knee surgery was about a year ago. A year ago for...

But I can't activate my glutes and I, without using my quads, I can do that.

Good. That's that was the first thing I was going to ask is how are your glutes? Can they work? Do they do they do you have control over them? If you have that, then Kimberly, you you've gotten you've gotten that milestone. That's a big deal. A lot of people struggle with that. So, what's up next for you is you have to get a lot of glute reps in. A lot of you you have to basically tire out your glutes. Make them feel make them feel burned and fatigued on a daily basis right now. I would even say multiple times a day. I'd say two, three, five. If you can ma if you can manage 10 times a day, that would be best. Ideally, if if we were talking about you had all the time in the world to solve this problem and didn't have a life other than fixing this this knee and hip issue, I would say do it as much as you possibly can before things start to get worse, where you find the sweet spot of how how how can you get better. So I would say hourly do glute sets, do them in standing, do them in sitting, do them lying down and start your day like that. And then if you start to get worse in your IT band or knee or hip, then back off for the day and then do it again tomorrow. And what you should find as you keep going day in and day out like this is that you can tolerate a bit more each day. What I just don't want you to do is overdo it to where you say, "Oh, I paid for it. My IT band's really hurting or my knee's starting to swell and hurt or my hip hurts." You you should generally say, "Okay, I'm starting to feel a little bit of discomfort. I'm using the wrong muscles potentially. No longer using my glutes." Stop at that point. Call it a day. But then the next day, start over. And you need to get obsessive, Kimberly. You You have to get obsessive. What I what often happens and I don't know if this is the case with you because you said you're going to therapy is therapists are great at helping people after surgery, but they cannot they they don't do a good job of helping people recover from a muscle imbalance problem like what I'm talking about with you here. And what's necessary for you is to get a lot of reps in, a lot of reps. And they're probably not telling you to do that many reps.

I I don't mind them and I do like to do them. It's just sometimes it's like aches where my plate is in my hip.

Or I can do them. It doesn't really bother me. But it's like when I start to do exercises where I have to bend my knee because my range of motion is maybe 100.

But it's like when I don't have any strength in that whole leg, my leg is stiff. So that means the front of my ankle is always stiff because you know I don't walk like you know a normal gait.

Yeah.

Yeah. Good. Yeah. So it sounds like to me then that you just need to work on glute sets right now. I would I wouldn't worry about bridges because you can't bend your knee that much. You said 100 degrees. I wouldn't worry about getting on a bike. I wouldn't try to go walk for exercise. Kimberly, I would be doing glute sets till kingdom come right now. And then what should happen? You'll reach a point where you where you start to say, you know what, my my knee feels better and my hip feels better. My my whole thigh feels better. That's when it's time to start to do other exercises like bridges or biking potentially if you get more motion in your knee.

Okay. Thank you.

Yeah, I hope that helps, Kim.

It will. Thank you so much. I know everybody appreciates all the hard work and the passion that you have for what you do.

I appreciate it. Thank you so much, Kimberly.

Have a wonderful day.

Okay. Thank you.

Thank you too. Bye-bye.

Awesome. So, Kimberly, just to review that, um, you have low strength in that left side because of the hip break and the knee replacement and prior to the knee replacement, the ACL problem. The IT band can get tighter because there's a muscle at the top of the IT band called the tensor fascelata that often compensates. It works harder when it shouldn't because of weak glutes. And when that TFL starts to get really active, it's like where your front pocket would be right here, it can put tension on the IT band and the IT band has the ability to move a little bit. So, it can kind of snap and especially if you had the the hip uh break and the replacement with the plate installed, it can move over things. There's there's tissues that it can move over the plate. It's hard to know exactly what's causing that that click or that snap sensation. But either way, getting stronger glutes and really ramping that glute strength up is absolutely the first step I would take right now. It's going to take you some time. It's going to take you some effort, but I'm glad that you're you can already fire the glutes. That's a huge win. All right, let's get back to our list here. We're talking about glute sets and bridges. Up next, I call this one butt burners, but I've heard um other people call it donkey kicks and um fire hydrants. And the reason why I call it butt burners, hair splitting here, but it's kind of a combination of a donkey kick and a fire hydrant. Either way, what we're focused on is getting the glutes to tire out. That's the whole point of helping your knee pain here. So, let me show you what I mean. This is what it looks like. So, this right here, is this angle good? You want me to turn around the other way? We're good. Okay. Um you got to get on your hands and knees for this. And I'll show you a standing version before we're done. Uh, but the the traditional way to do this is hands and knees. And I'm on my fists here. You could be on your hands flat. It doesn't matter. I'll do it flat for now. And if sometimes it bothers my wrist, so I'll be in this position. Doesn't matter. Um, anyways, a donkey kick is picking up your leg like so and going straight up as if you're trying to reach your toes to the ceiling. That's a donkey kick. A fire hydrant is coming out to the side like a dog would go visit a fire hydrant and mark their territory. That's why they call it a fire hydrant. So, what I'm proposing we do is a butt burner, which is a bit of both. So, I'm moving my leg out to the side. I'm rotating my my leg this way, my thigh outwards, but I'm also raising my leg. Ultimately though, more than the position that my leg ends up in, what I care about for you is that you feel the butt muscle on the leg that you're picking up, tighten up, flex, and begin to tire out. You got to hold it there for 10 seconds. I'll get to that. I keep saying it, but I'll do it right after this. So, you're going to pick up the leg out a little bit, and then you're holding right here for 10 seconds. And I am consciously thinking about making my butt muscle flex and tighten to get the most out of this exercise. And I don't have to go all the way up cuz I have room to go up even more. But I kind of found the right spot, the sweet spot if you will, where my glute is working hard. I'm winning here. We're we're effective. Then after you do that side, you can go to the other side. Same thing. So I'm moving my leg outwards towards the wall in this case and then picking up my foot. And right there, I feel my glute working hard. So, I'm going to just think about tightening my glute even more. Do a slow 10 count. And then after 10 seconds, I can come down and you can alternate sides. And I love this one for targeting the glutes. Of course, you have to have gone through glute sets or at least know that you have good conscious control over glutes. But what will happen if you start to compensate is you'll start to use your hamstrings a lot, the muscles that are on the on the back side of your thigh right here. Or you'll use your back quite a bit too, especially if you try to go higher because you'll rotate in your hips and back. And that uses your back muscles. Focus on tiring out the glutes. That is number one. After 10 seconds, come on down. And the one the way I would do this one, this is a progression. All these exercises that I've described are progressions. So glute sets are kind of the easiest version that you have to first um master and figure out. Then bridges is a little bit harder. This one's even harder because now you're isolating one leg and you have to have good concentrated focus on the glute muscle. Now, if you have problems with kneeling or getting on on your hands and putting a considerable amount of weight through your hands, a standing version of this exercise could be that you're leaning on a counter, um the back of a chair, something sturdy that you can hold on to. In this case, I'm just going to lean over to the to the treatment table here. You can lean onto your dinner table if you want as well. And then you're picking up your leg in the same motion that I was showing you to do the butt burner. A combination of the donkey kick and the fire hydrant. A mix between the two is where you get the the glute to maximally work. You have to understand the action of the muscle back here. The glutes in general is to extend the hip to move the thigh backwards. And it does both. And externally rotate or move the thigh outwards this way. So that's why I like combining the donkey kick with the fire hydrant because you're taking advantage of both motions that the glute muscles do. And that's why you can make this really burn in the butt area. So that's exercise number three, butt burners. That this one I would have you do hourly as well. Um you could do 10 second holds each side. Um I would this one be starts to take up a bit more time than bridges and and glute sets. So, it would be okay even if you start to try to get in a 100 reps in a day and you can break it up into sets of 10, sets of 20, or even get it what would be best is if you can get them all in one sitting with breaks in between. But it'll take you anywhere from 10 to 20 minutes depending on how fast you go. But it's a butt workout at that point, which is good for you because it's going to help boost your strength up and you need that very often um to take the pressures in the knee joint off to fix the imbalance and to get rid of the knee pain. We're good. All right, let's come back over here next. So, I showed you the butt burners and kneeling and standing. Up next here, now we're getting into a traditional looking exercise, squats. And here's the thing with squats, guys. If you have knee arthritis, especially, you might be watching right now and you're in your 60s or 70s and you're really here because you have knee arthritis. That's your that's your type of knee pain and you've heard that glute exercises are good for it. But as soon as I say the word squats, you're like, "Oh my god, too hard. No way. Hey, you want me to get weights out and go all the way down, bring my bottom to the floor, to my heels, and no way. No way. I can't do that." And you're right. I don't want you to do that right now. Let's start out with mini squats. Mini squats are excellent if you have knee arthritis, and they're a good starting point for meniscus tears, condomish patella. You don't have to go full depth squats to fix knee pain. I'll show you a full depth squat eventually, but we don't have to go there. Um, all right. Before I forget, let me just do the let me write a note down because I need to tell you about why the 10-second holds. All right, let's cover mini squats. So, best place is going to be over here. Yeah, this is good here. To do a mini squat, you need to first be able to fire your glutes because that's the starting position. You're standing up. I'm putting my feet about hipwidth apart here. Shoulder width, hipwidth apart. You just don't want them super close together. You want them just slightly apart. I'm angling my toes slightly out. That's the starting position. Then my knees are just comfortable here. They're not locked out because that means you're using your quads. You want to unlock them just a bit. Once you figured that out, your foot placement and your knee position. Next thing is to tighten your glutes without thighs. Tighten those glutes. That's the first. This is the top position. The first position. Then to do the mini squat, you're just bending your knees slightly. Drop your body an inch or two. Hold right here and keep tightening your glutes. You might need to feel like you're shifting your hips forward like a forward hip thrust. That's going to make you engage your hips. And then the the one thing that really takes it up a notch too and focuses it in focus focuses the burn into your glutes is to look at your knees right here and push your knees out. So it's a combination of push your hips forward and knees out. And then you're just holding here for a 10 count. After 10 seconds then you can relax and come up. And what you should have felt throughout the exercise is this muscle working hard. And if you didn't feel it here, check the exercise because if you weren't pushing your knees out, experiment with me here. Get into the mini squat position and then bring your knees in. Hold it there. And you're likely going to feel these thigh muscles working. That's not good. That's going to put a lot of pressure on your knees. Your knees might even hurt to do this. That's an obvious sign you shouldn't be doing this. But as soon as you push those knees out, all of a sudden, you're like, "Ah, better on my knees and feel it in my glutes." That's how the mechanics work in here. This is the biomechanics of your legs. So, that's just knees out. If we're trying to get the glutes to work really, really well, then you also have to shove your hips forward. When you do that, you take your quads out of it and you take your back muscles out of it and you really intensify it in the glutes back here. So, let's make sure you have those two components on the mini squat that you tighten the glutes first, then bend your knees, hips forward, and and then knees out. So, the cues that I'm giving people when I see them in person here in the clinic, I say hips forward, knees out, hold 10 seconds, hips forward, knees out, and then get the glutes tired and then take a break. You want to get that sensation so that you know that you targeted the glutes. Because when you get that sensation, that's your your body's getting warm. You're burning oxygen in your muscles and you're maybe increasing your breath because your your body is saying, "I need more oxygen because these muscles are running out of oxygen." So that's your body's response to get oxygen to the right area. That's a good sign. That means you're working the right muscles. All right. So knees knees out, hips forward, slightly bend the knees. What you should feel over time as you get better at this is that you can tolerate going lower and your knees are fine and you're still burning back here. But there's going to be a point where if you go too low, you feel the quads working too much. That's a compensation. Too low. Don't do that. Stay a bit higher. Make sure you find the spot at which you can the depth, how low you can go before your your quads take over. If if you feel your quads taking over your your muscles here or the back of your thighs, then come up a bit to where you feel the glutes working more and that's where you hang out. This is how you do a correct mini squat. And I can tell you with confidence, I've had so many people that have gone through our knee arthritis recovery program and they've never done a full depth squat, but they've done lots of mini squats and they felt their glutes work really well and they have gotten themselves so much better that they didn't feel like they needed a knee replacement anymore. They didn't have any knee pain anymore and they got back to hiking and walking just fine. Because to walk, you don't need to be able to bend your knees this much. You just need to be able to bend it this much, which is what you'll work on in a mini squat. Now, if you do intend to do more extreme activities that require more knee bending, then I would encourage you to work on a deeper squat over time. Just make sure that you're not overusing your thigh muscles. All right, guys. That's a mini squat. The the full depth squat. Um, it's the same principles. You need to keep your knees out and hips forward. Let me just show you here. I'm a little sore in the glutes actually today, but I'll I'll power through it. So, I'm going to get my feet out right here. And I'm going to come down and at the bottom of the squat right here, I'm thinking about shoving my hips forward and knees out. And if I had weights or anything on me, I'm still thinking as long as I'm keeping my knees out and my hips forward, I feel it in my glutes here. But as soon as my knees come in, quads take over. Keep the knees out all the time. One of the Oh, let's since we're on glutes, one of the things that I want you to avoid are heel elevated squats. Elevated The reason is because you see these in the gym. You see these in u you know on social media where people will put a platform on their heels and they'll put a a weight a weight one of the circular plates and their heels are up like this and then they're doing their squats with their heels elevated with something under their heels. I'm just tiptoeing here just to um demonstrate it. When when you do that, when your heels are elevated, it forces the mechanics to change in your legs and it makes you want to use your quads more and takes your glutes out of the exercise. So, you need to make sure to have this wider stance right here, feet flat, and then come down into the squat right here. Hips forward, knees out. That is how you get your glutes engaged. Because what I care about most here is that your glutes work because the stronger your glutes are, the better the pressures in your knee. the the the ideal pressures go through your knee joint. Your knee is designed to take pressure, but in a certain way based on the mechanics around it, getting a little sweaty. All right, before I go on to number five, let me talk to you guys about the 10-second thing here. Thank you so much. My staff knows that I sweat so easy. I just one degree too hot and all of a sudden it's water works here with with sweat. You see me in the gym, I'm a mess. I used to do live streams in the gym and I was so sweaty during my live streams. All right, let's talk about the 10-second holds because up to this point, I've been telling you to do 10-second holds the entire time. And the reason for this is because there's this idea called a uh motor unit. Let me just write it out for you guys here. So, I'm going to write motor unit. And what it is, there's a uh if if you think about your your brain, we'll say that's your brain right there. And then there's nerves that come down to a a muscle that's supposed to be a muscle. And that muscle has a lot of cells in it. They don't look exactly like that, but I'm just visualizing a lot of cells. And there's multiple nerves that come down, but the one nerve that connects to a group of muscle cells, that's a motor unit. When you have a muscle that has not been working very well for a while and you're having a hard time activating it, like the glutes, what helps a lot to get all the cells to become more active is to hold a contraction for 10 seconds. The research actually says 9 seconds. I just rounded it to 10 for to make it easier. But when you hold it like that, you what happens inside the muscle is there's a few cells that are active that eventually they they wake up. And just to personify it, people, if you think of the muscles, it's the muscle cells saying, "Uh-oh, they want me to work here. I'm a glute muscle, the cell, and there's all these dormant, sleepy glute muscle cells around me." And it the longer you hold it, you're sending more signals, and it's it's like your nerves saying, "Hey, glutes, WE NEED YOU. WAKE UP. AND SO the glute muscle cells saying, "Holy cow, we we Hey neighbors, come on. Get up." And the longer you hold it, the harder the KNOCKS GET. COME ON. WE CAN'T USE QUADS ANYMORE LIKE WE have been now. Now it's us. It's glutes. And so more cells wake up. And the longer you hold, the more glute cells work. This is why you need to go through the 10-second holds throughout this process. And if you go through this properly after days and repeated times doing this hourly like I'm recommending, you'll strengthen this cycle and get more glute muscle cells to activate and then it becomes a situation where you can activate them on command. They're working and that sets you up to then do exercises where you don't have to hold anymore. the type of exercises that you see in the gym where people are doing reps repeatedly. They're doing squats with reps, but that quick rep requires that you use all the cells. But if a lot of them are asleep, it's not a good idea to do that right now because then you're just going to work the ones that are that are actually responding. And if that's not enough force generated by the muscle, then your muscle says, "We don't have enough people awake right now, enough cells awake. So quads, I need a little bit of help. Come on, quads. go and take over because we're all on vacation here. So that's why the 10-second hold, guys. I probably just woke up the entire building by knocking on there. All right, let's do number five here. Lunges. And now this is a exercise where you're going to do reps. But remember what I just said about the the 10-second holds in the motor unit. You have to have gone through being able to fire the glute first off and then secondarily being able to do the 10-second holds throughout these exercises, two, three, and four. So that now you can do lunges and it's your glutes are going to respond. So here's how the how the lunges work. A lunge is typically just taking a big step like this. And very often you'll see people drop their knee down and then come up and then they might do these taking steps where they're dropping their knee down then taking the next step and dropping the knee down and take they continue to take steps. But you can also do them static where you're just dropping up and down like so. And the thing is if you do this exercise you'll probably feel your quads working quite a bit. So what I recommend you do to make this a glute driven exercise is start with a squat stance like we're doing with a mini squat, right? You're doing this this squat maneuver here. And then just move one leg forward, but your feet are still kind of wide. Your toes are turned out. And now if you dip down right here, you can let your back heel come up like so. And you think about shoving that knee out, you're going to feel the glute on the leg that's forward really work. You might even feel it on the leg that's back work. Let me show you the the other leg. So, I'm as I squat down a bit here in my lunge position with a wide stance, I'm shoving my knee out because that makes my glute right here activate. You can play with this. So, you can I'm doing a mini lunge. Essentially, if you drop your knee inwards, glute turns off, quad turns on. Shove your knee out, quad reduces, glute increases in activity. That's what we need. That's good. So, we should be doing lunges with knees out, toes out. That's going to help the glutes activate better. And what I would recommend if you like to do lunges, you don't have to do them, but they're a good exercise if you can get your glutes to work. Because if you can't get your glutes to work on a lunge, you have no business doing the lunge. Don't do lunges just because somebody said lunges were a good exercise for knee pain. or don't avoid lunges because somebody said they're terrible for knee pain. What's really needing to happen is you need to get your glutes involved. And I would ask the question is I would ask the question of can I do a lunge and make the glutes primarily work? If you can, then lunges are good for you. But if you can't get your glutes to primarily work in a lunge, then they're bad for you. It really depends on how well your glutes activate. And if you have trouble with this, then you need to think back to what's going on earlier here. Do I need to spend more time on glute sets? Should I focus on bridges or butt burners? Maybe even just do squats before you get to lunges. I hope that helps you out, guys, because many people so many people I get so many questions about doing lunges all the time. All right, guys. We have a helpline open right now. The phone number is right here, right below me, right here. Um it's 91520020004159 and I'm willing to take a call um as we're on live with you guys right now before I finish up my my list here. I'd love to help out somebody who's who's uh got a question about knee pain or or any other problem. All right, should we go to comments next? We doing this next? All right, I'm going to keep going on my list and see if I can get to some of these over here. Let's do an honorable mention. There's an exercise that I sometimes like. So, let's talk about it here. Clams. Clamshell exercise. I'll just call it clamshell. That's probably how most people know it. Clam. Clamshell. And here's the thing. I'm going to show you what this exercise looks like and how to do it properly so that you can see when it might be right for you. I am not a huge fan of this exercise as a consistent regular glute exercise. I like to use it as a an optional exercise to better fire your glutes. But as soon as you've achieved that, I would ditch it. But here's here's why and here's how to do it. A clamshell looks like this. You're picking up your your knee like this and ideally holding it. I like the holds on this one, but you could do reps. It just depends what your goal is. But you're trying to pick up your leg and you're trying to fire the glute muscle back here. But very often people end up firing the side of the thigh and the TFL muscle in the front like where your front pocket would be right here. And that's not good. So the proper way to do a clam is you have to roll your hips over. And if you look at my shoulders, it looks like I'm about to lie flat down on my stomach, like on my chest. That's proper because when I roll over like that, if you look at my knees, my top knee should shoot over forward past my bottom knee a couple of inches, two or three inches while my feet are still touching because it's possible to do this and shove my knee forward, but I want my feet to stay together. So, roll over up top. When you do that, you position your hips to where your your glutes are are more facing up towards the ceiling rather than the wall behind you. And then if you try to pick up your leg from here, all of a sudden it's targeted better back here, like where my back pocket is, rather than on the front pocket right here and on the side of my thigh. So this is a much better clamshell. People don't typically do them like this, kind of partially facing down. They're typically back like this. They're in the, you know, in the beach pose right here, and they're picking up their leg like this. And really, they're working out their their quads and and their TFL muscle. And it's an ineffective exercise at this time. I don't like it at this point. But if you can roll forward and target the glute back here and hold it for 10 seconds and make it burn, then it's a good exercise. The part that I don't like about it is that it's only training the external rotation function of the glute. Remember, the glute has two motions to it. can rotate your thigh outwards, which is what you're taking advantage of here, but it can also move the leg backwards, the thigh backwards, and you're not really doing that here. But when I recommend clams to people is if they're having a lot of trouble getting their glutes to activate. If if we're trying to do the glute sets and they're they're just not getting it, I'll say, "Let's try clams." And sometimes we can figure it out with clams and then get back to glute sets and then get back on track with the rest of the exercises that I've recommended. But if you can't get the glutes to work on clams and I would go back to glute sets and we might even try jumping into the mini squats and that could sometimes get it working as well because at the very beginning of fixing a knee problem like knee osteoarthritis, a meniscus tear, whatever it is, we have to get your glutes working. We have to find a way somehow. Otherwise, you're not going to be successful at fixing this knee problem long term and you're really just going to be doing short-term fixes while the root problem fers. So that's why clams are an honorable mention. Can I get some water?

Thank you.

Comments.

Comments. Let's get to some comments here next.

I appreciate it. Thank you. Water's coming. All right, let's look at some comments here from you guys. And uh Kimberly is giving us a super chat. Thank you, Kimberly. I appreciate that. All my staff, I'm sure, appreciates that. That keeps everybody going here. Um Kimberly says she she says, "Thank you so much. You're welcome, Kimberly. The IT band is painful on the lateral side of my knee. As I bend it, I can hear and feel little popping bubbles. Oh, I'm so sorry, Kimberly. Your channel has helped so many of us. You are very appreciated. Oh, you're welcome. Let me speak to the IT band here in a second. The IT band, as I said a second ago, let me come back. Come over here to the side. It is all back in the clam shell position. How about that? The IT band runs, it stands for ilotibial tract or band. There's different names for it. And it's a connective tissue. It's kind of like a big long um tendon if you will or ligament. It's the same tissue except that at the top and on the front side right here where your front pocket is, you have a muscle called the tensor fascelada. We call it TFL for short. And it connects it. It starts up here in the hipbone and it connects into the IT band. And if you have pain in the IT band, there's two things that are potentially happening here. Um, one, you could have flared up nerves in the area. That's that's a thing. You can have just nerves that are aggressively flared up because um I forgot the name of the there's like complex regional pain syndrome. There's like nerve related issues. I doubt that's the case in you. Um, Kimberly, what because I know we've talked before, you're one of our one of our best attendees here. Um, but what is often the case, I know you I remember you had a hip surgery if I remember clearly, but anyways, your TFL is probably overactive. And when that TFL is overactive, this is the other problem that happens in IT bands, it starts to tighten up and it pulls on the IT band and then it affects how your knee bends and moves. And because there's tissues under the IT band, it can rub and and cause like grittiness, that bubbles, crunching sensation, the just uncomfortable feeling down in the knee. It can even happen anywhere along the thigh or or up at the hip. It's usually happening at the knee or the hip, though. What needs to happen to get that IT band better is you have to get the glutes stronger. And you you could use the mini squats, you could use the lunges that we talked about. You just have to figure out where you are. Are you needing to turn on your glutes? Do you need to just go through glute sets? Or are you doing that already and you need to strengthen the glutes? Those are kind of the two places people typically get stuck is they they can't fire their glutes very well and they're figuring that out. And then the other place is they they figured out their glutes, they're just trying to get the glutes stronger and they're realizing how long it takes or they're frustrated with how long it takes. That's probably where you're at, Kimberly, based on chats that we've had so far. You probably need just more strengthening. So, hourly glute strengthening, 10-second holds. Figure out something to get the glutes to burn every hour of the day as much as possible. Hope that helps you out, Kimberly. All right, up next, I'm going to take a call from Cheryl who's in Indiana and also has an IT band question and she had a knee replacement as well. So, let's catch up with Cheryl here. Hey, Cheryl, are you here?

Yeah, I am. Hi.

Hi, Cheryl. It's Dr. David. It's nice to meet you.

Nice to meet you. Thank you so much for taking my call.

Absolutely. Happy to help. How can I help?

Well, I'll try to shorten the story. Um about a a year ago, it would be June um June 24. Okay.

Had a total knee replacement on the left side. Uh didn't get any relief. Had what appeared to be it band issues really really intense after the surgery.

Yeah.

Always had had lateral knee pain as well as went on after the surgery. went through all the PT, dry needling, acupuncture, um all the usual gamut of um lots of anti-inflammatories. He then told me um eventually that we've tried about everything due to IT band release. Had the IT band release done, no help, just as much pain if not more.

Um went through I've been on cane since June of 20 24. So wow,

this has been a long journey. Um at that time after the um after the IT band release

um I went through and had no therapy for about four months. He wanted it to heal. Yeah.

Then went back to some therapy. They tried some more things. Uh nothing. I went in one day to him and said uh my hip is really tight. Um he, you know, to give me some hip extensions. He said, "Well, let's take a hip X-ray." Comes back in and slaps the X-ray up and said, "You need a need a hip replacement on that same thigh." Gosh, probably the worst hip I would see all day.

Wow.

Um, so I'm a very active 69 year old and have been all my life. So, this has been quite a gamut of now looking at what they're recommending of a hip replacement. Um, not sure.

I did have a um one day temporary um diagnostic injection into the hip to see if it would give me any relief and see if that would help the knee.

Wow.

The hip got somewhat numb. It did not help the knee.

Okay. Um, so I'm now back at PT and she's kind of looking at my spine now. So, um, I I just wondered from your frame of reference and I I followed you a lot. I'm an occupational therapist myself, so um I've been following you a lot and I really respect your science and just wondered what your input may be that you might be able to add or maybe think more of or the other last thing was they wanted another physiatrist. I've gone to several orthopedic surgeons. One other physiatrist suggested I have the nerves cauterized around the knee.

Oh.

Um the the surgeon said I would suggest he would recommend I have the hip done first. See where we are then with the knee and then decide if I need the cauterization done.

Wow.

Wow.

It's been a it's been a journey.

Yeah. That to say the least. Yeah. Absolutely. Oh man. So h how how has it been going with glutes? Have you tried to activate your glutes and strengthen the glutes? Tell me more about that.

Yeah, I have and I had been doing a lot of your exercises quite a bit and I have a lot of pain my knee um when I'm doing certain ones. Um I do try to keep doing them. I don't know that I'm doing them 10 12 times a day. Yeah.

Um I try to do much as I can um but I haven't seem to gotten over the hump to say that it's taken the strain off of my knee.

Okay.

Perhaps I'm not enough still. I feel like I was really really trying to do a lot and I finally kind of cut back a little bit. I wasn't quite getting what I was hoping.

Yeah.

Um but that's not to say.

Yeah. Here's here's what I think ba just based on the you've told me so far and you can let me know if I'm on the right if I'm guessing right or not. You're very health conscious being a health professional yourself. You know, you're you're thinking this through. you're you're trying to critically think through this through this IT band problem that you've had a release for and it's been bugging you and you they're telling you um you know that they want to cauterize the nerves and all that. The root problem is not being addressed and even though you're working on glute strengthening, my hunch is that you're a busy bee. You're you're moving around quite a bit. You're you're still working I'm guessing, right? Even though you said you're 69 years old.

Yeah, I work part time and I work now with kids. um school based.

Yeah.

So you don't >> you're not sitting around most of the day, you're you're you're an active person. You probably do a good job taking care of your house and and you know, taking care of yourself and all that. So

my hunch is even though you're getting in some glute exercises, you're you're kind of undoing the that work when you go to move. Because when you go to get up and move and work and take care of your home, take care of the the kids you're working with for your job, for your part-time job, you're inadvertently using the the the TFL muscle, which is the one that connects into the IT band, and putting extra tension through the through the TFL, I'm sorry, through the

um through the uh IT band.

Okay?

And so you have to be very careful with that. So, it this might require you slowing down significantly throughout your day to be very deliberate about learning how to walk with your glutes, learning how to get in and out of vehicles and out of chairs and and moving through your house, moving through your workplace, being deliberate about your glutes because if you're not, then you're by default using your TFL, which affects your IT band.

Okay. I I've tried like u when I'm walking when I'm trying to be focused on and I'm present I try to tighten up my glutes on each step as I'm trying to take steps. I truly can walk um so limited without a lot of pain that my walking has been so I'm in up and down all the time and I'm doing around the house and so forth and I may go out to you know whatever. Uh but I'm always in pain and so somebody who was always a walker has been in shock mode. So I I you know getting in and out of the car is so painful when I bend my knee and hip to try to get in it and out of the car. So I'm still concentrating on that. Yeah. Um, yeah. So

how how long did you rest after you had the um the IT band released? Released.

Well, I I went around the about daily activity, so speak, but it was four month four months that he had me not do any PT or do any He didn't want me to do any any exercises, per se. Okay. So I was up, you know, doing, you know, there's nothing heavy duty work, but up and about, you know, and we have a full set of stairs, so I'm up and down the stairs two or three times the day.

So you really didn't rest enough. That's this is what I'm getting is is you were still using your TFL muscle, the tensor fascelata, which attaches to the IT band. So you really never took tension off the IT band then.

That's okay. That's that's why you're not getting the the results you need. The IT band is not contractile tissue. It's connective tissue. It's like tendon or ligament. So, it can't tighten.

What tightens it

is the is the TFL muscle and that's the that's what's being constantly used when you get up and you're going up and down the stairs and you're doing activities. So, this is tough because Cheryl, you're the active person who loves to probably, you know, seize the day and get things done.

And for a time, you're going to have to become the sloth. That's why you you already know me.

I know you. Y I've I've seen your type come through my clinic too many times and and it's tough for you because you're going to have to sit on the couch and let things get dusty.

Damn, that's hard.

You're going to have to let the dishes pile up. You're going to have to so that your I your TFL cannot be overused. And while you're sitting, you can still accomplish things. By the way, you need to be working on glute sets.

Okay. Okay. just do it from more of a sitting position with glutes

or lying down. You could stand. I mean, I would say go ahead and I'm not saying sit all day, 100% of the day or lie. You can stand, but you need to be very you need to bring your activity levels from your current level. If we call that 100%. we need to cut it in half or maybe even a like down to a quarter because your regular daily activities right now are causing you to use your TFL muscle which then tightens your IT band and it's not letting it recover all the way.

Okay.

That's why the the surgery is not working out for you. It's the surgery might have been successful if you had rested enough.

I see. I see. Okay. and and perhaps you could even have avoided the surgery altogether if you had rested enough as well.

Okay. So, and I don't mean to dominate the the program. Question possible is it possible then of what activities that

as far as when I'm up what what to do and what to not be doing or I just you're just saying minimize that 50% of whatever

I'm doing. >> Yes. If you think of intensity that requires your your your body, I would bring the intensity down to like on a zero zero to 10 scale. Let's let me ask you this. On a zero to 10 scale, what's the 10 meaning the most intense thing you do all day in a week? What would it be? Would it would it be like doing the laundry, something at work, shopping at the store? What do you think?

>> Um, probably Well, if I when I go if I go shopping at the store, it's a major major. I don't do it often. I've decided to do Target pickup most of the time and my husband's wonderful, but probably at home as far as home activities go. Um, I just threw a pillowcase full of laundry down the stairs and then I drag it into the laundry room.

>> Yeah. On my pain. Oh, that's probably not a good idea, but you know, you think you're >> Yeah. >> Thinking that one through a little bit. So, you know, I stand at the kitchen, >> load the dishwasher, you know, I I make dinner. I you know I the those kind of light basic activities I let him do the heavier things you know >> good >> um or what I think are heavier. >> Yeah. You know >> and that's that's okay. Yeah. What you think is heavier is perfectly fine. You need to ask him for help for the next two to four weeks, maybe even six weeks so you can work on your glue sets and not use your teeth. Because when you go do those more intense activities like walk through Target, do the laundry cuz laundry is no joke. picking up a basket of wet laundry, even dry laundry, and dragging it up and down the stairs, that is serious effort for for a lot of people.

>> So, if you can get someone else to help you with that, that saves your your TFL and your IT band. >> And meanwhile, you get to go enjoy some, you know, your favorite show or book or whatever you like to do for fun and work on your glutes. >> Okay? >> And then you'll get back to it. This is the thing is this isn't forever. You're very active and I think you can get back to it, but you got to get your glutes involved in the TFL to calm down. >> Okay, sounds like a good plan. The surgery that I have scheduled for March 23rd, I should hold off on it. >> That's up to you. I mean, which surgery is it on the on in March? >> Yep. Replacement >> the the hip. Yeah, there's huge potential for you to avoid that surgery to feel good enough in your in your hip and and your your leg, everything if you can do what I'm asking you to do right now. And it's going to be your call at the end of the day. It's going to be how you feel and and how successful you are. But if you think about it, if if you take the next month off of of heavy duty activities, you know, for heavy relative to you, and let your husband help you, let target bring the groceries or, you know, whatever you're getting from the store to your car >> and and give it some time, you might be able to save off the surgery. >> Sounds like a great plan. Thank you so much. I appreciate >> Absolutely, Cheryl. I wish you the best. I hope you don't have to have any surgery and you feel great really soon. >> I hope you're right. Thank you so much. >> Absolutely. Nice to meet you. Nice to talk to you. Bye-bye. >> You, too. Bye-bye.

>> All right. All right, guys. Let's get back to the lesson over here. It was a great call, by the way, from from Cheryl. And I I really hope she gets this problem fixed. It was so fitting because we were just talking about the clamshells, the tensor fascelata muscle, and the IT band kicking in. It's a common problem because and the reason why the TFL kicks in, that's the muscle right here in the front hip pocket, is because glutes are not strong enough. When your glutes are consistently active and strong enough, because it's a two-part thing. They have to they have to fire at the right time. We call that coordination. And they have to have enough strength to help control your movement when they fire. So, make sure that you understand those parts. If you can fire your glutes, great. That's you check one box. But the second box that's important is does it have enough strength and endurance to tolerate walking through a store, doing the laundry, doing the dishes, cooking a meal. You have to have strength and endurance in addition to the coordination. Those are the three big factors that you need. All right, up next after lunges, we cover lunges. Um, we're going to do some hip thrusters. And um I'm going to clear out the table here, guys, cuz let me make sure I'm not missing anything else. We got the pinches. Uh yeah, we should be good to clear out the table. All right, so as I set up for the hip thrusters, I'm going to do my best here to not break any equipment. This is like a bridge but with weight. And ideally, you should be doing this on a um on a >> bench. Yeah, I'll move the light. Ideally, you should be doing this on a bench or a chair um behind you, but just think of it as a bridge exercise. I'm going to move this over here. And the way that it looks, I'm using a big heavy barbell. You can use small weights. Actually, let me use the small weights first and I'll bring the barbell in and put the weights here. So remember, a bridge is you're on your back like this on the surface. You're tightening up your glutes first and then picking up your hips. The the next progression would be to add some weights right over your hips. So you can get dumbbells like this, and these are 5 lbs each, but you can work up to 10, 20, 30 lb dumbbells. After you're at about 20 or 30 lbs, it's probably time to get a barbell like this. This big long bar that's a barbell. Same concept here. You're tightening your glutes, then picking up your hips like so. And you don't, now that you've gotten good at firing your glutes on the bridge, we were doing holds where you're counting 10 seconds. But for a a thruster, you're going to do reps. You're going to come up, tighten the glutes really hard for a moment, then come back down. Tighten the glutes, then come up. Make sure those glutes are firing hard, then come back down. That's the essence of a thruster motion. in a hip thruster motion. As you get really good at it and you can pick up 20 lb dumbbells, a barbell like this is going to start at about 45 lbs on average. Some are heavier, some are lighter, and you put that across your hips. You know, make sure you're safe with the barbell. And then you're doing the same thing. You're going to tighten up the glutes, lift up, and come back down. And when every time you lift up, you're thinking about tightening those glutes as hard as possible to make sure that you're getting fatigued, tired in the buns back here. Now, like I said, you can have a chair behind you, a a weight bench, something soft to be on, but either way, you want to make sure that you're tightening up those glutes. And at this point, you're doing reps, no longer doing holds. All right, so that is your hip thruster exercise. And this is advanced. This is for someone who's, you know, getting into the weight room again, if that's what you intended to do. And if you if you wanted to um um return to weightlifting and really push the strength, this is where I would go next is hip thrusters. And you know, speaking of the weight room, now that we're talking about nearing the end here, I want to get into some other exercises to avoid because if you're back into the weight room, what you'll find there sometimes, oops, wrong color, is a bunch of machines. And one of those machines that's very popular in the gym that people love to do that I strongly discourage is leg presses. Now, I can't bring a leg press into this room, but if you just search what a leg press is, or you might know what a leg press is. It's a machine where you sit and you're in a seated position, and usually there's a big plate in front of you where your like a a foot plate where your feet go, a big rectangular shaped plate. Sometimes they're different shapes. And usually you load plates, weights onto the sides, or there might be a stack of weights and you just kind of adjust the pin. But the idea is you're pressing your feet away from your body. And this is called a leg press machine. I don't like that one because it tends to focus on you using your quads because you're in a relatively seated position. If you can see my my hips here, um you're you're pushing from this position right here. So, you're then extending your legs like so. And you can't fully extend your hips. You're you're using your you're really just straightening out your knee and then bending your knee to accomplish the exercise. So, because you can't fully extend your hips, you're not using your glutes. So, you're not really going to strengthen the muscles properly to fix the imbalance. You're actually going to feed into the imbalance. If you're doing a lot of leg press, that means you're going to get very strong quads, which is then going to make your knee pain worse because of the compression that the quads bring to the knee and and it feeds into the imbalance. So, we got to get the glutes stronger. Don't do leg presses. Um, another one that you'll see people do in the gym is side stepping. And uh you know, this one doesn't require weights, but what I see a lot of people do, especially with with side stepping, is they'll they'll get into like a a partial squat position, and then they'll do side steps like this, and they'll go back and forth, but then they'll put a rubber band around their their thighs or their knees to get resistance in the side stepping motion. And the reason why I don't like that is because of the TFL muscle, which feeds into that IT band problem. Because if you're in this position right here, it's really challenging to truly target the glutes on the back of the hip right here. What ends up being targeted when you take that side step is the entire side, including the front hip pocket area. Cuz this TFL muscle is what we would call an abductor. Abduction is what abductors do. They move your leg outwards. And if you're strengthening that TFL with resistance from a rubber band, that IT band that the TFL connects into, this is a TFL and then the IT band runs down to the knee. You're going to tension the the TFL then tension the IT band and then put bad pressure to the knee joint. So this side stepping walking I highly disagree with. I think it's not a good idea to be doing it. It's only going to feed in more pressure to the knee joint. I would avoid at all costs and make sure um that you uh avoid the rubber band as well. Just going to write band. You'll hear banded side stepping or side stepping with the band. I don't think it's a great idea. The next one that I don't recommend, hip hinges. And here's the thing with hip hinges. I hear fitness professionals and health care professionals all the time talk about how important a hip hinge is. And this is a hip hinge. You're you're bending forward and then straightening up. Bending forward and straightening up. And there is a way to do this and primarily use your glutes. But you have to one be conscious about using your glutes. You have to be able to fire your glutes. And when you when you come to the up position, that's when your glutes should fire. You need to think about doing that forward hip thrust. If you can do that, then I'd say, okay, hip hinges might be decent for you to do. However, what I often find is people are doing hip hinges and they're using their back or their hamstrings and they're skipping their glutes because they haven't gone through the process of doing glute sets and making sure their glutes fire. And then on top of that, they're doing a hip hinge with a barbell like this. And they call it Romanian deadlifts. So your your legs are straight, relatively straight, and then you're coming down and standing up like so. And if you're doing this and you're not feeling much in your glutes, even though you're supposed to feel it in your glutes, you're missing the glutes. Your body will tell you which muscles you're firing. So people get all hung up about doing a hip hinges if there's something magical about it. But what really needs to happen, regardless of the movement, is did your butt muscles fire? because if they did not, then the hip hinge is worthless to you. Now, you might be doing a hip hinge and you are getting your glutes to to fire, then great, excellent for you. It's probably going to be a good thing for you. But I consistently see people very focused on doing a hip hinge. And then I tell them, "All right, well, muscle's working. Keep going. Just keep doing hip hinges until you feel something burn." And then they'll say, "Oh, I feel it in my hamstrings." Then I'll say, "It's not good. Stop doing hip hinges." Then I'll have them do mini squats and they'll say, "Woo!" Feel it in my butt. Then I'll say, "Great, let's do mini squats. Stop doing hip hinges." So hip hinges, I strongly advise against. All right, let's take care of our honorable mentions here. Cycling. Cycling is a confusing one, similar to hip hinges. Um, but I I put it in the blue category rather than the red because people tend to figure it out. The problem that I have with cycling is, you know, as a knee exercise, as a knee pain exercise, is when you cycle, because of the motion in a bike, your legs are generally in this position. Your knees are kind of pointing forward and you're just you're moving the pedals on the cycle in this direction. Your knees are just kind of coming up and down. And if you're not conscious about what muscles are firing, often what happens by default is your quads, the front of your thighs, kind of dominate the motion, and that's where you feel the burn the most. And you could try this out. If you just start sprinting on a bike or add resistance to the bike, press the button or turn the knob, and feel what muscles you're having to work to make the bike move, it's often your quads. What you need to do is make it your glutes. And the way you do it is when you're pushing down on the pedal, you have to think and concentrate to tighten the glute on that side. So if it's your right foot that's going down, then the right glute should tighten up. And then as you finish pushing it down, you're going to begin to push the left foot down. The left glute needs to tighten up. And if you practice cycling like this with low resistance and then and you can consistently get your glutes to fire, it should feel like your glutes are just alternating left, right, left, right, left, right as the you're pushing down on the pedal. left, right, left, right, left, right. Then you're going to make cycling a positive thing for you. And it could be actually very helpful because if it's consistently your glutes working, then your knees will benefit. Especially if you have like a a a cartilage problem like knee arthritis or condom patella or a ligament problem like an ACL tear or an MCL tear or an LCL tear. Those those high repetition but low resistance exercises like cycling are gold for you as long as you're not driving it with your quads and it's coming mostly from the glutes. So that's why it's an honorable mention here. The next honorable mention one is going to be walking. I love walking if your glutes are working right. I hate walking if you don't have good control over your glutes. Walking in and of itself is highly recommended without any idea about the glutes. People just healthcare professionals will just say like your doctor might say, "Oh, you have a knee problem. Let's start walking. You have knee arthritis. Have you How much do you walk right now? Let's start a walking program. And there's no mention about the glutes. And if you're walking right now to help your knee pain and haven't figured out how to make your glutes work, you're going to mess yourself up because by default, as you start to get more tired, your quads are just going to take over the activity, the walking, and you're going to be strengthening your quads. Try it out. Go on a walk. Get on a treadmill. go outdoors and take a brisk walk and pay attention to which muscles are firing, which muscles are getting tired and fatigued. And if it's your thighs, walking is not good for you right now. But if it's your glutes, walking is good for you. And you're probably going to feel good in your knees. But if you can't get your glutes to fire right now with walking, then you need to slow down. And it's painful for people because not painful in the literal sense like you're hurting your knee. It's emotionally painful because you might think, I know how to walk and I've been walking and I I enjoy walking. I I have this park that I love or the route in my neighborhood. I have a treadmill and I, you know, I pay good money for this and I want to use I have a gym membership and I go use the treadmill there. You might have all these thoughts competing with yourself. So, it's painful for you to say, "Darn, I have to stop walking and walk really slow and think about my glutes working." Because what should happen when you walk is every time you take a step, like when I step onto my right foot, my right glute should tighten up. It's just like the bike. On the bike, when you press the pedal down, right glute tightens up. With walking, when you bear weight on the right foot, right glute tightens up. And then as you switch to bear weight on the left foot, the left glute tightens up. And then you're just alternating right foot, right glute, left foot, left glute. And that's how you should be thinking about walking all the time. And if you're doing that consistently, eight out of 10 steps are better. When you go on a walk, now walking becomes helpful for you. And just pay attention because the longer you walk, your glutes might tire out if you're not fit enough for it yet. But you'll get better as you keep walking and keep practicing proper glute activation. And it may even require you coming back to some of these exercises to boost up the strength in your glutes to tolerate walking for longer distances and more time. So, walking is an honorable mention here. It could be beneficial if your glutes are working right. All right, guys. You ready for the last one here? Next, here's number seven. Continuing with the weight room theme. This is my favorite glute exercise, especially if you have knee problems. So many people benefit from this. Deadlifts. I love deadlifts so much. And there's a proper proper way to do deadlifts which I'm going to show you here next. I demonstrated a moment ago Romanian deadlifts which means you're you're deadlifting. You're picking up the weight from the ground with your knees straight. But what I want you to do if you get to this point, if your knees are healthy, you shouldn't be doing this if you're if you're in pain, by the way. You should only come to deadlifts when you've already been doing bridges, you've been doing some mini squats, and all that's felt good for you and your pain in your knees has been going down. Excuse me. And you're at a point where you feel healthy enough to start to add some weights in. Then what you'll do is you'll grab the bar about hip shoulder width apart, like so. And if you think about this starting position right here, my knees are right over the bar. And my what I'm thinking about doing is pushing my knees out against my arms forcefully. some pretty good force here because as soon as I do that, my glutes turn on. And as soon as I bring my knees in, my glutes turn off and my quads turn on. We want the glutes to be active here. So, push the knees out. So, this is the bottom position. And then when I stand up, I'm going to stand up here next. I have to think about tightening my glutes as I'm coming up and then shoving my hips forward doing a hip thrust motion just like we practice on the mini squats and the bridges and the hip thrusters. So then in real time you're coming down, knees out to turn on your glutes and then come up, tighten the glutes, knees out, hips forward, knees out, hips forward. And if you do deadlifts like this every single time, you'll feel your glutes working really well, your thighs working some, and maybe a teeny tiny bit in your back, if anything at all. I consistently have people that do deadlifts come and tell me, I stopped doing deadlifts because my back was hurting or somebody told me that it was going to hurt my back and so I deadlifts are bad for backs. But if you're focused on using your glutes right and you're not compensating with your quads, you're probably not going to compensate with your back muscles and you'll actually feel the deadlifts target your glutes very very well. And it'll be a super beneficial exercise for you so that you can fix knee pain for the long term. Fix it for good. All right, guys. That wraps up our list here. I'm getting out of breath, but I'm still going to answer some comments here next so that we can continue to help you guys out. We have a little bit of time left. We're coming up on time, but let's get to some comments here next. I felt it in my glutes. Let's see who we got here. We have Michael H4f says, "David, you're awesome." Oh, thank you so much. I appreciate it. I hope you guys are feeling better. You know, I I love the praises. First off, let me let me just say this and and I don't mean to make anybody feel bad. Um the the the kind words are really nice, but I really care mostly about making sure you guys get the help that you need. So, um and I get it. You know, I say thank you all the time, too. So, I'm thankful for a lot of things, and I can see that you guys are expressing thanks, but just know I care that you guys are applying this and using this. What what means the absolute most to me is for you guys to tell me like I I've we've seen some comments already of people that that say, you know, I was in your program or I did your thing from YouTube, your treatments, your exercises, and I'm better now and I avoided a surgery. That's like I cry sometimes when I read those comments. So, um thank you guys so much for the for the kind words. I I really appreciate it. We have Guy Miller 6891 who says, uh Guy Miller, Utah. Oh, Utah's in the house. I get PRP every six months. Um has helped a lot. still but still painful when going downstairs. Yeah. So PRP stands for plateletri plasma and that's where they take some blood out of your body and then they put it in a centrifuge. those things that spin your blood really really fast and it separates out your uh the different components of your blood. And then what the what the medical staff will do is take out the platelets which is a part of that what separates it gets separated out and then that those platelets are thought to have healing components in them and they'll inject the platelets back into your knee or wherever they whatever body part they're trying to help. And then when they put it back into your your your knee joint in this case, it might help with some healing. But if you still have an imbalance because you're not using your glutes enough, you're or you don't have enough strength. Maybe you are using your glutes properly, but you don't have enough strength, especially on stairs, you need strength. You might still feel the pain come back because you have a mechanical problem. and and the PRP is helping with the healing problem, the like the tissue healing potentially, but it's not fixing the mechanics. So, you might still have bad pressure going through your knee joint. So, that that's that's why you're potentially getting that problem. And doctors know this because they'll tell you, you know, come back every six months or even more often if you need it because they know that it doesn't solve the problem. It just delays pain a little bit. It just takes the edge off. It makes life a little bit more livable without knee pain. But come on, Guy Miller. I think you can fix this problem. Let's get more glute strength. Let's get those glutes more active. Figure out how to use the glutes on the stairs. I talk about that on YouTube all the time and you'll be able to get over the pain on stairs and most importantly potentially not need the PRP injections anymore. I think that would be pretty cool for you. All right, up next we have Cynthia Strong. She says, "I think my pur performis muscle is inflamed and painful for a few weeks now. Do you think the massage gun will help?" Good question. So the purformis muscle is in the glute area. It's a deep glute muscle. And um if you have pain right in the glute, there's potential that nerves in the area are irritated. It could be um a certain muscle that's spasming. It could be a hip problem, like a joint problem in the hip. Um you could try putting the massage gun in there and seeing if it if it'll help. I would recommend because there's a big nerve right there, the sciatic nerve. The massage gun could irritate it. It's worth trying though. Um, but I would recommend starting out with like a a tennis ball or even just get your hand in there or if you if you know if you have a loved one that that can dig on your glute muscle like lay down on the floor on the bed or something and just have them massage the you know over your clothes just massage the the glute out that might be helpful as well. That's a treatment that we actually do here in the clinic. We'll have and people come in with pain in the area and I'll say okay go ahead and lie face down clothes on and everything and we're digging in on the glute and I I'll feel a knot in the muscle and I'm just freeing it up. And once I free it up, they'll say, "Oh, it feels looser and better." And then I follow up with this. Now, we need to fix the muscle imbalance. All I've done is calm muscles down so that you're having less pain, but it's going to come right back unless you get the muscles to work well when they need to and you get them in the right strength balance. So, just keep that in mind here, Cynthia. You need to fix the imbalance so that you're not constantly getting this puriforis or this deep glute pain. Hope that helps there. Right up next, we have Poppy Love 3673 who says, "I have bone on bone, both knees, but there's also meniscus tears or other issues that involve the inner side of your knees, not the inside the knee itself. Bone on bone like the inside part of your leg." Yeah, I get it. Like inner knee pain like between the knees on that on that side of the knees. Um, so to answer your question here, Poppy Love, um, I think you're asking like, "What do I do?" You You probably have this this key muscle imbalance that I'm talking about where your glutes are weak and your quads are overdominant because that's going to apply a lot of pressure to the knee joint. Where's my knee joint? Oh, here it is. So, here's the knee. Quads are up here in the front of the thigh. Okay, this is the quad tendon. So all the muscles, they converge and they come onto the tendon and then there's your kneecap. So if you have very strong quads, the quads get very strong because the glutes are weak. When the glutes are weak, quads take over because they can help move you. They can help help you with walking, help you with getting in and out of chairs, out of vehicles, picking up things and moving while you're walking. Quads do a lot of heavy um compensation for weak glutes. So, when you have very strong dominant quads, because you're using them all the time, you're working them out all the time, then they start to apply constant pressure through the quad tendon, which means the the kneecap pushes on the on the thigh bone, and then because of this tendon that runs down into the shin bone, it pulls the shin bone up into the thigh bone, which then compresses your poor meniscus right here. So, this all speeds up arthritis. It tears your meniscus and depending on where exactly you get the forces, you can get inner knee pain. You might get the nerve that's irritated as well because there's a big saffinous nerve that comes on the inside part of the knee and can irritate it. So, this is all often related to the muscle imbalance. If you get stronger glutes, if you first if you just activate your glutes if they're not even active, then strengthen the glutes, then learn how to use the glutes while walking, while using stairs while doing your everyday chores, then you're going to be in a much better position to keep the pressures down in your in your knee joint and keep the tension off the nerve and keep the the pressure off the back of the kneecap and and off the meniscus. So, I hope that helps you out there, Poppy Love. Hey guys, if you're dealing with knee arthritis, um knee osteoarthritis, I just say arthritis for short, um you need to know that we have a program called the knee arthritis recovery program and um it's a paid program. However, we have the first part of the program available completely for free and it's it's right here. You can see you're looking at it on the screen. Um, if you go to our homepage right here, um, you can click on on the the part that says start start now for knee arthritis. Then you'll go to this page right here. And right there where it says welcome and there's a picture of me, that's the first video of the knee arthritis recovery program. Notice there was no login here. It's it's there. You just go in and you can start playing the video and clicking around and there's to the right of the video player right there in the list of videos, there's a button right there that says take the the free phase quiz. There's four phases in our program and you can take this qu this this quiz. That's where you'll go next when you click on that button and you just answer these questions and as you answer the questions you'll get to a report and the report is based on your phase. So we have four phases. If you're phase 1 2 3 or four you'll get a report that looks like this. This is the phase one report. You can see it has a one right here on the bottom. And um it has specialized information for your phase what what you should focus on. Here it is right here. Treatments to focus on in phase one and you know what what life will look like when you're in phase two. Um what it looks like if you regress. There's all kinds of helpful information here that would be beneficial for you if you know what phase you're in. The whole reason for the phases, by the way, is because there's certain treatments that should happen at certain points in the recovery for knee arthritis. And a lot of people get mixed up in that, even healthcare professionals, because they'll start you on a more challenging exercise like the ones that I have here at the bottom of my list early on when you should be doing easy stuff. And like even glute sets here is is at the end of phase one, like what I what this reports for. There's other stuff that you should be doing and worried about. And you have no business doing these exercises if you're in phase 2, three, or four if you haven't even turned on your glutes. So, there's specific information that I want to share with you if you want to take that quiz and and get the report. And like I said, you can just start watching the videos and work your way through phase one right now. So, um, go check out our website. Do we have the website? We'll put the website up at the bottom here for you guys. Um, epanmanualphysical theapy.com. And then you'll be able to, um, as soon as you load the homepage, you go to the homepage there, you'll see, uh, the videos that talk about going into the knee arthritis recovery program. And then at the top on our website, we also have a bunch of other knee programs you can check out because we have the meniscus tear recovery program, the um ACL tear recovery program, the con the um uh patella pain recovery program, and then we also have a failed knee replacement program for those of you guys that have had a knee replacement and you're still having problems with it. I had to make that program. Like I I feel terrible that I had to make that program because we had so many people calling us and asking us for help when they've already had a knee replacement and they don't know what to do next because they're still in pain and they don't want to go back to the surgeon because that means they're potentially going to have another surgery. So just keep that in mind. And then um I've also got case studies. So, um, I have lots of treatments with patients, and I've put some of our treatments into books that you can download, ebooks, and I'm detailed in here. I put in all the treatments we did. I got a good background story on on certain patients we made case studies for. So, if you want to learn about, there's a a QR code on the screen right here that you can you can screenshot this and and uh go to the website. But if you want to get the case study and see what we're doing in treatment, because it's nothing magical. There's no like, you know, people call me a guru sometimes in what I'm doing because they fix their knee arthritis and avoid surgery. And I get it. It's kind of miraculous because that's not typical. Usually people with knee arthritis or or knee problems end up having surgery and live life with knee pain the rest of their life. But if you want to see what we did with people, go to this case study and you'll see that it's pretty straightforward stuff. We were just consistent and we did it right. And I'm happy to help you with that through our case study, through our YouTube videos here, um through our programs if it's right for you to work with us. There's free ways to work with us and there's paid ways to work with us. It's really up to what you need and what you prefer. Just want everybody to get better here. All right, guys. We're nearly done with time. I do have to get going. Or are we can answer? Oh, yeah. We got comments coming up. Uh Monica Daniel says, "I had TKR two months ago. A TKR is a total knee replacement. Um, the emphasis my PT is giving me is quads. Should I include glute work more? This is a good question. So, if you had a knee replacement done, and it's very common for physical therapists to recommend quad activation afterwards and quad strengthening exercises. And Monica, it's appropriate because after you have surgery, I mean, think of a knee replacement. They cut the front of your knee open. They pulled all the tissues apart. They sawed off the bones and they installed new, you know, artificial parts inside your knee joint. Then they had to close it all up. And in that process, your quad muscles above your knee probably shut down. They they make sure those muscles aren't working during your surgery because that can really be devastating for you. Um, so after surgery, it's important for you to activate your quads just to get them going. The problem that that I see in patients recovering from a knee replacement though is that they keep going with the quads well beyond what's necessary. So if you have good quad activation, like if you can look down at your quads and make them work and the entire muscle fires really good, then I think you're done. I think you're done worrying about the quads and it's time to now worry about the glutes. But if you look down at your quads and they're doesn't want to fire very well, it kind of it fires only on one spot and not in the others because it should fire all over the front of your thigh, all up and down from your hip to your knee. The entire muscle should fire pretty well. If you feel like you've restored that, then good. You're great to move on. But if you're not, hang out there, work on the quads a bit more, but you do need to eventually come back to the glutes. Now, I think that most therapists out there, they're great at helping people after knee replacement, and they'll focus on the quads. And really, you just work with them for, you know, two to three months, occasionally more depending on, you know, special circumstances. They really just barely have enough time to get you up and walking and using your quads again and get you mobile enough to get back to life independently, and they don't have enough time to focus on the glutes. So, it's good that you're here right now learning about this. You're going to have to work on your glutes because chances are your knee replacement was for knee arthritis and you develop knee arthritis because you have that imbalance of weak glutes over dominant quads. And even though you went through the surgery and you're having to probably wake up the quads now, probably still have those weak glutes. So get get on those glutes. You need to fix that. >> Last question. >> All right, we got time for one more question, guys. This is from Robert Mendes. He says, "Doc, what do you think about ab stimulators/shockers to initially turn on muscles that are turned off? Asking because it seems very hard to turn on my lower abs without using hip flexors." I love this question, Robert. I think it's cool. I think it's a good idea. Um, if you're open to it, some people don't like it. I personally have never liked electrical stimulation. You know, I'm a physical therapist and so I had to be tested and all these things. cuz I had to feel what it's like and um I've just never liked the sensation. But I've met people that say they don't mind it and and they actually like it. Um so if you feel like you're open to it and you want to get one of those devices, they're not that expensive these days. They used to be thousands of dollars. You can get one off Amazon for probably 30 or 40 bucks now. And you put those electric electrical pads on on whatever muscle you're trying to activate. And then there's a little like a beeper looking device that you crank it up. I think they use like AAA batteries now. the you have to plug it into the wall. Kind of scary. Um, and you could turn up the kn the the the little um knob on there and it'll start to give you electrical stimulation. And if you can get it to rhythmically give you stimulation in a pattern that you can begin to recognize and when you feel the electrical shock coming on your on your abs and it makes your muscles want to tighten up, then at that point you have to say, "Okay, think about tightening up those muscles." and time it with the device. Then eventually you can take off the device and you on your own should feel like you have good contraction of those muscles. That technique is done to get muscles to wake up if they haven't been very active before. Just make sure that you're not compensating with the upper abs and with other muscles, but I I think that's definitely worth a try and can help to speed you into to where your abs are working well. Good question here. All right, guys. That's our time. I'm going to wrap up here. Thank you so much for joining us here on on this uh live stream talking about the best glute exercises to help knee pain for good. I hope that you're helped. Don't forget to check out our playlist for specific knee problems like knee arthritis, ACL tears, meniscus tears, and other knee conditions. Um if you if you want deeper information on specific knee problems, just go into our YouTube channel and you'll find the playlist in the playlist section. And um and please if you haven't yet subscribed to our channel, we we find a lot of our viewers aren't subscribers and we don't want you to miss our videos because it might be very helpful information that could help you avoid a surgery and fix a problem for the long term. We have so many cases of check out our comments. We have so many cases of people saying, "I avoided surgery. I fixed my knee problem that that I've had for a decade or longer decades. And you know, I've seen all these doctors and they've just had me do these the wrong things essentially. Started doing your things and it got better. So, I would love to help you out if we can. So, please hit that subscribe button and turn on the notification bell so that we can make sure to catch you next time you're available on YouTube. Thanks so much, guys, and we'll catch you here next week. Bye-bye.