10 Exercises That Make Painful Knee Arthritis Worse

Hey everyone, it's Dr. David here. We're going to be talking about the top 10 exercises that make painful knee arthritis worse. So, uh, let's just get Instagram going here. Let's make sure everybody's up and live with us. Yep, we're live on Instagram now. Fantastic. I got some people on the call already. How are you guys doing here? Got comments coming in as well. Let me take a look at the comments here real quick and highlight some. We have some new members to our channel. Fantastic. We got patience oak pier and and then oh make sure my audio is on here. It's always something. Can y'all hear me? Okay, let's do that banner comment if you can hear me guys.

So, who do we have on here again? Um Oak Pier, thank you for becoming a member. And then we also have Joy Bird who is a member now as well. Can you guys hear me? Okay, great. I got a couple of messages. Uh Kathy uh Bishoff 33683 says, "I can hear you." Great. Hey Kathy, awesome. We have Will Zoo saying I can hear you. Uh Kimberly's here. Hey Kimberly. She says hi Dr. David. Monica Star says, "We can hear you." Well, great. Thank you guys so much. Howdy. Great to Great to have you guys here. Polls JT, everyone's here. Fantastic. Um, people are coming in. Let's hear where you guys are from now. Can you guys type in the chat what part of the world you're in? Um, country, state, city, whatever you feel comfortable sharing. Uh, let us know where you're at.

We're going to be talking about knee arthritis exercises that you should not be doing today because there's a lot out there that is done that isn't helpful, but it's it's thought to be helpful. And it might be helpful short term, but really sets you up to to just be worse long term. Let's see what we got in the comments here. People say we have people from Seattle. Great. Uh that's Monica Star. Debbie is in Bloomington, Illinois. Very cool. We have uh SG New from Vancouver. Sorry guys, I can't read all your names. Uh Nathan, I'm sorry. Natalie Walker is in Englewood, California. We have Jacqueline in Missouri. So cool. Nerra Kape is in West LA West Luck. Oh, we have somebody from Saskatchewan. Polar Vortex. Very cool. Mount Vernon is here. Timothy. Well, that was Polar Vortex. And then we have Specs Mania in London. Ps JT's in London. Awesome. We have more people coming in. Let me get one or two more in. Connie is in Maryland. Scotland. Hippie heads. Hey, hippie heads from Scotland. Alex from San Francisco. Awesome. We have Philadelphia is here. Leopold. And then we have uh Bal Baliri Manac from Canada.

All right, guys. I'm gonna move on here. Let's get to what we came to discuss here. This is the top 10 exercises that make knee arthritis worse. You're going to want to stay tuned throughout the whole video because I'm going to go in reverse order. I'm going to start with number 10 and we're going to go down to number one. We're going to count down. And these I was thinking about the the order that I gave them. It's not really like one is way worse than the other. It's it's a little bit of that, but it's also ones that are recommended, highly recommended. So, I I'll I'll just get started here and then it'll make more sense to you.

So, number 10 is going to be quad sets. And um I'll show you a picture of what this exercise looks like in just a second. This one is recommended quite a bit to people that have knee arthritis. Let me bring up the the slides here. I'm experimenting with slides, so apologize if I if I make an error here. So, there's our title, the top 10 exercises that make painful knee arthritis worse. And this is a quad set right here. So, this is commonly done in physical therapy. Um, you might see videos on the internet of people telling you to push your knee down against a towel like somebody's got on the left right there. the the person with the green shirt and the gray shorts. And then the that's a picture on the left. The picture on the right is just showing you the arrow. The idea is you're trying to straighten out your knee and push your knee down. And what you should feel as a result is your quad muscle tensioning up. Now this is generally like a low-level exercise, like an easy exercise, a beginner exercise if you will. But this is very commonly recommended in physical therapy for somebody with high knee pain because it's an easy thing to start to do. And it might compress the joint initially and move things around, move the kneecap around for sure, which could bring relief initially, but it's strengthening the quad muscles, the muscles in the front of the thigh, which end up compressing the joint in the long term because you're going to you're going to get them stronger.

Let me just show you what I mean here on the on the knee model. So, here's a a joint of a knee, a right knee joint. Here's the kneecap. This is the the quad tendon. So, when you're doing a a quad set, usually your knee's a little bent like that. And then you're pushing it straight and you're causing the thigh muscles on the front of the thigh right here to tension up and yank the kneecap this way, which pulls it further against the thigh bone right here. And then because of this connection, there's a a ligament right here that connects the kneecap to the shin bone below the knee. It pulls the shin bone up into the thigh bone. So it compresses the knee joint right here. Initially, you could feel pain. Initially, you might feel um like it the muscles just tightening up and maybe even some relief. But over time, in the long term, because what we all care about, if you're watching this video right now and you have knee arthritis and it hurts and you're doing a quad set as instructed by a health care professional or somebody like that, you probably care to get rid of the pain right now. Obviously, you want to feel better, but you probably also care about getting rid of this problem for good. If if it's right for you, which it very often is, you can get rid of knee arthritis for the long term if you fix the muscle imbalance. And the number one muscle that feeds into the problem for knee arthritis is overdominant quads. So why strengthen them? Don't strengthen them. We shouldn't be doing these quad sets aggressively to strengthen the quads.

Now, what I'm okay with is doing some light mild quad sets for a very short time, like maybe for for a few reps, a a day or two initially because that's generally not going to make a big dent in your like like massively shift imbalance for the worse. It might be helpful to get things moving. But what I'm not okay with, which I think what I think is absolutely terrible for knee arthritis, is if you keep going on quad sets, you keep strengthening your quads, you keep making those quad muscles burn, you aggressively smash your knee down like to straighten it out and compress the kneecap on the on the thigh bone and pull the shin bone up into the thigh bone as well. Not good. Now, one other situation where I make an exception is if you have a limitation of motion, like you can't fully straighten out your knee. This exercise might be necessary in those circumstances. But many of you guys watching this video don't have a big limitation. You you don't have a loss of motion that that like a major loss of motion, very minor. And so, you don't need to be working on this exercise. So, make sure that you talk with with the doctor about how necessary this exercise is for you because if you don't have a loss of motion, you can fully straighten out your knee. In other words, it straightens out. You probably don't need to be doing quad sets. It's only going to make things worse in the long run, especially.

All right, number two. I'm sorry, not number two. Number nine, because we were counting backwards. This is going to be balance exercises. So, this one is one of my favorites to to talk about with colleagues. And um I'll give you some background on this. Here's the thing. When it comes to balance exercises, there's been a decent amount of research studies done on connecting knee osteoarthritis improvements to working on your balance because there's an association, a connection between people that have knee arthritis and people that are more likely to fall, to take a stumble or fall all the way down. So, the thought process is that if we work on balance exercise, then you're going to reduce your risk of falling. And maybe that'll also help knee osteoarthritis. However, as you can see on this picture right here that I'm showing you on the far left, you have somebody standing on one leg and they have their or they don't have their arms out, their arms are down, but they're practicing standing on one leg. The the middle one, the the gentleman in the blue shirt with the black shorts, he's standing with his feet tandem. So, one foot's in front of another in a line and they're just balancing like that. And then the woman on the far left, I'm sorry, the far right, the one that has the uh uh her hands out like this and she's standing on a on a board. That's a wobble board. So that board, it tilts sideways. I can't tell if it's a sideways tilting board or a front to back or there's some that go in every direction. It's got like a dome shape on the bottom. The idea is to keep it balanced. But here's the thing. You can work on balance and it mildly improves strength and you don't really have a a good way to target specific muscles here. You're just using whatever muscles turn on. So, it's not fixing the muscle imbalance. It's working on your balance, but it's not really making a huge difference in your strength. What I have seen time and time again and maybe some of you guys have experienced this yourself, but if you instead of balance work do strength work. You work on your strength especially in fixing the muscle imbalance. Like I talk about strengthening your glutes instead of your quads. Getting that glute strength without ever timing yourself on, you know, how long you can stand on one leg or on a wobble board or in tandem balance. just get better glute strength by literally doing bridges correctly because I I teach them a certain way. Doing mini squats correctly the way that I teach them. Your balance will improve. Your your one minute stance time will become easier. You'll wobble a lot less because you have better strength. Better strength overall directly influences your standing balance. So why are we going to waste time working on balance?

Now, I'm I'm okay with it if you do it here and there. It's no big deal. But if that's the focus of your treatment, if you're spending a significant amount of time on balance exercises instead of working on strengthening exercises, I think you're on the wrong path. I think you're going to end up making your knee arthritis worse because you're missing opportunities to strengthen. Meanwhile, you're probably feeding into the imbalance because it's your quads that have been dominating your balance right now. And it's going that's that's what's making you be off balance. You don't have strength on the back side of your body. It's more so on the front side of your body. So, if you start to tip over over forward, you can't easily correct. You need that strength more than you need the balance. The balance will come naturally the more you strengthen the correct muscles.

All right, let's do number three here. I'm sorry, number eight. All right, let's do number eight here. And that is a sit to stand exercise. The idea with this one is that you're starting in a se seated position. Let me show you the picture. There we are. Borrowed these from different places on the internet. Um, so you start by sitting in a chair and then you stand up and then you sit back down and you repeat sit to stand exercise. I love the simplicity of this and that's one of my my the things that I like about it. There's a lot of things that I don't. I'll get into that. But what I don't like about it is there's no coaching ever. I've never seen a therapist coach somebody on what muscles to use. They just say stand up and sit down. Stand up and sit down. And for some people's understanding, that might be appropriate. But if you know what I mean, if you if you're hearing me right now and I tell you make your glutes work more when you stand up than when you than when your quads, make your glutes work more on the way up and then make your glutes work on the way down during a sit to stand exercise. And then we're actually doing good in the sit to stand. That's a good situation. But what often happens is you just get told stand up, sit down, repeat for 10 reps, three sets of 10 or however many reps you're going to do. And there's no coaching. There's no guidance on which muscles to use. And by default, because you have knee arthritis, likely if you're watching this, you end up using your quads too much because that's the muscle that's already dominating everything else that you're doing. And when you're using those quads too much, I already said you're going to smash everything inside your joint. You're going to smash your meniscus. You might already have a torn meniscus that you know about and you're making knee arthritis worse over time by doing this exercise. I've met patients that have that were told years ago do sit to stands and they've been doing it and their knee arthritis got worse. That's why they got in touch with me. And it's because they didn't use your glutes. And that simple tweak simple yet difficult. It's simple because it's I'm telling you like stop using your quads, start using your glutes more. It's that simple. However, in practice, you have to go through mental gymnastics and pra like repeatedly getting your glutes to work and getting it to work while you're getting out of the car and getting off the toilet and getting out of that low chair in the house and getting out of that restaurant chair and that couch at your friend's house. You have to be doing it on a consistent basis in different situations in order for it to benefit you the best for the long term.

All right. So, just to recap here, we got quad sets at number 10. We're counting down the worst knee knee arthritis exercises. Starting with quad sets, then balance exercises, then we have the sit to stand exercise. Let me check to see who's with us here now that we've gotten into the video bit. We have Barbara who's in Arizona. We got a few thumbs up. Uh, we're talking about directions to El Paso, westbound on I 10. Yep, we are right on I I think I 10's like two blocks from from my clinic. Um, Polar Vortex says, "Yes, I have a few strength exercise. No balance yet. I'm just transferring from walker to cane." Good job, Polar Vortex. Balance is improving. Great. Yeah, you need to work on strength. That's what's going to push you more than anything else. Um, what else? show. We have a new member, Five Lynwood just became a YouTube member. Welcome, Five Lynwood. Thank you so much for your support. What else have we got here? Devon, UK. Linda Lie is from Devon, UK. Very cool. And then Debbie says, "Uh, I have pain in my quads when I'm on my feet too long. I just finished my second round of suparts injections for my knee arthritis and I'm trying to hold off knee replacement uh surgery. That's why the quads hurt when you're standing on your feet too long. You're using them too much. You need to throw it onto your glutes more and your glutes might not have enough strength to to support you, enough endurance to support you for as long as you like to stand. Um so Debbie, you got to stop working on those quads. They're overworked. They're overworked. And when they get overworked, they eventually become weak. Just think of like yourself. If you're overworked, if you've been awake for way too long, longer than you normally are, you get tired and then you're not very productive as a human. When the quads on the front of of the thigh are overused, they get tired and they're not productive and they can then become weak. And health care professionals often will interpret that quad weakness as a reason for knee arthritis and then strengthen the quads. They they'll think, "Oh, the quads are weak. We got to strengthen them. That's why you have arthritis." But they can't seem to connect as a as a profession that they're weak because they're overused. If you go test the glutes, they're even weaker because they're just not used at all. They're just they've been lazy relatively to the quads. You might have glutes that work a decent amount, but your quads are way more dominant, and that's a problem for your knee joints. Awesome comment there, Debbie. Thank you for sharing.

All right, let's get back to the list here. What is number seven? Oh, this is a good one. Straight leg raises. Let me show you what this one looks like just so that we're all clear on this. Let's get the right angle for y'all. So often people are on their back just like so. And then they're picking up their leg. There's different versions. You might have your leg, they might tell you turn your leg out or turn your leg in, knee bent. There's all kinds of different versions of straight leg raises. But guess what muscles working to hold your knee straight? these quads. And then you're also working out your hip flexors, the the muscles that bring your leg up at your thigh right here, which one of those is the quad muscle. And the rest of the hip flexors, they will contribute to the same muscle imbalances that set up knee osteoarthritis. So, I don't like straight leg raises big time. And often times health care professionals will they'll they'll tell you you have the weak quads because they're overused and they've become weak now. They're just they've just they're done. They're done working. You've made them work way too much because your glutes haven't been involved. But as but the hip flexors will also become overworked and weak in people with knee arthritis. So then the health care professionals will often think, "Oh, we got weak hip flexors. let's do straight leg raises to help fix that. But it's feeding into the problem. It is feeding into the knee arthritis because it's going to make you get stronger hip flexors and quad muscles, the muscles in the front of your hip and the front of your thigh. And that's just going to add compression to that kneecap against the thigh bone. It's going to pull the shin bone up into your thigh bone and squash everything in there and make arthritis worse. So, don't do straight leg raises. I disagree with them. What you should be working on instead is glute exercises. That's like bridges where you're where you're getting your buns tired. Your butt muscles need to get tired, not the front of your hips and thighs.

All right, what's next here? Number six. This one gets under my skin. Sidewalking. I'll have to demonstrate this one for you as well. I got a picture, too. And um oh I have a picture of the uh straight leg raise as well. I forgot to show you. There it is right there. Straight leg raise. Let's do the sidewalking though. So let me just show you this real quick on the on the slideshow. And then I'll I'll demonstrate some variations of this exercise. But what you see on the far left, the the side view with the arrows, that's instruction telling the person to bend your knees and hips a little bit to to squat down. A little tiny mini squat is what I would call that. They already have the bands around their ankles and then they have their hands on their on their waist just to for balance I guess and then they're told to step sideways and the bands adding some resistance. Now some variations that you'll see from this let me just move this away from me. I'm going to stand right here. You just see my legs is you'll see this here. Hold on to something for balance and then they'll have you move your leg out to the side like this. Thanks. And that's using the same muscles out here that you would use like in that picture where you're side stepping this way. Here's the problem with this exercise though. The reason why people are doing it is because there's research that has connected weak hip abductors. Let me show you on my on my hip model here. This is the right hip. This is the front of the hip. This is the back of the hip. The hip abductors make the this is the top of the thigh bone. They make the thigh bone move out this way. Makes your leg move out to the side like when you're doing sidewalking. However, you have a bunch of muscles that make up your abductors there. A lot of the glute muscles like glute max, glute minimus, glute medius. You have another one called TFL, tensor fascelata. That one's kind of on the front pocket side of the hip. All those muscles work together to move your leg out to the side, but they also do other motions. They help with rotation inwards, rotation outwards. They make your foot turn in, turn out, and some of those glute muscles can help you move your leg back, and some can help you move it forward. They work like hip flexors and and their hip extensors, too. When you're moving out sideways, you're working all of them. Very often, you'll work the muscles that are stronger, which it's the ones towards the front that have been working with your hip flexors. In other words, let me say it differently. When you do sideways walking, you'll bias working the the sideways walking muscles that are on the front side of the hip that feed into the muscle imbalance. So, I get it. the research is is making some connections to helping knee arthritis. But where the research is incomplete is that they haven't thoroughly studied how hip extension, how how moving the the the hip backwards, the the glute muscles has influenced knee arthritis. There's not much out there. There just isn't much out there. So, as a result, a lot of healthcare professionals just don't do it. But that doesn't mean it doesn't work. So, what I'm a proponent of because I've seen it work time and time again is just work hip extension. Move your leg back behind you and get the butt muscle to get tired. So, instead of doing sideways walking, what we should be doing is squatting, bridging, just tightening the glutes. If you and that's that's number one is you have to be able to activate your glutes because if you go try to do any sort of movements that involve your glutes and they're not you can't even activate them like you can't consciously activate them you're not going to get anywhere with glute strengthening. You have to start there and then begin to do the bridges and mini squats. And what I would advise against because some of you guys are probably thinking this way is backwards walking. Backwards walking makes you activate your quads and your hip flexors quite a bit. You have to try it to see like if you go do a little bit of it, you'll feel which muscles get most tired. Don't do backwards walking, especially if your quads and hip flexors get most tired. You need to make your glutes tired.

All right, so that's side walking. I wrote a walker. Let's fix that. Side walking. So, just to recap this one, you don't want to do side walking because you're using the wrong muscles that they feed into the imbalance. You want to make sure to use the muscles that fix the imbalance, which is going to be your glutes, which are on the back of your hip.

All right, number five. Wall squats. Commonly recommended exercise. Um, let me show you the picture I have of it here on the screen. There's the sidewalking. Here's a wall squat. So, it is what it sounds like. You lean up against the wall and then you bring your you slide your body down on the wall and the idea is to exercise your legs. But anybody who's ever done a wall squat, you know it's your thighs that start to work almost immediately. It's going to be heavy on your quad muscles on the front of your thighs as well. This directly feeds into muscle imbalances that add compression to the knee joint because you're strengthening the quads. I would highly discourage you from doing this exercise because you're going to make your knee arthritis worse. You're going to compress the knee joints over time. It might feel good in the short term to do this because you get the endorphins from the exercise. You get that that immediate feedback that you got to work out. You might even start to sweat doing this one because it could get challenging, especially if you haven't been exercising in a while. All those positive benefits you get at first might be interpreted as feedback as like, "Good job. You got a workout. Pat on the back. You're doing phenomenal." By health care professionals, they'll tell you, "10 more seconds. Come on. Two more reps." And they're encouraging you encouraging you to do these exercises, but they don't have a full knowledge of fixing knee arthritis. They're just pushing you through exercises they've done in the past with people. Very often, um, people that are guiding you through exercise are helping people recover from surgery. And if you had a knee replacement surgery or other knee surgeries, this exercise might be appropriate for you. But if you're trying to avoid knee arthritis surgery, a joint replacement, if you're trying to keep your per your own knee that you were born with and make it work well for you, I would not be doing wall sits. I would not be doing wall squats, wall sits, wall slides, any of those variations. Slides are where you go up and down. You're not just holding. Wall sits is where you're sitting like like if you had a chair, but there's nothing under you. You're just holding up against the wall. And wall squats are probably like wall slides, just different variations of that same exercise.

All right, let's take a look at the uh comments here. See what you guys are saying. You guys done these exercises? And have you guys felt what I'm talking about? Like where you initially feel better and then after a while your knees kind of hurt worse. Maybe later that day or maybe after a few days of doing this these exercises or even a few weeks it consistently happens and then you get told, "Oh, it's supposed to hurt and then it'll get better later." I strongly disagree with that. You should be taking pressure off the joint right away and feeling relief, not further pressurizing the joint because then you're going to feel worse. Let's see. Debbie says, "That makes sense." Thank you. I'm glad it's making sense for you, Debbie. Who else we have on here? Um Bob says, "I think watching this station in psych psychologically made me injure myself. I may have taught in my meniscus last month. It was my hips and back." Okay. I'm not sure I understand. I think you So you're thinking that you injured yourself by watching this channel maybe the station you taught your meniscus last month. See Bob, see if you can uh elaborate on that just a bit. I want to make sure I help you out. Wendy's over in Saskatoon, Canada. Uh Polar Vortex says, "PT told me there should be no pain with sit-tostand exercise." Yeah, there shouldn't be. Um but very often people get it. Let's see. Jennifer Taylor says, "On Northwest Indiana, 18 inches of snow ain't help in the paint." Oh no, you guys already got snow. It's barely November. Debbie says, "That makes sense." We already saw that one. Um Julie Parker says, "I have weak hips and glutes." It happens all the time, Julie. But it's good. It's a good that it's a good thing that you're aware because now you can work on it. A lot of people aren't even aware. They don't even know. Some people don't even think you can fire your glutes. like it's impossible, but you can. They just haven't done it in so long that they're not used to the feeling of fire in their glutes. Alfred says, "I'm here. My municush is meniscus is really hurting. I'm so sorry, Alfred. Let's get those glutes going." James says, "St. Catherine." Catherine's five. Lynwood says, "Uh, Nusraat." Okay. from water waterlue Ontario. Fantastic. Uh unexplained anomalies says any safe stretches we can do. Uh good question. Unexplained anomalies. Um there are a lot of stretches you can do. I'm going to just take a a quick detour and then I'm going to get back to finishing off this list here. Um but a lot of people want to stretch for knee arthritis. I'm not opposed to stretching for knee arthritis. However, I don't think that it's a good thing to focus on. Um, I think it's much better for you to focus on strengthening the correct muscles to fix the imbalance. But if you feel stiff in your knees and you do some stretches like where you bend your knee or you, you know, reach towards your toes, move your stretch out your hips or your feet and ankles, I don't have any specific stretches. I think it's up to you to figure out how to stretch where you're stiff and tight. There's there's a lot of options out there. I think a lot of the stretching um information out there as far as like which stretches to do are fine. You could go try them all out and you determine which best help you. But I wouldn't expect more than 12 hours of relief. That's on the high end. Really, you're looking at more like an hour or 30 minutes of relief and then it's probably going to come right back because you haven't changed the strength. You need to fix the strength in the muscles in order to have an impact for the long term. Stretching does not fix knee arthritis for the long term. It's an okay thing to do in the short term, and I do recommend it for some people who are stiff, but I wouldn't pursue it for the long term.

All right, let's get back to the list here. So, went over wall squats, wall sits, we're counting down. Uh, let's get to number four. And we've got, oh, I love this one. I love to talk about it, especially with my fitness pals. The leg press machine. Let me show you what I'm talking about in case you've never heard of this. This is the leg press. So, it's usually found in a gym. It's a machine and it's got a plate that you put your feet on and you put weights on the sides and you usually sit kind of low and you press your legs away and and you go up and down with a machine. Very heavy quad exercise. But the thought is you're using your knees and you're strengthening the muscles around your knees. That's what people often get instructed to do when they have knee arthritis. Superficial level that makes sense. deeper understanding though that I want to impart on you guys is you're compressing by by getting stronger quads, you're adding all this compressive force to your knee joint. And over time, over weeks, months, definitely years, that compression builds up and makes knee arthritis worse. So, you should not be doing leg press exercises. I highly recommend people stop doing leg exercises because you're going to further strengthen your quads and add a ton of unnecessary compression to your knee joint and it's not helping. It's not helping knee arthritis. It's making it worse. In fact, I would want you to work out completely different muscles, the glutes. avoid working out your quads at all for a time and then later on when you start to do different exercises that are more complex, you'll bring your quads back in but in a way that they're supposed to work without adding a bunch of compression to the knee joint. Exercises like squats, deadlifts will help you to use different muscles, but the leg press, the one that we're looking at right here, it uses way too much quads and it doesn't let you use your glutes very well on the machine. It's almost impossible to use it. Some people will say they can do it, but it's it's very hard to do it and and make your glutes work more than your quads. It's it's just you're putting yourself at a massive disadvantage by using the leg press.

Um, let me get a swig of water. See who else is here. Kimberly has a question here. Are these don't do exercises the same for after a knee replacement or just knee arthritis? Excellent question, Kimberly. I wouldn't do them for after knee replacement. Absolutely not. Because you're going to feed the imbalance if you've had a knee replacement or if you're planning on getting one in the future because you might need one. I'm not completely against it. It's it's appropriate for some people for sure. But what got you to the knee replacement very likely is this muscle imbalance. And unless you fixed it by doing the right exercises, going through the treatment approach that I'm talking about where you fix your glute strength, you have to look at your abdominal strength and your abdom your uh foot strength as well, your toe curl muscles. Um, and it's a process that can take you 6 to 12 months. Go through that even if you've had a knee replacement because then it's going to balance the forces out in your knee replacement. If you don't fix the muscle imbalance and you have a knee replacement, you're going to compress the knee, the the the parts that were replaced inside the new knee, and it's going to wear the parts down much faster than it's supposed to. The doctors will tell you, you know, this this joint replacement is supposed to last you 20 plus years. You'll cut it down to 15, 10, or even less. you'll loosen the hardware, something will go wrong with the procedure that was done. And you don't want that because then they have to go back in and do a revision, do a second knee replacement, and it's usually because people have this muscle imbalance that was undetected by health care professionals because they're not trained in seeing it. That's that's what I do for you guys here. They're trained in surgery. They're trained in rehab after surgery, you know, physical therapists and surgeons. And then uh general practitioners are trained in medicine, pain relief, which is all shortterm. They're not into fixing the long-term problem. So, you've got to fix the muscle imbalance. Even if you have a knee replacement, Kimberly, you have to fix it. Hope that helps, sir. Good question.

Almost to the end here. We got number three. I remember hurting myself on this one as a teenager. This is knee extensions. So, I'm talking about the machine in the gym, but there's different versions of this that um are done with like a band a banded uh rubber band exercises, um cables. There's all different kinds of versions of this exercise, but there's a picture of the classic leg extension or knee extension machine in the gym, and it's got that stack of plates where you put the pin. It's got that pad that goes in front of your shins right above your ankles. And you you kind of have to get your legs in from the side. And then once you have the right weight, you're pushing your knees straight. You're extending your knees and you're feeling your quad muscles working hard. I mean, if you look in the picture right there, you can see that person's thigh muscles on the front of their thighs just popping out. And if you ever do this exercise, you immediately will feel your quad muscles work a lot. So, here's the thing with this exercise. There's a lot of false positive feedback because think about it, you're doing the exercise and you look down at your thighs and you just see them working and you feel it too. It burns. You're getting a sweat. And then you might even up the weight over time and and get this positive response where you're thinking, I'm doing better. I'm doing good work. I'm getting a workout. I'm getting stronger. Meanwhile, silently over time, if you don't already have a knee problem, that those quad muscles are getting tighter and stronger. And at rest, they'll even pull a little bit. We call this resting muscle tension. You increase your resting muscle tension whenever you get stronger. That's why muscles feel toned after you work out versus flabby if you don't work out. Because when you don't work out, you have a decrease in your resting muscle tension. When you have an increase in your resting muscle tension though, that means those quads are just pulling on a low level all the time. You could just be sitting around and those quads are pulling. And this this machine right here is perpetuating it. It's it's continuing it. It's allowing it to get worse because you're you're just strengthening your quads further. This is why some people they they can't sit for long. they can't travel in in flights or long car rides or sit through a movie or a meal sometimes because their knees get painful and achy. It's because they've strengthened their quads so much using an exercise like this, like the knee extension exercise and they they initially feel good, right? I worked out, pat on the back, I got my quad sets in, my my I got my knee extension exercise in. I I'm doing 10 plates now instead of seven. but you're making the problem worse for the long term. Don't do it. Stay away from that machine. And many of you guys are lucky enough to instantly get pain when you do this exercise. You start doing it as soon as you up the weights within a week or two. You're like, "That machine hurts my knees." It's your body telling you it's not good. Don't do it. Your cartilage inside your knee is saying you're overdoing it. is too much. I wasn't designed to work this way. Knees aren't designed to do that. They're not. How often do you have to get in a machine like that and forcefully straighten it out? The most common thing you do with your knees is walk and stand up and sit down. And that though in those situations, your quads are working with glutes and with abdominal muscles and with your foot muscles. It all has to work together. That's why I would prefer for you to go do squats or deadlifts because those are very common movements that you'll do in regular life. You'll squat down to pick something up. You have to pick up something kind of heavy from the ground. That's a deadlift. You have to sit down and stand up. Use a toilet, get in a vehicle, sit down in a chair. Those are all squats. So, if you can train squats and deadlifts with resistance, with weight, using the right muscles, you're doing a heck of a lot of good for your knee arthritis. But if you isolate quads, like right here in this picture and you focus on that, you're just smashing the heck out of your cartilage. And you know, I saw a question on here about Let me Let me pull it up. Let me get to this one right here. One second. It's totally worth it. Sue said, "I've had endstride on my left knee as well last November 2024. Hot and cold packs don't work very much. Please advise." And right before that, she said, "Hello, Dr. David. I'm having lots of pain behind my left knee going down my calves. I have osteoarthritis in the left knee. two two slash three two-thirds of the cartilage is worn out cuz stuff like this is probably happening. I don't know what you're doing exactly Sue, but the point I was trying to make is even if you've had injections, the instro injections are are um proteins from your bloods, proteins from your blood. However, you can get uh uh high hyaluronic acid injections, stem cell injections, any kind of those regenerative medicine injections, PRP is the other one. um you're potentially going to regenerate cartilage or heal cartilage. Cartilage can heal, but if those injections make it go faster and then you're doing quad extensions, knee extensions like on this exercise, you're smashing your newly healed or your newly formed cartilage cells. You're just undoing all the work that that injection hopefully did. I say hopefully because it's not a a completely proven thing yet. I have had people that have a positive response with the uh injections, but not everybody does. And my strong belief is that it's because they have not fixed the muscle imbalance. That needs to be fixed in order for you to have long-term relief of knee arthritis and avoid a knee replacement surgery. You can't just inject it and and and fix it. You can't get surgery. You can't get a knee replacement and expect to never have knee pain again because this muscle imbalance can still be present causing you problems in other tissues besides the actual joint where the cartilage is. Stay away from knee extension, friends. It's not good for you. And your knee will tell you. And if it doesn't tell you immediately while you're doing the exercise, it'll tell you later on in the day. It'll tell you weeks later, months later, definitely years later. But you have to connect it back to you're putting too much pressure through your knee joint when you're doing this in the moment and then the muscle getting stronger is continuing to put pressure on as the days go on when you're resting. So, please watch out with this.

All right, let's go to number two. We're counting down the top 10 worst exercises that that contribute to knee arthritis. We have cycling next. Number two, cycling. It's good and it's bad. Let me tell you the the bad part first and then I'll get into the good. There's different kinds of cycles as well. Uh let me just cover that real quick. So, there's outdoor cycling like you see right there in that beautiful um lake or or ocean bay area right there. I have no idea where they are, but that's doesn't that look nice? Um there's there's leisure outdoor bike riding. You can cycle for sport of course as well. But then you have these two types of stationary bikes that you see in the picture. The recumbent on the top left that just means the seat is behind the pedals. So the pedals are out in front of you and you usually have a back rest. And then the upright bike is the one where the seats above the pedals. That's your more traditional looking bike, um stationary bike. They're all the same though in that when you pedal, when you go through the pedaling motion, if you're not conscious, if you're not thinking about which muscle you're using, you're probably going to default to using your quad muscles on the front of your thigh. And the thinking with bike is that it's low level. It's not a lot of impact and compression going through your knee joints. So, it's safe is what they say when you when you're using the bike. And it might feel good. It might feel good initially to get some motion in your joint, to get some fluid moving inside your joint. You might literally feel improved after 15, 20 minutes on the on the bicycle, and you might think, "Wow, that did a lot of good for me." However, the sinister thing that's happening is you're using your quads a lot. Go get on a bike, go get a workout on a bike, and you'll feel your quads work a lot if you're not aware of it. You have to consciously think to use your glutes. And the way that it works is when you push down the pedal when your leg straightens out, you should be thinking to tighten your butt muscle. And then when you cycle through the pedal and you push the other leg down, now your other side's going to contract. But if you're not consciously tightening your butt muscles and alternating left, right, left, right as you cycle, by default, you're going to use your quads. Which means after 15, 20 minutes, 30 minutes, an hour of cycling, and if you up the intensity on the bike, you turn the knob or hit the button, depending on your bike, you're going to get resistance in the pedals as well. If you're going uphill on a on an outdoor bike, you get some resistance as you're pushing through the pedals. All of that is going to force your quads to work more unless you're conscious of using your glutes and you have the the capability because you have to be able to turn on your glutes and you have to have some strength in them to sustain your your use of them throughout the time that you're on the bike. So, be careful with the bike. This one is so easily done all the time. I I hear I hear this all the time from patients that went to the doctor and they say, "Oh, jump on the bike. Get yourself a stationary bike for home. The bike does miracles for knee arthritis. And then there's even people

That will tell you, "Yeah, I got the bike. It's been two weeks. My knees are feeling better, but listen to them in a month. Give it two months." And they'll often say, "Well, yeah, the bike helped for a while." Then my knees got worse.

And what health care professionals will often say is, "Well, you're not getting any younger. This is an age-related problem." Which I disagree with completely. It's a pressure over time problem.

And if you've been cycling to try to fix your knee arthritis and you've been dedicated to doing it like the doctors told you to, the physical therapist told you to do, you go to physical therapy and the first thing they do is, "Hey, let's get you on the bike for 10 minutes. We'll warm up and then we'll get some quad exercises after that." They make it so easy. This is why it's number two on the list. You got to be careful about what muscles you're using when cycling. It's not always bad, but it very often is because you don't have guidance on how to do it. But you guys all watching this video right now have guidance. So kudos to you. Good job for being here. You're not going to get very much instruction from the rest of the healthcare profession. I can tell you that for sure. They're just going to say get on the bike and zero instruction on what muscles to use and the timing of of how to use them like I was explaining on on how to use the glutes when you push down on the pedals. Please fix it if you're going to cycle. If you can use your glutes while cycling, then it becomes productive for you. And I would recommend the bike then, but you have to be diligent to not overuse your quads on the bike. Don't overuse your quads on the bike.

We made it to number one, guys. Let me check the comments here. Let's see who's on what kind of comments are coming in. We got lots of comments. Thank you, guys. I see comments coming in from Facebook, from YouTube. I can't see you guys on on Instagram, but I know some of you guys are on Instagram as well. Let's get to the most recent one here real quick. Uh, Zor, I can't pronounce your name. I'm so sorry. Have you heard of bioresonance alternative therapy? No, have not heard of that one. I'll have to look it up. Thanks for bringing it to my attention. Bio-ressonance alternative therapy.

Um, Mert629 says, "I get hamstring cramps when doing glute bridges. Advice." Yes, this is a good one, Mert. You're probably overdominant with a hamstring. So, I don't talk about the hamstrings a whole lot because quads tend to be the biggest problem, but hamstrings are also very much a problem for knee arthritis because the hamstrings cross the knee joint and they can compress the knee joints as well. So, if you have very dominant hamstrings, they'll add a lot of compression to the knee joint and they'll also get overused and tired like I was talking about with the quads and they can begin to cramp when it when you're doing something so simple.

Um, so on a bridge, you need to make sure that you're using your glutes the entire time. And I wouldn't lift up your hips on the bridge unless you're certain that your glutes are firing. I would do like like just maybe a teeny tiny half-inch lift, but make it glute dominant. And don't go up any higher unless you know that your glutes are working as you hold up higher. A sign that you're getting a sign of cramping on the bridge. Let me say that differently. Cramping on a bridge exercise is a sign of underused and weak glutes. So, get those glutes going.

Specimen, oh, sorry, Specs Mania 1 says, uh, "Having listened to your videos with strong emphasis on strengthening the glutes, I have been able to be more mobile with less discomfort and reduced pain." Woo! Good job, Specs Mania. This stuff works, guys. Just put it to the test. I have people on our channel all the time that are like, "Oh, this guy's full of baloney. This guy's, you know, he's he's t he's giving people bad health advice. Don't listen to him." They say all stuff like that. Test it before you before you ding it and, you know, throw me under the bus. Please go do it. Thank you, Spec Specs Mania. I appreciate that.

Um, Julie Parker says, "I tried stretching my hamstrings and was in a lot of pain for a couple of months." Yeah, it's it's not it's not always worth it. I wouldn't I wouldn't do it. I would I wouldn't focus on it. Let me say that. Try it out and don't be aggressive. That's something that I didn't mention earlier. Julie is is it Julie or Julia? Julie.

Um, on a scale of 0 to 10, intensity of stretch, I would only stretch to a two. So, think about it. You have zero, one, two, three, all the way to 10. If 10 is like the most intense stretch you've ever felt in your life, like if you go any further, you're going to tear something. And then zero is nothing. I feel absolutely nothing. You need to be at a one or a two. That's it. Because if you start stretching more intensely, three, four, and beyond, you set off a stretch reflex where the muscle actually wants to contract. It no longer relaxes and you you can hurt yourself doing that. Stretching harder is not necessarily better and especially as we get older, we we're not growing anymore. So, there's not a good reason to stretch aggressively. That's why it's that's why I don't like stretching. It's it's commonly done wrong with the wrong intensity, the the wrong way.

Um, and I would rather you just stretch a little, light intensity, enough to kind of make you feel a little bit better. Going any further than that, not worth it. So many problems people run into. All right, let me get back to my list here. Number one, what do you guys think I'm going to say? You want to drop it in the comments? I bet some of you guys guess what I'm going to say. What's my number one worst exercise to do for knee arthritis? Come on, bring the comments, guys. What do you think I'm going to say? What's it going to be? I already said a lot of exercises that I don't like.

I see some comments coming in. All right, so I said, let me just review this while some comments coming in. Number 10 was quad sets. Number nine, balance exercises. Number eight is a sit to stand from the chair. Number number seven is straight leg raises, picking up your legs straight. Side walking was number six, especially with the bands. Well, don't do that one. Number five, wall squats, leaning up against the wall and making your thighs get tired and shaky. Leg press. That darn leg press machine. Just stay the heck away from it. That's a number four. Number three is knee extensions. Oh, even worse than a leg press in my opinion. Both bad though. Number two is cycling. You use your quads way too much in cycling. Number one, y'all see the comments on there. Walking. Some of you guys got it.

Walking is absolutely terrible for you if you can't fire your quads. Oh, I'm sorry. Let me say that again. Walking is absolutely terrible for you if you can't fire your glutes. If you're not firing your glutes, that means you're using your quads and you're increasing the pressure at your knee joints and making osteoarthritis in your knee worse. And it's so easy to do because we do it all the time, right? You get up first thing in the morning, you walk around your house and do stuff in your house, you walk to work, you walk out in the grocery store, appointments, meeting with people, and doctors will tell you, physical therapists will get you on the treadmill. Doctors will tell you, "Go walk for exercise. It's it's free. Just all you need is some shoes. Go to the park. Walk around the neighborhood." But there's zero instruction. There's zero examination on whether or not you're using the right muscles that fix the imbalance. You just end up walking however. And it might help initially. That's that's true. You might, some of you guys might be watching this and and have been saying, "Well, I started walking. The doctor told me, you know what? I actually felt better. The PT got me on the treadmill. I have a treadmill at home. I walked around the block. I feel better." That's probably because you haven't been doing much. And just getting some movement feels good. But give it some time. As you keep walking, you keep overusing those quad muscles right here in the front of the thigh. And then you start to get that increased strength which builds increased resting tension. And then all of a sudden it hurts more to just sit around. It hurt. You start feeling it when you're walking. If you walk for longer distances, you use the quads even more and you rub that cartilage right here even more. You smash the shin bone up into the thigh bone even more. And then the doctors and the physical therapists out there, all the people that help people with knee arthritis, start saying, "Well, you're you're you're in your 60s now. You're in your you're you're in your 70s. Some people you're in your 50s." They start blaming it on age. But it's not age. Cuz how is it that I have people going through my knee arthritis recovery program or coming here physically, we tell them to stop walking, we get their glutes going, we don't even start walking again right away. I mean, besides what they have to do for the regular everyday stuff and they're feeling better naturally. They start to walk more with less pain, but we're doing it right. We're using the right muscles. You have to use your glutes when you walk. Then walking's okay. Walking is only okay if it's glute dominant. If you're not feeling your glutes working when you're walking, it's harmful for you and you shouldn't be walking until you go figure out how to get your glutes to work right. Yeah, you got to walk for your everyday stuff. That's fine. But I wouldn't go walk for exercise. This goes against a lot of what doctors will tell you, a lot of physical therapists will tell you. But when I explain it like this, you know, don't take me out of context. Listen to the whole message here. I'm not saying never ever ever walk in your life if you have knee arthritis. I'm saying stop walking for exercise. Go fix your glutes. Make them work while you're walking. Figure it out. Take some time and practice. You should be feeling better at that point. Then go walk for exercise. Then it's okay. Then please be my guest. Walk miles. Walk for an hour or more. You should feel like you could do it at that point. I encourage people to do it at that point.

You guys got it. A lot of you guys said walking. Yeah. Here's a comment. Here we go. Shirley back says, "So, basically, stop walking, sit around squeezing your butt and to strengthen those glutes." Lol. You simplify it. I love it. I love it.

Um, I saw I saw this uh like um sarcastic short explanations of hit movies and and one was a Wizard of Oz. Everybody knows the Wizard of Oz. It's been around for like almost a hundred years. Um groundbreaking movie of the time and you know it's a very very much a classic especially this time of year. Um, and somebody said something along the lines of like, "Girl gets lost, kills a witch, and goes back home." They make it sound so dull and boring, but you watch the whole story. It's a fun movie as long as you're into those kinds of movies. So, that's what I see this this commentes. So, basically, just stop walking, get your glutes working, and and that's it. Well, yeah, in a nutshell, just like I described The Wizard of Oz, but it's a journey. If you go through it, it's a journey. It's a process. And those of you guys that are watching that have been through my knee arthritis program, or even if you haven't been in our official program, you just been doing stuff from our videos, it's been a journey for you. You've been at it for a while and you've done a lot of wrong stuff guided by health care professionals trying to do good, trying to follow the the plan that that's set out for you by experts that are educated in this stuff. And they've led you the wrong way. And you start going through the journey of all right, I got to get obsessed. I got to start thinking about glutes all the time, thinking about it while I'm walking and cycling and quit doing all these quad exercises and straight leg raise exercises. It's it's consuming. It's like getting a degree almost. I that's what I tell people in our program. You're getting a a a bachelor's or an associate degree in fixing knee arthritis. It's not that simple. It sound you can make it sound simple if you wanted to, but it's it's more complicated than it sounds as you as you start to go through it. Sorry, Shilly. Shilly. I'm not sure. Shelly, sorry. Uh I don't mean to call you out, Shel. I'm just The comments come sometimes.

All right, guys. So, that's my top 10 list. Let me show you some slides I got. I got some extras for you here because I I I love it. There's walking. Um, shoes kind of matter. They kind of don't. You We got to talk about feet if we're going to talk about shoes. I'm going to go through comments here next, but let me just throw in a a bonus here.

Swimming. And I like this picture in particular because you can see what the legs are doing underwater. When you swim and if you're kicking your legs, what I would prefer you to do if you're gonna swim is not kick from your knees because when you kick from your knees, swimming's bad for you because you're using your quads a lot. But if you can think to kick from your hips, in other words, drive your entire leg backwards and tighten your butt muscle in order to swing your leg to the water, now it's a glute exercise and that's good for you. But if you're not conscious of doing that and you're kicking from your knees, you've turned swimming into a quad exercise. And I'm talking about freestyle swimming and similar strokes, but some people get in the water and walk and they're not using their glutes. There's physical therapy clinics out there that have pools. They do aquatic therapy with underwater treadmills and they're taking weight off of you by putting you in the water and they have you walk and they give you zero instruction on how to use your glutes. You're still working out your quads and it might feel good in the water. It might feel good to unweight you. There's devices, harnesses with with contraptions that'll unweight you on top of a treadmill, too. Some of you guys might have seen physical therapy clinics that have that. All that's pretty good because they're unweing you. But there is zero instruction on how to use your glutes. You have to learn that and it needs to apply to every motion you do because then only then are you truly fixing the imbalance and depressurizing your poor knee and allowing your cartilage to heal and allowing yourself to take advantage of the of the healing properties that your body naturally has. And if you do end up getting injections for regenerative medicine, allowing that to actually stick and not kill the new cartilage cells or the newly healed cells. Sorry, I get worked up about this. It's my passion.

What else have we got here? Bonus. Here's the hamstrings. Hamstring curls. I mentioned it earlier. Hamstring strengthening adds more compression to the knee joint. And here's why. This machine, let me just tell you that real quick. They're laying face down and then they they have that pad on the back of their heels, the their their ankles like on their Achilles tendon. There's a stack of plates and then they bend their knees and it works out the hamstrings, the muscles in the back of the thighs. Doesn't really work out your glutes very much. It focuses on your hamstrings. And so here's the the knee. The hamstring would be right here. The foot would be over here. And you're working on bending the knee like this. The hamstrings attach to the shin bones down here. And so they they because of that attachment, they compress the shin bone, the lower leg bone on the thigh bone. It it pulls the shin bone into the thigh bone as you bend the knee here. Not a good thing if you have knee arthritis because knee arthritis is too much pressure over time. We need to take the pressure off. So I would not be doing hamstring exercises. I would be focusing on glutes.

Here's the stretching. Somebody was asking about stretching. Um, this isn't a bad thing to do if you're keeping it on a one or a two out of 10 stretch intensity, but what a lot of people like to do is do this stretch exercise. They'll hold on to something, grab your foot, bring your heel to your bottom, and really feel that big stretch on the front of your thigh. And there's variations of this. People will do this kneeling to get an extra big stretch. And but then they're going beyond a one or a two. And now you're adding a lot of compression to the joint as well. So remember, if you stretch at a higher intensity, I said stay to one, one or two, but if you go past that, and I'm using these numbers, I don't have any hard science on this except for the fact that there's muscle spindle cells. You can look that up, that there's hard science on that. And Golgi tendon organs, if you want to look it up, or you could take my word for it. These cells inside of your muscle and tendon cause your muscle to contract if they get overstretched. And if you go for a hard stretch for a long time, you're going to make that muscle contract and you're working against yourself. This is why some people get hurt stretching. But it happens when you stretch too intensely. It's not a whole lot of value in stretching hard for a long time. You're better off strengthening. That's number three.

And then here's a hamstring stretching. There's different ways to do it. This person's got their leg up against the wall. But there there's people that will get a strap, a belt, a towel on their foot and they'll bring their leg up and stretch their hamstring. Similar thing can happen if you overstretch. It's going to add a lot of compression to the knee joint. You're going to potentially tear something because you get the stretch reflex going. You're you're okay to do stretches low intensity for a short time, but I would not pursue it um and and and doing a lot of stretching for a long time and doing aggressive stretches. I think we might have another one or two here.

Leg squeezes. Oh, this one's I've seen this one done in clinics a lot. And um these are the other muscles on So, we talked about the front of the thigh, we talked about the back of the thigh, we talked about the sides of the thigh a little bit. There's not a lot of muscles out there. It's more the hip muscles. Remember I talked about the sideways walking with your legs that works out the the sides of the thighs, if you will. The muscles that oppose those are the groin muscles on the inside of the thigh. They make your knees come together. And doing that ball squeeze like I was showing in that picture makes the thighs come together, which works with your internal rotator muscles.

Um, let me say this as simply as I can because I'm I'm getting too technical. The muscles on the inside of your thigh make your knees want to come in, which turns off your glutes on the back because when you fire your glutes properly, it makes your knees want to go out. So, I would not strengthen the inner thigh muscles. Those muscles will just naturally get stronger as you become more active. They're more stabilizing muscles and they don't need to be isolated with the leg squeeze. So, like the uh the thigh master was a famous machine that was um on a lot of infomercials on television on commercials um back in I think the 80s, maybe even earlier than that. I would not pursue doing that exercise to heal your knee arthritis.

Right, we got one more bonus here. These are all exercises you should not be doing for knee arthritis.

Lunges. So, this is a a situational exercise kind of like walking. Lunges can be beneficial if you're using the right muscles. But very often like walking, people don't know what muscles to to use. They just do the motion like I have in the picture here. They take one step out, big step, and then they drop a knee down and then come up out of it and then take the next step and they're walking like that. Doing lunges as they're walking. You might do them in place. Different ways to do them, but usually you'll feel it on your quads, on the front of your thighs. Those are the main muscles that are going to work unless you're conscious of how to use your glutes during a lunge, which is very possible. And it'll look very similar to a typical lunge, but you'll feel the difference. I teach this in my knee arthritis recovery program. You can use your glutes during a lunge, then it's productive. However, I would not be doing lunges until you're in later phases of our knee arthritis recovery program. If you're in a lot of pain right now, there's other things that you should be doing to get out of pain first and fix the muscle imbalance. Turning on the glutes, getting the glutes some endurance, getting them to become active while standing and walking. You have to go through a bunch of milestones before you can actually get to lunges properly using your glutes to where they where they're actually beneficial for your knee arthritis problem.

All right, guys. That covers the list here. Hopefully, that was thorough for you guys. Hopefully, you guys learned some things. I'm going to be answering comments here next. I'll go as long as I can. Um, and then and then we'll they'll pull me out of the room. I'm going to go back to the way beginning and make sure I get everybody from there. Let's see this first one here. We have Aishariah says, "Dr. David, I've conjur Patella. I took two GFC's and focusing on glutes, core, ankle, calf. I still feel pain after walking and swelling is also there near quad and patellar tendon. What to do?"

I'm so sorry you're dealing with contrail patella. You've you've got to get the the glutes stronger. This contrail patella is a problem that happens before knee arthritis very often. So when those quads are overdominant, they're pulling the the kneecap up into the thigh bone. And in younger years, usually people get condro patella in their 20s, sometimes even teenage years, but often 20s and 30s. And if it doesn't go away completely or the root problem doesn't go away, the muscle imbalance, they just deal with it. They avoid activities that make it worse, but by the time they get into their 50s and later, they've got osteoarthritis on the back of their kneecap. That condro patella will form osteoarthritis. It's the same root problem, though. We think that it's a different condition, but it's the same root problem. So, you've got to make sure that you get those quads um relaxed. I would initially to get you some quick relief. I would be using a massage gun, something like this. There's different ones out there. And put that on your thigh muscle right in here. Let me get the comment off the screen so you can see what I'm doing. On your thigh, on your thighs right here to soften them up because if you're overusing your quads, this is helpful for knee arthritis as well. Your quads are going to be stiff. Remember, they have that resting tension. So, if you massage them with something like this or your hand or you get a a rolling pin tool, there's all different kinds of massage tools out there. The point is to loosen it up, to tenderize it so that the muscle literally relaxes because then it it translates to your quad relax here. It it loosens up the pressure down here at the kneecap. You'll feel pretty quick relief from doing that. You don't even need to use a massage gun that much. You might use it for 3 to five minutes. And you'll get massive relief from that. Very often that happens.

Um, same for osteoarthritis. Then you need to simultaneously be working on getting your glutes to become active, learning how to use them while walking. Um, if you cycle, learning how to use them while cycling, getting stronger in the glutes. So, you have to fatigue the glutes while not letting your thigh muscles work. And then over time, you can begin to use your become glute dominant. Use your glutes more as you do your daily activities. This is what allows you to take the pressure off the the the back of the kneecap, the patella, to allow the cartilage to heal and this will help you to get over conjella. I talk all about this by the way. I have the whole system laid out the treatment approach in the patella pain program. Um hopefully we can get a link up for you here. We'll figure out how to put in the comments later, but it's on our website. The patella pain recovery program. It would be the best program if you have condra Malaysia patella. So, if you want to check that out, um, I'd love for you to get some relief from there.

You had an a follow-up comment. Also, please ha fat pad and some easy core exercises in the upcoming videos if possible. Hoffas fat pad is related to the same muscle imbalance. This is the same exact thing. The f there's a fat pad right here behind this tendon right under the kneecap and it can get inflamed and swollen. It's all pain on the front of the knee from those darn quads pulling on this. It just becomes very sensitive. I've had that same problem that you have. I had controia myself in my younger years and I fixed it. I don't have any knee issues anymore and I've helped a lot of people fix the same problem, arthritis problems because it's the root muscle imbalance. I live with this muscle imbalance myself and I run right now. I ran three miles last night. I deadlift hundreds of pounds. I squat hundreds of pounds and I exercise just about every day. And I'm not a small guy. People meet me in person, they're like, "Oh, wow. Very taller than you thought. I I look like a football player. I got muscles on me and I go run miles. My knees feel great doing it. They didn't used to. That's because I had muscle imbalances. I hope that helps you out. Oh, let me get a swig of water and then we'll get to the next comment. We still have 163 people watching. You guys drop your comments. I'm going to go as long as I can.

Here we have um addit addit additarm08. Hello Dr. David, I hope you're doing well. Is there any link between coffee and osteoarthritis/cartilage damage by any chance TIA? Thanks in advance.

Um I'm not sure. I would hate if there's a link because I love coffee. Um, I've not seen anything like that, so I can't speak to this. Um, I would I know a lot of people that don't have any cartilage problems that I know of and they drink plenty of coffee. So, I can't tell you with certainty.

Next one. Oh, we talked about Sue. She was talking about um uh the the pain behind the knee. We're talking about the cartilage being worn out and then she got the the endstride injection on the left knee. Cool. We got to that one.

Kimberly's here. She says, "Is it possible after a broken hip and knee replacement, same leg, both in 2024, that with a new leg discrepancy, 3/4 of an inch, plus the IT band just can't adjust? Um, painful when it catches gate is bad."

I'm so sorry, Kimberly. Um, yes, you can have a a leg length problem and 3/4 of an inch, you know, it's it's on it's getting up there. It's not the worst I've ever seen. I've seen over an inch. Um, but you can't I mean, you're not going to have a surgery just to fix a leg length. It's not practical. The best thing to do is just get stronger because the stronger you are in the glutes, the muscles that I talk about, get stronger in those muscles. Get stronger with with bridges and eventually mini squats. And if you can do deeper squats, even better. Not necessary, but even better. Um, you can still get plenty strong just doing mini squats, by the way. But if you get strong in those activities, you'll overcome the issues from the leg length discrepancy. Let me say that differently. Get so strong that you make the leg length discrepancy irrelevant. It's really a big issue if you're weak cuz yeah, you'll be a little off when you walk, but the stronger you are, the better the balance you're going to have and you'll be able to tolerate it just fine. That little shift you make because of the leg length difference isn't going to matter to you because you're so strong. Just get stronger. It's going to benefit you in so many other ways anyway.

Um, as far as the IT band, the IT band often gets involved because you have a muscle imbalance where the hip flexors are too strong, quads are too strong. The IT band is part of that group very often. It's a it connects to the TFL muscle, tensor fascelata, up in the hip. It's a front pocket muscle. So, it acts like a hip flexor and and it can help to bring the leg off to the side as well. You're using that too much. That's why the IT band issues. You got to get stronger on the backside, the glutes, and it'll shut down the the IT band, the T the TFL. It'll take tension off the IT band, and you should feel better after that. You can do this. Come on. You got this, Kimberly. Glutes. Go get those glutes.

Nathaniel. Nathaniel A. Miriam. 50 5148 says, "Hi, Dr. David. Would aquatic exercise be helpful for the knees? Thank you from Aruba. Great question. I was talking about this a moment ago. Hopefully you caught it."

Um, aquatic exercise, there's different kinds. There's swimming, like freestyle swimming, there's, you know, brush stroke, backstroke. There's all kinds of strokes when it comes to swimming. As long as you can use your glutes during those exercises, it can be good for you. However, you don't live in the water. You probably live on the land. And so you eventually have to walk. So you better figure out walking, but it might help you to strengthen out your to strengthen your glutes if you enjoy swimming. That's why I love swimming. I think it's good for people overall. But you don't live in the water. So getting better at swimming isn't going to directly translate to getting better at walking. However, there's underwater walking where you're, you know, you're covered up to here with the water and you're walking for exercise maybe on a treadmill or just walking through the pool on the ground of the pool. There's um floaty things like belts that you can put on that keep you floating and you can simulate walking without touching the ground. There's different methods out there. You can also do squats and leg exercises in the water. All of that is generally good except that you have to use your glutes because it's very possible for you to do all these aquatic exercises and never use your glutes. What are we doing here then? Why even get in the water? Aquatic therapy is a big deal in physical therapy. There's clinics like you're a you're a well-endowed clinic if you have a a pool and you're treating aquatic therapy patients. Doctors look for physical therapy clinics that have pools because they want to send their knee arthritis patients there because there's some research connecting that being in the water takes off weight and that extra weight that you're taking off helps knee arthritis. But but what good is it if you're not using your glutes and you're just strengthening your your quads there? You're going to worsen the knee arthritis over time. And then these health care professionals will say things like, "Well, you're you're 70. You're almost 80. We tried. We did the aquatic therapy. Didn't work for you. You're just it's going to it's going to get worse no matter what." They'll say things like that and it's just not true. Unless you have massive losses of motion like like you have 50% loss of motion or more. In those cases, I tell people, "Yeah, you probably need a surgery." We usually don't let people into our programs unless they have 80 or 90% of their full knee range of motion because after that, there's usually some structural changes and the the chances of them getting significant improvements start to decline. But if you're looking at this video right now and you bend your knee and you're like, "It's actually almost like the other side. Maybe a teeny tiny loss. It hurts. Absolutely it hurts. But I but my motion's there." Then you have an excellent chance at improving through this pro through through through our knee arthritis recovery program and you can fix the muscle imbalance and avoid surgery. But you have to be able to fire your glutes. Whether you're on the water or on the land, whether you're walking or cycling, you have to fire your glutes. And you have no business doing these exercises, quad exercises, cuz you're not going to fire your glutes. It's a waste of time. Good question. Don't do aquatic exercises unless your glutes are working. Go get your glutes working first, guys.

Will Zoo says, "Knee pain and rainy climate are a good combo. I know it will rain when my knee feels pain." Yes, some people are human barometers. You guys know the weather just with your with your joints sometimes. We got another aquatic question here. Nathaniel, does does aquatics work for patella and inside pain? Okay, that was the same person.

Uh Laurel Frenette says, "Hello. Hear you loud and clear." Fantastic. Just making sure I don't miss any comments here. Seattle, Washington. Woo says also the rain comment. Hopefully answered your question. There's there's connections with um there's pressure sensors in your knee. Um and the the uh oh gosh, the name slips me. Proprioceptors. Um that's the technical name, but they sense pressure. So that's how you know like if you if you close your eyes you can tell if your hand is open and closed because you have proprioceptors inside all your joints that tell you the position of your body in space and if those joints become injured or irritated they get very sensitive and they can start interpreting pressure as pain. So, when you have barometric changes in the pressure, um, because you know, the clouds are coming in, the rains in, usually there's low pressure, then some people start to feel it in their pain. I don't have any hard research for that, but that's my my best guess as to what's going on. Um, because there are people that have arthritis problems and they're like, I can't tell. My joints don't I don't have that se that superpower.

Josephine, Texas. Cindy Castillos in Josephine, Texas. Fantastic. A fellow Texan on the other side of the state. Uh Nadia Mardani says, "May I ask for partial tire rotator cuff after a year? Did not get better. Should I go for surgery?"

So you have a partial rotator cuff tear. It's been a year and you're asking if you should go for a a rotator cuff surgery. Um it depend. It depends. Nadia, I would I would want to know if you fixed the muscle imbalance. I would want to know just quick test, easy test. When you reach up overhead like this, are you shrugging naturally? See how I I shrugged right there? And then when you come down, you should be able to relax gradually. If you've mastered that motion and you and you have strengthened it, like you could go pick up some weights, you know, like if I had weights and I just reach up and and I can shrug and and you should feel this shrugging muscle working and you consistently use it. That takes a lot of pressure off the rotator cuff tendons and that's what's going to that's what fixes the the root muscle imbalances upper trap strength but being able to consistently use it whenever you're just even raising up like if I'm reaching up I have a light here above my head I can touch the light I'm shrugging and I just I I subconsciously do it I don't have to think about it because I practice it most people with rotator cuff tears they don't shrug the muscle's weak it's it's like the glutes for knee arthritis. The glutes just don't activate and you have to figure out how to activate it and then get strong be able to hold it. A lot of people I have them strugg like this and they're they're shaking and it get it starts to hurt them up here. This they're just weak. Just like I I have people activate their glutes for knee arthritis and hip arthritis and condalia patella, other knee problems, meniscus tears in the knee. They don't have good glute activation. Just like people with rotator cuff tears and and shoulder impingement problems, they don't have good upper trap activation and that sets up too much pressure out in the shoulder joint very often affecting the rotator cuff tendons. So, go get stronger there. We have a program, by the way, it's called the rotator cuff tear recovery program. Goes into all the details, takes you through that journey that I was talking about. Splits it splits up the process into four phases so that you know exactly what to do at each phase during the rotator cuff recovery program and it will help you fix rotator cuff problems. We've had people cancel their surgeries and get back to zero pain lifting weights up overhead. They often get told by doctors, don't lift anything up overhead. And that's good advice in the beginning, but eventually you have to eventually have to reach up overhead for something. But there's people that stick to that advice indefinitely and then they just get even weaker in their upper traps. And so the problem gets even worse out in the shoulder because they never learn how to use their upper traps. And it's just doctors don't know this stuff. They're just giving you the pain relief help because they're they're trying to help you by getting your pain down and they obviously it hurts to raise your arms so they tell you stop doing that. But then what you have to learn eventually. Hope that helps there.

Samina, I hope I got that right. Uh, but when have to do this if we have knee surgery because quad muscles get gets weak, right? Okay. Yeah. So, after surgery, quads can get weak. That's probably the most common time that quads are weak is right after they do a a surgery, any surgery in the knee joint, an ACL surgery, a meniscus surgery, um a debreedment surgery, a definitely a knee replacement surgery, when they go into the knee joint, the quad muscles shut down, very very commonly. So, right after surgery, I'm talking like in the couple of weeks after surgery, you might need to spend time doing quad sets. It would be appropriate very potentially. But once your quads activate, once you they they've come back online, once they're working again, I would stop doing quad sets. I would stop worrying about doing quad sets and I would go to doing glute exercises and making sure your glutes are strong and then figuring out how to use them during walking and cycling and other stuff. And as a result, I mean, think about it. In walking and cycling, you're going to use your quads. You have to. They will work during walking and cycling. Quads will be active during these two exercises and especially with walking because that's an essential function for most people. You can walk. You should be walking. You will use your quads, but you need to make walking glute dominant. You'll secondarily use your quads and your quads will get a workout. Your quads won't just go away and wither away and be gone forever and cause you problems later on. They'll they'll still be used. You just need to make it glute dominant whenever you're walking. So, right after surgery is the only time that I tell people, yeah, you should probably work on your quads, but that's for a very short time after surgery.

Alisa is here from Massachusetts. Cool. We have um Loren Boyd from Calabasas, California. An Garcia, I've seen you before. An uh in Dayton, Ohio. Hey, Ann. All right, we got a question from Brendan McConnelly. Brendan Connelly, I'm sorry.

If I'm walking using my glutes, is it normal to also be using a lot of the hip flexors? No. Um, you might need to shorten your stride length. If you're taking a big step, you're you're potentially going to use your quads and hip flexors uh more than you should. Walking should just propel you forward. Like when you get your glute active, if you're going to take a step here and your your your body's moving forward, you're using your glute to kind of push you forward, but you don't have to take a big step. In fact, there's good research out there that I saw um that shows that decreased step length is associated with decreased injury. And that makes sense to me because the longer your step, more forces are going to you're gonna you're gonna have more forces to impact. It's less forces down here. There was no study. There was no um consideration about which muscles are active in this study, but I've experimented personally because I run a lot um with taking longer steps and taking shorter steps. And unless you're sprinting, you don't need to take long steps. I would take normal to short even shorter slightly shorter steps. That might be what's setting off your hip flexors to work more. So, um I would just double down on making your glutes work. You can do that. A lot of people are gonna 80% of people are going to get massive improvements when it comes to knee arthritis by just making sure it's glute dominant walking, not hip flexor dominant walking. I hope that helps.

Brendan Polar Vortex. Hey, Polar Vortex. Um um they're saying, "I'm at 6 weeks and my new exercise is lying face down on bed with leg hanging over at knee level. Hold for 30 seconds." That sounds like a stretch. Um, are you missing knee motion? If you are, then it would be appropriate. If you can't extend your knee, then this exercise you're telling me about letting your leg hang over the edge of a bed with your basically you're trying to stretch out your knee into straightening it, then it would be potentially helpful. But if you're not missing motion, I wouldn't be doing this. It's a waste of time. Work on glute strength instead. Go work on other stuff that that you're missing, other other aspects of your of your knee health that that need to be improved.

Sherry Sheree Blizzard says, "Southwestern Virginia in the frigid mountains. Thank you so much for the info that is helping this old lady." Oh, we're happy to help you, Sheree. I hope you're getting a lot of help. Enjoy the mountains out there in southwestern Virginia.

Jessica says, "New arthritic spine disease. I'm so sorry that you're dealing with that." I'd love to help you. Do you have any questions?

Susan uh Flardi says, "I had a TKR, a total knee replacement, and was instructed to strengthen my quads. Of course, the arthritis was no longer there." Okay, so if it was right after your knee replacement, quad strengthening might be necessary. That's what I was talking about a second ago. However, if it's if it's been weeks, um really the the milestone is your quads are active now. You can consciously contract your quads. If you think about it, you can make your quads tighten on command. If that milestone has been achieved, you're done working on quad stuff. I would, if I was your therapist seeing you after knee replacement, I would say, "All right, we check that box. Your quads work. You're good. Let's move on, Susan. Let's go to glutes now. And we're probably going to talk about glutes from here on out because you your dominant quads got you here to where you had to have a knee replacement very likely. So, we're going to do a lot of glute bridges. Let's just make sure your glutes work. Let's do glute sets instead of quad sets. Do glute sets. Make the glutes tighten up and hold it. Hold it for 10 seconds. Then relax. Get conscious control to where you can flex the right apart from the left and and the left apart from the right. Do that in standing. Practice it in walking. Make yourself glute dominant while you're walking. We'll do some mini squats as well. I would just push quads on you. And your knee should feel fine, by the way. Your knee your joint replacement should feel like it's getting better as you're going along. That happens consistently whenever I have I've had patients with knee replacements. And we don't work on quads anymore. You'll, like I said earlier with the walking, you'll work on quads.

secondarily as you walk. So, it's not like your quads are going to be neglected. They will get worked out, but we're going to make you glute dominant. That's what I would focus on.

Susan, all right, my staff is telling me I have a little more time left. Let's keep going here.

Polar vortex has another question. Quad exercise not as you are describing. Instead, I rest leg at ankle on a 3-in rise and hold up for five minutes. So your your legs on a on a step stool, a 3-inch step stool rise and you hold up. So So sounds like you're extending your knee a little bit. I would think that's a quad exercise. That would be like a a kind of like a quad between a quad set and a knee extension. Bottom line is you're using your quads. People get all worked up over well this exercise is different from that. Like a big one that I that I debate with people is a deadlift is different from a squat. Front squats are different than back squats. Uh goblet squats are different than than barbell squats. They're all hip and knee bending exercises. It's just the the way the weights distributed is a little bit different. It might be on your back if it's a back squat. If it's a front squat, it's over here. If it's a goblet squat, you're holding a a kettle bell. If it's a deadlift, you're holding the bar down here. But you're on all of the motions. You're bending your hips and knees and you have an opportunity to use your glutes or your quads. It's all the same to me.

Now, if you're in a powerlifting competition and they want you to do a a back squat a particular way, then you're subject to their rules. But most of you guys are probably not in a competition right now. You're just trying to avoid a knee replacement. You're trying to get out of pain and get back to doing the things you love. So, forget all the details on this squat's better than that squat and this quad set is different than that quad set. Just make the glutes work. And if you get the glutes to work on a mini squat, fantastic. If you get it to work on a glute set or a bridge or you have some other exercise that works for you to get your glutes working, I'm happy for you. Just don't overdo it with the quads. You should see progress that way. I've got my specific treatment approach that I like, but I allow for a little bit of flexibility depending on on you following the guideline of using your glutes and avoiding using your quads. As long as your quads are active, which usually they are, they're very active, unless you've just had a surgery.

All right, next up, Barbara is in Arizona. Fantastic. Uh, I think we looked at this one from Polar Vortex already.

Julie Parker says, "I was told to do this with a resistance band around my legs." Yeah, very often. You're probably talking about the side walking, like walking to the sides. Um, I see this one overdone so much I I don't think it's a good idea. Um, banded exercises I'm okay with if you are glute dominant. And I'm talking about the back of the glutes, not the sides. The like the meat of the glute where the glute maximus muscle is. You need to be able to activate that muscle consistently. How often do you walk sideways? Maybe for a step just to go around something or get out of the way. But you don't walk sideways consistently. So, I don't think it's a practical thing to do. But the reason people are doing it is to exercise key muscles. The abductors, they're not really helping you for knee arthritis directly as much as the hip extensors are, the glute muscles. So, work the glute muscles. Stick to that.

All right. All right, we got Polar Vortex says, "Yes, I have just started this sit to stand and have books for height and working on removing height." Okay, you're on the right track. But is it glue dominant polar vortex? I wouldn't be doing this exercise unless it's glute dominant. I would what I tell people to do instead of a sit to stand would be a a mini squat. So, you're just bending your knees and hips a little bit. See how I just sunk down like an inch? That's all. But then you have to think about using your glutes. You have to push your knees out. You have to shove your hips forward to tighten your glutes. You should be feeling in a mini squat without even sitting down all the way, your glutes tight, working hard without your thighs working. Cuz if you go so hard, too hard, your quads will want to activate. That's part of your muscle imbalance. Your quads are so compensated. They want to take over. When you tell your glutes to work, quads say, "I got your glutes. take the day off. You've been doing that forever. That causes problems. So, I wouldn't do sit to stands unless you're glute dominant. You know how to fire your glutes. You can consistently fire your glutes, then go do sit to stands. And you could go lower as long as you can feel your glutes still working. But I I would advise against doing sit to stands if they're quad dominant.

Debbie, Debbie and Oh, Debbie Henchett. Hope I got it right. I have pain in my quads. Oh, I did answer this one. You're you're quad dominant. So, pain in the quads when you're standing on your feet too long and you had an injection in your knee. You're trying to hold off in your placement. You you're you're quad dominant. That's why your quads start hurting. That happens a lot.

Bob J2447 says, "I think watching Oh, we looked at this one as well. I got that one.

Polar Vortex says, "PT told me there should be no pain with sit to stands." Yeah, there shouldn't, but you also shouldn't feel your quads working a lot. It's possible that you're doing sit to stands have no knee pain, but you feel your quads working a lot. That means that you're increasing the strength. You're you're fatiguing your quads, which is going to strengthen them over time, and later you'll get knee pain because of that resting muscle tension. This is what's misleading about some of these exercises. You know, you're you're doing exercises in PT. You're getting the sweat. You're doing knee extensions, leg presses, all these exercises here, the sit to stands. You're walking, cycling, and you actually don't feel pain in the moment because your arthritis isn't that bad potentially or you tolerate it well. But then after a few weeks, the pain starts to get worse. That's because your quads got stronger and it's applying more pressure to the knee joint. And the PTs don't know this. So, the feedback the PT is getting is is they're saying, "Pull vortex, you're doing great. You're working hard. You're building a sweat here. Here's a towel. Wipe all the sweat off your face. Good job. You're working harder than anybody else here, man. Your quads look ripped. Pull up your short a little bit. Let me look at the definition on your quads. High five." Meanwhile, a month later, you're sitting having a meal and your knee just throbs and hurts and aches and you're like, "I've been working so hard at this. What the heck?" And then you go back to the PT or the doctor and they're like, "Polar vortex, you're just getting older." Yeah, I I guess PT isn't for you. I guess it didn't work out. You're not a good candidate for PT. You just need to have the replacement done. We tried. You didn't work out quads. I'm sorry. You didn't work out glutes. You worked out your quads. You made the muscle imbalance worse. It just you didn't feel it getting worse in the moment. You felt false positive feedback. Hope that helps. Polar vortex, thanks for asking all your questions, by the way. Excellent job.

Jennifer's in 18 in of snow. Polar Vortex says, "Yes, I do leg raises. Raise leg two inches and hold for five seconds. Do it 10 times." Polar Vortex, I hope I hope you make some tweaks.

Um, Kimberly says, "Are these don't do exercises the same, right? We talked about that." Great. Making sure we didn't miss anything. Can you please share some glute exercises? Thank you, Te Tessy. There's so many I've put on YouTube and Facebook, Tessy. Um, I've already talked about some here. I hope I've answered your question. I'm going to keep it to, you know, what not to do here. Things you should avoid.

Boy, I was just told to do that in PT, says Kathy Stone Street 9487.

Polar Polar Vortex says, "Good question at Kimberly. I'm recovering from a knee replacement and exercises have been working for me." There it is. You're recovering from a knee replacement. So, you might need to activate your glutes and you're going to have ma I'm sorry. You might need to activate your quads and you're going to have massive improvements because you just had the knee replacement. See, I didn't know that part. If you're if you're trying to avoid a knee replacement, then I would definitely not be doing any quad exercises. But because you had a knee replacement polar vortex, you might need to do some for a little while. But as soon as your knee is feel feeling better, as soon as all the the wound is all healed up and your quads are now active, I would shift on to doing glutes because then it's going to potentially cause some pain. And another false feedback you're going to get if you have had a knee replacement is you're potentially not going to feel as much pain in the knee because it was replaced. You don't have nerve endings in there anymore. You have artificial parts. The way that people feel knee pain after knee replacement later, it comes months later, six to 12 months, a year or two later, is because of the other structures, the tendons, the nerves in the area, the muscles, the ligaments. Those begin to get overstressed because of the muscle imbalance. The the glutes being weak up in the hip and then the quads being strong in the and dominance in the thigh. it starts to tension the the tendons, the ligaments, the the muscles, the nerves, all that stuff that I mentioned. And that's it off pain. And it leaves it often leaves people um discontent because they'll say, "Well, my knee's better overall. I can walk. I can do stuff. However, my knee still kind of aches and hurts at times, and I was hoping it would take the pain away completely having the knee replacement, and it didn't take it away all the way because you still have a muscle imbalance, and your other knee is probably getting bad, too. And hopefully you don't have to have a second ear replacement on the other side or the same ear replacement because you're going to wear the artificial parts the way that it's attached to the bones where they where they had to cut things off that can loosen up and free up because of the excessive pressure from the muscle imbalance. So my advice to you polar vortex is fix the imbalance to protect your current knee replacement to make sure that you don't have any other procedures the rest of your life. I would I would think you want that. I would hope that for you.

All right, they still are letting me go. Here we have uh Monica Star. So far, everything on this list my PT has me doing. I'm winning in pain procedures producers. LL. I'm so sorry, Monica. It happens. It happens. You know, most PTs are just they're they're great at helping people recover from surgery, like polar vortex. So, it would be appropriate to do if you've had a surgery and when somebody who's avoiding surgery like you might be like if you don't want an ear replacement, you're you're here to fix the arthritis before it turns into an ear replacement. PTs in general don't have good training. I I I was a professor. I went through PT school myself and then I taught PT school for orthopedics and they're focused on making sure to help people not get worse in the short term and they're focused on helping people recover from surgery but they don't have good training on how to fix a root problem that causes knee arthritis. That's additional training beyond physical therapy school which I've gone to go get. I've studied with some of the best in the world but it's just not stuff that you find in school in regular PT schools. So, as a result, what you'll find is the PTs there are great at helping people recover from knee replacements and other knee procedures and other hip surgeries and back surgeries and shoulder surgeries, but they'll if you walk in hoping to avoid surgery, they're probably going to treat you very much like somebody who had surgery because that's what they're specialist in doing. So, you're going to be put next to the person that had knee replace a knee replacement. You're going to be put next to Polar Vortex and Polar Vortex is going to say, "Hey, this is working for me. Look at my quad sets. Look at my sit to stands. I took a book away." And and you might be there trying to avoid surgery. And the PT's thinking, "Oh, well, it's working for him or her and let me try it for him or her." and it might give you some false positive feedback like it kind of feels better, but overall you're feeding into the to the problem and we're not making long-term progress, which is what you want so that you avoid a knee replacement. It comes back to the glutes. You have to get those glutes going. Quad exercises are only for the short term right after a surgery.

Julie Parker says, "I need to watch this again later." A lot of you guys got to stop doing your quad exercises after after um watching this video. Get get on the glutes.

Zel Zelma Mitchell 2982 says, "My therapist has me doing every exercise you've listed and now I have a new issue, a tight invisible band feeling around my knee with a tingling sensation like electricity and I get a stabbing pain too." Yeah, that happens. you've probably compressed that joint. Um, sounds like you might have a nerve problem, too. That's what that tingling sensation, electrical stabbing sensation can cause. Um, there's a nerve called the saphinus nerve. I've talked about it on on many of my videos. It it wraps around the knee. Let me show you. I don't have a picture of the nerve, but there's the knee. The saphinous knee. The saphinous nerve runs from here, kind of goes a little around the back of the knee, and then we have branches that wrap right around the front right here. And then there's some branches that go down. And those nerves can get irritated along because of the muscle imbalance. And the muscle imbalance itself is putting pressure through the knee joint. They can give you that tight band feeling. I've heard that those exact words from many patients with knee arthritis. They said, "I have a tight band around my knee." Some people will say, "It feels like I have a bunch of rubber bands squeezing my knee." It's that pressure buildup because it's a pressure problem from the quads. Take the pressure off. You'll feel less band pressure. Get the glutes stronger. Come on, Zelma. Get those glutes up.

Julie Parker says, "I was told to do the crab walk with resistance band." Yep, that's a sideways walking.

Julie Parker says, "Oh boy."

Kathy Stone Street says, "My knee collapsed. I'm so sorry."

Then we have Zelma Mitchell again says, "This pain I'm experiencing feels like a nerve damage. The doctor sent me back for this crazy therapy. I feel like I'm not being heard by my orthopedic doctor concerning the knee and that band pain." Yeah. They don't know what to do about this stuff. They get so focused in on there's a nerve and then they're doing nerve treatments when it's the muscle imbalance. It causes all this stuff is together. The the nerve is embedded in the muscles. It's between the muscles and the way you move affects not just the muscles but the nerves. It can put tension on the nerves too. We got to get the glutes stronger. You got to take that pressure off the knee joints.

Elma Monica Star says all of them.

Hippie Head says, "I'm 74 and I have weak glutes and painful knees." That's how it works. Hippie head, get those glutes stronger and the knees will probably be less painful.

Jacqueline says, "Do these apply to knee teninitis?" Yes. Yeah. I I I see a lot of these knee injuries on a spectrum. So, when you're in your younger years, you can get knee tendonitis, knee burcitis, ACL tears is also very commonly due to this muscle imbalance problem because of the way that you stabilize your leg as you're moving. If it's quad dominant, your knee is going to go a certain way. That can set up knee um ACL tears. Um then after that comes patellar problems like your patellophoral pain syndrome, condondromeat patella. Then after that comes meniscus tears, cartilage in the knee. This cartilage right here gets smashed. It's all pressure problems from the same muscle imbalance. Then after the miniscus tears, miniscus tears tend to happen 30s and 40s. Then you have osteoarthritis in the 50s and 60s and beyond. And if it keeps going, eventually you get a knee replacement and still have pain. It's all the same muscle imbalance the whole way though that's behind it all. And if you're watching this video and you're like, "Oh, good. I just have a miniscus tear or or um conjmoral pain syndrome." Fix it now, please, before it becomes a a serious arthritis problem that you're looking at having a knee replacement for. And even if you have knee arthritis right now, or if you had a knee replacement and you're worried about your other knee, you still have a shot, a very good shot very often to fix this muscle imbalance and get your arthritic knee feeling good enough to avoid surgery and possibly even good enough to feel like you have nothing going on in your knee. It happens all the time, by the way. You're not doomed forever if you've been told you have knee arthritis. you can make it tremendously better to the point where you don't think about your knees by fixing this muscle imbalance I'm talking about. Good question.

Jacquine Barb D5777 says, "Any thoughts on red light therapy for the knee? I have a brace that combines that and massage and it's been helpful. Just started a light aerobic walking workout again and use it after walking. Number one on my list, Barb. I hope you're doing glutes. If you're doing glutes while walking, you're an A student. If you're not, you're an F student. Please make sure that you're using your glutes while doing walking and aerobics because it I I don't know what your aerobics instructors like. Hopefully, you're using your glutes plenty there. Um, as far as the red light therapy and the the massager brace, um, I think those are really cool. I don't know the research behind red light therapy. There's some there's research that shows that it's helpful, but if we think about the mechanics of it, it's not fixing the muscle imbalance. It's not strengthening your glutes. It's straight up short-term pain relief. The both the massage, the compression from the brace, and the red light therapy. And if it's working for you and you're not taking pain medications or going to the doctor for injections, go for it. I like it. Just don't rely on the the brace, the red light therapy, the massager as a long-term solution that you're banking on fixing your knee arthritis, which most people get that. I just want to say that clearly. It's not going to fix your knee arthritis. It's going to give you some short-term pain relief so you can sleep better, enjoy the day better, not destroy your liver and other organs taking pain medications, but go fix the glutes. Go get the glutes stronger. Use them when you're walking, please. That's going to give you the long-term fix. Hope that helps, Barb.

All right, they're telling me one or two more people that I can answer questions for. Try again.

Hi, Dr. David from the UK. Hey, Caroline. Caroline Shipsy's in the UK. She's saying hello from the UK.

Robin Foster 289 says, "I had a knee replacement on my right knee two years ago. Whenever I drive, when I get out of the van, my leg draws up and painful. I have to wait five minutes or so before I can walk off." Yeah, that sounds like an unresolved muscle imbalance where your quads are too active, too. Glutes are not strong enough yet. And when you sit for a long time, like when you're driving, those quads just compress the knee joint and create stiffness in there. And then you feel like you have to loosen it up afterwards. You still have the same problem that got you the knee arthritis. that got you the knee replacement and the knees replaced now, but the muscle imbalance is still there. And this is what I'm talking about. You probably were expecting this to not be an issue at this point. Those of you guys that are staring at a knee replacement, some of you guys are probably watching this and you're scheduled. You have an appointment to go to the hospital and get your knee operated on in a in a few days or a few weeks or a few months. They're expecting you to show up and go under anesthesia and walk out with a knee replacement when it's all said and done. But look at this comment from Robin right here. You're still going to have problems because a root problem was not fixed. And possibly, very likely, if you fix the root problem now before you have a procedure done, a joint replacement done, you might avoid the joint replacement altogether. You might not need it. Some people are so painful and so swollen in their knee and it's so they're they're done that you know they're desperate they'll have the operation and if you simply went through phase one of our knee knee arthritis recovery program which we offer for free by the way on our website your pain would go down so much and you'd be set up to begin to fix the imbalance and you could go through the remaining parts of the program if you wish and you might not ever need a knee replacement. you can't lose because even if you do need the knee replacement, if you truly need the knee replacement, going through phase one of our program will probably calm your pain down enough for you to sleep better at night. And if you are going to go get the knee replacement, which is fine, it's up to you. It's your body. You're probably going to recover faster because you were less inflamed going into it. the recovery the recovery after the knee replacement will be easier. But I would still urge you to go fix the muscle imbalance because then you'll enjoy your knee replacement better afterwards. But hopefully you never even have to have it because you fixed the imbalance and it was good enough. You had the potential before. Very often people do even if they're bone on bone in the knee.

All right, one more. ISOILM 400 says, "Knees got bad three months ago. How do I break the cycle and get the worst flare up to ease? Staying home, not walking, doing leg ding dingling. I haven't heard that one. Leg dingling. The tailgate swings. When I fire up the glutes, laying down, the next day my QL is cramping. QL is a muscle in the back." I hope that's we're talking about the same thing.

Um, all right. So, this is good that you're trying to figure out how to get the So, first off, I hope you're taking guidance from our free phase one for the knee arthritis program and our website. If you're not, go through the videos there. There's like a dozen videos, I think more, that walk you through the entire phase one. It's it's the it's the beginning of the program. Go start that. It's free. You don't have to have an account. you can just go load up the website and start watching the videos right away. Um, the leg dingling is is the tailgate swings. That's a pain relief exercise, but there's a lot of other pain relief stuff that that I include in the program there for free on the website. There's a whole list of mechanical pain relief stuff. There's a whole list of um chemical pain relief stuff to look at. There's exercises to do, pain control exercises. go through all of that and that usually helps you get the the flare up to go to flare down. There's usually a combination of things I explain in the videos. There's a combination of things that you need to use for today for a few days and that combination might not work after that time period. You might need to switch the combination of things. That's why I give you an exhaustive list in phase one that's for free on our website. Can't repeat it enough. It's for free on our website. go through that thoroughly, isofilm 400, apply it, and you will get that flare up under control, and then you're going to be primed to start fixing the imbalance so that you're not flaring up all the time. So, you can get that true long-term benefit. Um, as far as your QL when you're laying down, when you're frying up your glutes, there's some It looks It sounds to me like you have a um, oh gosh, the word slips my mind. A compensation. You're trying to fire your glutes and your back muscles kick in. That happens all the time. Hamstrings kick in, the quads kick in, the thigh muscles, and then back muscles kick can kick in, too. I talk about it in the videos on phase one for free. You have to make sure that you're only firing at an intensity where other muscles aren't kicking in. And it just takes some time and reps. You have to think about it. You have to go through this journey so you can get the milestone of being able to truly contract your glutes without all these other muscles firing. That will keep your QL from from picking up. And then you'll be able to progress the exercise. Cuz now you said you're just lying on your back firing your glutes. How are you going to do a bridge if your back muscles are already hurting you? you're not ready. Don't do the bridge yet. That's in phase two anyway. Stick to phase one exercises, which which is just get the glutes active without all these other muscles firing. So, go back to phase one for free uh of the knee arthritis recovery program on our website, ISOILM400. I think that's going to help you out quite a bit.

All right, guys. I've got to go. Thank you so much for hanging with me here. For those of you guys that are still here, um, if you're watching on the replay, thank you so much for watching and I wish you guys all the very best. I'll see you all here live next week. Have a wonderful day. Bye-bye.