Thought of Bill's words..

[Glenn]

I'm not a die-hard supporter of knee circles, but are knee (or any other joint) circles meant to be stretches? I have never felt any kind of stretch/strain with them, and have thought they are just to loosen up the joints so we are not as stiff going into other exercises and techniques. Of course, it is interesting to read above that loose joints are a bad thing! But maybe that is a different "loose", in an anatomical sense versus a non-stiff exercise sense.

I'm not sure how widespread this is in the Uechi community, but we do what is called back-to-back exercise that seems to strengthen the knee ligaments (and eliminated knee problems I acquired when I was younger from doing a damaging form of sit-up in a previous class). I wonder if this counteracts any negative effect of knee circles, with both providing a balancing effect to the joint. I have heard a variant of this exercise (back-to-wall) is used by physical therapists to help strengthen knees in people with knee issues, whereas I have not heard that they do knee circles so it also may be that no balancing is needed.

[gmattson]

I guess we should begin be defining what each of us is doing. . . that we call "knee circles".

Mine don't cause any pain and I doubt if anything is being unduly stretched. I caution students not to push the knees back into a "locked" position, (last part of the exercise) and not to exert any pressure on the knee at any time. In other words, the movements shouldn't hurt.

At most, the exercise simply moves the leg around in a way that the legs may be moved during normal calisthenics, kata, sparring, play or sport activities.

The same can be said about the foot rotation.

I read all of Bill's and Ian's information. My question remains: can correctly performed circle exercises of the joints, help avoid injuries to the vulnerable ligaments and tendons that often get torn or otherwise damaged, due to sudden and traumatic exaggerated motions to these joints?

Achilles tendons often get damaged doing simple things, like getting into a deep stance, doing a jump back in seisan (just two I'm familiar with, that students have suffered) I would guess that the same concerns with stretching the Achilles tendon would apply as with the circle exercises, yet, there are many foot/leg exercises recommended for stretching out this tnedon.

[Bill Glasheen]

Here's another hint to the issue at hand.

Alignment Key To Knee Surgery Success; Even Small Degree Of Bow-Leggedness Can Lead To Degeneration Of Knee Joint After Surgery

ScienceDaily (July 4, 2002) — ORLANDO, FLA -- Just as failing to perform an alignment on a car after installing a new tire will lead to uneven wear and tear and ultimately tire failure, performing knee surgery without taking into account the proper alignment of the leg bones above and below the joint could cause future problems including degenerative arthritis, according to a new study by Duke University Sports Medicine researchers.

Even a small "varus knee malalignment" -- more commonly known as bow-leggedness -- can lead to serious future problems for knee surgery patients, the researchers said. They added that physicians should at minimum closely monitor all young people who undergo reconstructive knee surgery to ensure that the leg bones stay in proper alignment, and in some cases surgically correct the bowleggedness. They see such strategy a possible preventative measure against the future development of severe arthritis of the knee.

"Even a relatively small malalignment in normal knees can cause dramatic alterations in the pressures within the knee joint, and this negative effect can be greatly magnified if the cartilage within the knee has been damaged," said Joseph Guettler, M.D., orthopedic surgeon and sports medicine fellow at Duke. "With early recognition and intervention of the malalignment, we can perhaps prevent the development of serious osteoarthritis from occurring in the future."

Guettler conducted a study whose results were prepared for presentation today (July 3, 2002) at the 28th annual meeting of the American Orthopedic Society for Sports Medicine (AOSSM). The study received the 2002 Herodicus Award, given annually by Herodicus Society at the AOSSM meeting for the best paper submitted by an orthopedic resident or sports medicine fellow.

The Duke researchers sought to characterize the effects of malalignment on the knee joints of patients who had suffered damage to the cartilage within the knee. Specifically, they analyzed the pressures within the knee joint over the cartilage after the creation of a defect in the cartilage and removal of the meniscus. The meniscus is a piece of fibrous cartilage within the knee that acts as a cushion or "shock absorber."

For their studies, the Duke team placed eight cadaveric human knees in an apparatus that creates loading across the knee joint. They then used the latest technology to measure pressures over the cartilage within the knee joint.

The researchers found that even three degrees of malalignment, which can only be detected by X-ray, can lead to profound deformation of the cartilage. For example, this small deviation more than doubled pressures on the middle of the knee joint, and peak contact pressures increased 68 percent. Over time, these uneven pressures within the joint lead to uneven wear and tear, which leads to painful and often debilitating osteoarthritis.

"Past studies have shown that between 20 and 50 percent of patients who have had significant knee cartilage damage developed severe arthritis," Guettler explained. "What hasn't been shown is why some patients do and some do not. Our studies would suggest that a very important factor is the subtle changes in alignment of the leg bones relative to the joint and the pressures they place on the cartilage within the knee."

For patients who have significant cartilage damage or have had damaged cartilage removed, Guettler recommends that very close attention be paid to the alignment. These patients should be followed very closely, and if any clinical or X-ray evidence of deterioration occurs, an operation known as an osteotomy should be considered. This surgical procedure involves taking a wedge-shaped piece of bone out of the leg, in essence changing someone from being bow-legged to being knock-kneed. This over-compensation relieves the pressure on damaged parts of the knee and transfers it to undamaged areas.

"In these cases, the surgery is seen more as a preventative measure against future osteoarthritis, as opposed to a treatment for a specific disorder," Guettler said. "This is an invasive procedure with known complications, yet it should be considered for these high-risk patients."

Timing is the key consideration for this procedure, Guettler said. The osteotomy is usually reserved for someone in middle age who already has developed significant osteoarthritis. Based on the results of this study, an osteotomy would be recommended in a predominantly younger population. It may, however, be more difficult for the parent of an injured 18-year-old to make such a decision, since the teen-ager would not see the benefits until decades later, Guettler said.

Guettler said that as new surgical procedures -- such as meniscus transplants or the implantation of cartilage grown outside the body -- gain widespread use for patients with knee injuries, physicians should pay close attention to alignment, since it plays an important role in the ultimate success of the procedure.

The other members of the Duke teams were Richard Glisson, Alston Stubbs, M.D., Kenneth Jurist, M.D. and Laurence Higgins, M.D. The research was supported by Duke Sports Medicine.

[gmattson]

with the alignment of legs, even in Sanchin. But exerting constant stress to a joint is not the same thing as doing a mobility exercise for a few moments.

[Bill Glasheen]

with the alignment of legs, even in Sanchin. But exerting constant stress to a joint is not the same thing as doing a mobility exercise for a few moments.

I think your missing the point, George.

There are several issues involved.

• Teaching good general mechanics. For example, you don't want to teach someone to move around on the heels. Pivoting on, stepping with, and landing on the toe/ball-of-foot is both biomechanically efficient AND reduces the pounding forces on knees/hips when doing things line one-legged jumps. (Seisan anyone?)
• Not trying to bend a knee in a direction it was never intended to bend. This is where several of us have had orthopedists warning us that our knees are (were in my case) too loose. Loose knees are a ticking time bomb if you're an active athlete. You want muscles to be loose; you NEVER want loose ligaments. That's like having a frame of a car that flexes.
• Teaching someone NEVER to be in a position where they are vulnerable to an ACL tear. Never, ever, ever!!! It's like teaching someone not to lead with the nose, or stand in close with legs wide apart and no leg contact.

More in a bit...

- Bill

[Bill Glasheen]

This article gets more specifically at the point I've been trying to make. It's very long, so I'll take snippets of it. I have highlighted two portions that I particularly wanted to emphasize.

This article is just a month old, showing how recent the controversy is.

Remember that "football" is not the same in the UK as it is here in the US.

- Bill

Are women more prone to injury?

Women are being encouraged to take up sport as never before. But new evidence suggests it can have a devastating effect on their bodies. Anna Kessel asks what's being done to prevent an unlikely 'epidemic'

It is a familiar, agonising story. A star footballer is carried off the pitch on a stretcher after rupturing a knee. The diagnosis is a tear to the anterior cruciate ligament. The player is devastated: this injury can require a year or more of rehab, and leaves no guarantee that they will ever be as good again.

It happened to Paul Gascoigne, playing for Tottenham in the 1991 FA Cup final. He didn't feature in another game for 16 months. Michael Owen was out for 10 months after he tore the ligament with England at the 2006 World Cup. Ruud van Nistelrooy, Lawrence Dallaglio and most recently Tiger Woods have all suffered the same injury.

But it is not male stars that sports doctors are now most worried about. It is sportswomen. They are currently considered to be up to eight times more likely to suffer anterior cruciate ligament (ACL) damage than men, and in the United States so many women and girls have been affected that one expert has called it an epidemic. The problem has been highlighted from the morning news bulletin on ABC to the front page of the New York Times as thousands of women and girls in competitive sport undergo ACL operations each year, at a cost of millions of dollars. The higher the level of competition, the more they are at risk. One in 10 women playing college sports will suffer an ACL injury.

Why the concern? Partly because we know so little about how men and women are susceptible to particular injuries, especially about the neuromuscular differences between the sexes. Research is still being carried out into rates of concussion, thought to be higher in women, joint injuries and even bone damage in endurance athletes leading to stress fractures of the femur, such as the one Paula Radcliffe suffered before the Beijing Olympics.

'There are certain areas where you would say women appear to be at a greater risk,' says OSM columnist Dr Nicholas Peirce, a lead physician at the English Institute of Sport. 'We don't know how increased activity is affecting hips, backs and shoulders. We see a large number of women having shoulder operations in canoeing and rugby, and there are other injuries, stress fractures of the back or stress lumbars on the lower spine. We are challenged to really follow and observe the demands of elite sport because at the moment there is a lot we don't know.'

The most evident problems just now are with the anterior cruciate ligament, because it is such a devastating injury. Ruled out of action for sometimes more than a year, athletes fall behind in their sporting careers, are 25 per cent more likely to suffer the same injury again and, worst of all, face debilitating permanent damage to their knees. Women in their twenties are being described as 'crippled', even after successful ACL surgery, as osteoarthritis of the knee takes hold.

Football is the most common source of the injury, but every sport that involves landing from a jump or changing direction at speed puts women and girls at risk - which includes netball, basketball, volleyball, hockey, rugby, handball, skiing and snowboarding. In Norway, the reigning Olympic champions at women's handball, 12 out of 28 players from an elite club team suffered ACL injuries. When several members of the country's Olympic team tore their ACLs, the King of Norway donated funds to help research into the problem.

In the US, downhill skiing has one of the highest injury rates for females. 'A few years back you could not get to World Cup level without having had an ACL tear by the peak of your career,' says Dr Cara Walther, a former skier turned orthopaedic surgeon. 'It was almost 100 per cent of the girls on the ski team. And I'm one of the statistics. Back in the 1980s I tore both my ACLs.'

The International Olympic Committee (IOC) are so concerned by the statistics coming out of the United States, Sweden, Norway and Germany that this year they invited a panel of experts to report on ACL injuries. Their recommendations included building better injury-prevention techniques into training.

{snip}

The problem of ACL tears is simple to address. Prevention programmes are easily incorporated into warm-up and cool-down sessions and can reduce injuries by up to 70 per cent, cutting the odds to the same level as those faced by boys and men. 'The biggest issue we face now,' Hewett says, 'is getting the information out to the public. We can do all the research in the world, but if we don't get the word out to coaches, parents and players, the interventions will be of no use.'

It is generally believed that alignment of the knee is a major indicator of an at-risk athlete. If the knee falls inward when bending, running or jumping - as is often the case in female athletes - the ACL is more likely to rupture. Girls can be screened for these neuromuscular habits from a young age.

The problem is educating coaches, who are often more geared to performance than injury prevention, to spot the trend. Former world triple jump record holder Ashia Hansen says her knee-alignment problems went undetected by coaches and physios throughout her career. It was only her last coach, Aston Moore, who identified the habit, but by then she had already suffered a ruptured patella, in 2004. She never fully recovered and had to retire through injury before Beijing, aged 36.

Hewett says that Hansen is the kind of athlete who could have been immediately identified as being at risk. 'A triple-jumper puts significant stress on their knees. The muscles around the knee are not designed to absorb high forces when the knee is collapsing inwards. Quite likely if someone had worked on her biomechanics and taught her to control that knee joint, I'm near certain that could have made a difference. Not much research has been done on track-and-field injuries and gender differences, but certainly anterior knee pain is higher in female track athletes than male.'

Despite her long career and keen interest, this is information that Hansen had never encountered. She has been told she has long ligaments, she has been told she has had bad luck. 'I have footage from years back where you could see I'd take off and my knee would go inward, so I found shortcuts to compensate. That's not good when you're jumping, there's 10 to 15 times your body weight going through your knee, and you want everything in a straight line otherwise the force is going through the weakest part of your knee.'

{snip}

- Guardian.co.uk

[fivedragons]

I do knee circles, don't think there all that important, and haven't had any adverse affects from them. But the way I do them is really tiny circles that don't stretch anything. The whole way through the circle, my legs are bent forward, there is no straightening or locking out of anything. I just feel it is a way to move my knees around a little bit, without any stress on them.

I feel it's kind of like doing the neck circles, no big deal if you just let your neck relax forward without backward leaning rotation. Once your spine goes back past the natural axis, it's a very not good deal to rotate and grind all that stuff together.

As far as really good and therapeutic ways to treat your knees and neck, I haven't found anything better than what is in the intu-flow program by Scott Sonnon. I can actually feel and hear my knees and my neck thanking me.

Sometimes, feeling and hearing your joints moving can be a bad thing, like when stuff grinds together, but sometimes it is a sign that your joints are finding their way back to a healthy state of balance.

[Bill Glasheen]

I do knee circles,

****

I feel it's kind of like doing the neck circles,

No, no, no!! Dr. Ian and I are trying very hard to make this point.

The neck is classified as a pivot joint.





It bends in ALL directions and it twists in BOTH directions.

The knee is what is known as a hinge joint.





It was designed by nature to bend in one and ONLY one direction. That's it.

Trying to make it bend sideways (as per the mechanics mentioned in the above article) is making it do something that it wasn't intended to do. If you train your body to accept this type of movement as "acceptable" mechanics and then head out for the ski slopes, good luck! As the article stated above, in the past the women's ski team had a near 100% rate of ACL injury - perhaps the most devastating injury that an average person can experience to that joint.That type of injury has been linked to a type of movement that is done in the knee circles. Do that on the slopes where strong forces go down the leg, and POP!! Training proper mechanics can reduce this type of injury by 70 percent.

As far as really good and therapeutic ways to treat your knees and neck, I haven't found anything better than what is in the intu-flow program by Scott Sonnon. I can actually feel and hear my knees and my neck thanking me.

Scott's a good man. I like the way he thinks.

- Bill

[Bill Glasheen]

This is the knee alignment we want to avoid. In this case, both knees are turned inward.



In the knee circles, you are bringing the knees through this alignment one at a time, since they are moving in parallel.

This is what we want to be teaching.



- Bill

[chef]

Knees over the feet but never more forward than the toes on squats, right Bill?

I have been thinking about rethinking doing squats...maybe just walking lunges instead.

After not having done squats for atleast 10 months due to a dislocated knee cap and torn miniscus (that was never operated on) and recent stressed fracture May 1, I did squats for the first time Monday.

I only did two sets with bar only, no weight. I have done squats over the years and it really whacked me like never before. My lower back and hips were killing not to mention I can barely walk. I expected the thigh soreness for the first 2-3 days afterward but not the back problems. What's up with that?

Not sure if I should continue squats after that...I do align my legs out, FWIW.

Vicki

[TSDguy]

I've heard experts on both sides argue relentlessly about the toes-over-the-knees thing. From what I can tell, the force on your knee is greater when you go past the toe, but it's not necessarily bad.

[Bill Glasheen]

My apologies up front to Vicki. She's been trying to get my attention for several days on this. It's just REALLY hard doing it via text messages.

BTW nice workout last night, Miss Vicki. As far as I am concerned, you are ready for the Sandan test. Now we just need to jump through the hoops...

... and figure out how we make you start working on your yondan.

Knees over the feet but never more forward than the toes on squats, right Bill?

Perfect. Just like what I want in that Seisan front elbow stance, right? (Note: Always have lower leg angled away from front foot here so one can "push away from" the front leg. But the alignment is just as Vicki says.)

I have been thinking about rethinking doing squats...maybe just walking lunges instead.

I read what you wrote, and have a couple of thoughts.

First... Any change in your workout will tick your body off. Give it time.

Second... All those machine squats have made your trunk lazy. Bad, bad, bad!!! The core is where your power originates from, and is the link in-between your Sanchin legs and arms. You must work the core - particularly via this whole-body, open chain exercise. Do less weight and challenge your body more like a real-life load. The shock of going back to this has ticked your back off. You will recover... But stay friends with your doctor, OK?

Finally... With age, the discs in your back can get a little less spongy. So no more squatting 500 pounds, OK? That being said... I agree with what you are thinking. Walking lunges gives the same benefit for leg and butt strength, and yet puts half the stress on your lower back. Furthermore, it has an added advantage of challenging your balance for martial arts - particularly if you put bar on shoulders rather than dumbbells hanging from arms. Higher center of gravity means a greater challenge to balance.

Now that I'm no longer obsessed with numbers on my squats, I mix in back squats, front squats, and walking lunges. I do less weight on any exercise, but always challenge my body with all kinds of variations so that I'm constantly keeping it guessing. Getting out of your comfort zone is a good thing.

- Bill

[Bill Glasheen]

I've heard experts on both sides argue relentlessly about the toes-over-the-knees thing. From what I can tell, the force on your knee is greater when you go past the toe, but it's not necessarily bad.

The issue is the shear stresses behind the patella (knee cap). Knee beyond toes means you have that knee cap pushed HARD against the bones in your knee. Eventually you will get very sore knees, and end up on rehab. Not good...

Keeping the knee behind the toe is a good thing. Instead of trying to bend more at the knee, do more of a bend at your hip. Think of the body like an accordion, where all the sections of the diaphragm are equally flexed. That keeps any one section from having to take all of the load.



- Bill

[chef]

Thanks, Bill...feedback appreciated.

I think I may have arched my back a lot when doing this while looking forward with chin out...could be the reason for the stress on the lower back.

Yeah, I see you tempting me with that carrot of a Yondan...that's sneaky, boy.

I am loving this kata...I always fall in love with the kata when I intensely start working on one for a test.

BTW, I am enjoying my advanced workouts...please include as much as possible in our class time and I will deliver.

Thanks,
Vicki

[fivedragons]

For some reason I'm inclined to take your advice, Bill.

No more knee circles. It's not like I ever noticed any benefit from doing them. Thanks.

Wow, I feel so liberated.