GCY: Chronic Medial Knee Pain: Phase 4 (4-2-18)

Phase 4:

Try the organization I have listed below
You will see some updates to your program below in CAPITAL LETTERS
DAY 1 : STRENGTH CIRCUIT #1 (2 SETS) AND DAILY MOVEMENTS
DAY 2: DAILY MOVEMENTS
DAY 3: STRENGTH CIRCUIT #2 (2 SETS) AND DAILY MOVEMENTS
DAY 4: DAILY MOVEMENTS
DAY 5: STRENGTH CIRCUITS #1 AND #2 1 SET OF EACH + DAILY MOVEMENTS
DAY 6: DAILY MOVEMENTS
DAY 7: REST DAY/DAILY MOVEMENTS
THIS WEEK WILL PROVIDE A FEW UPDATES/PROGRESSION OPTIONS
- Light movements that I call “Daily Sequence”
  - This is a sequence that is all about light movement and muscle activation
  - It is meant to improve mobility and possibly serve as a warm up, cool down, or a light sequence in the morning or at night to improve mobility
  - I will continue to give you some alternative options over the next few weeks to include in this sequence
  - The goal is to isolate 4-5 movements that you feel are most effective in moving parts of your body that are stiff/painful and feel that they improve mobility/stiffness
  - You will do one set of 10-20reps for each movement so this sequence should be very quick and user friendly
  - There is something called the “5 Tibetan Rites” that had a great impact on me
    - Basically, these monks for thousands of years did this sequence, some calling it “The Fountain of Youth”
    - I do not necessarily hand out the 5 rites, but I do believe that everyone should have their own personalized version of 5 movements that are not incredibly challenging, that move areas of their body that they do no move enough in their daily life
    - This sequence should be brief and take only 5-10 minutes at the most
    - I do my own 5 rite sequence before bed each night and I do it as a warm up pre workout/wrestling practice/jujitsu
- Strength Circuits
  - These are meant to challenge you with the goal of creating fatigue or tension in muscle without overloading painful structures
  - Your goal with this is to feel muscle tension and hopefully fatigue
  - Each movement will have a time goal or a rep goal, once you achieve that goal with no negative side effects, you are ready for a new challenge
  - When your body fatigues, you may start to get pain and that is your cue to stop
  - Pay attention to what you feel later that day and the next day
    - Mild pain is alright as long as it goes back to baseline within 24 hours
    - If pain is more severe you have a couple options
      - 1) Ice right after to minimize inflammation
      - 2) Try to decrease the intensity of the exercise by not going through as much range of motion or not pushing so hard
        
        In my mind, most exercises can be made painful or not painful by the way that you go about it
        
        Example: If I give you a squat variation, there are many ways to decrease risk of pain
        
        Don’t go as deep into the motion, do it slower, keep weight more on the heels, hold an isometric position squat without moving in whatever range is least painful, do only 2-5 reps
        
        Have the mind set of getting through new exercises making it super easy just to find a safe zone…you can always increase the challenge from there
Daily Sequence: Complete everyday
- Self Myofascial Release Options, press on any area that feels tender, especially if it is worse on the painful side
  - Focus on areas that feel more sensitive on the problem side
  - spend 30sec to 2 minutes on each tender spot as discussed in the video
  - Self MFR Quad/Hip Flexor VIDEO
  - Side Lying IT Band VIDEO
  - 38) Self MFR Ball Glute/Piriformis VIDEO
- 113.1) Ball Hamstring Curl to Knee Extension VIDEO
  - Full active knee motion with very little pressure on the knee
- 29.1) Prone to Supine Quad Stretch, Isometric, Active Motion VIDEO
  - One of my favorite quad mobilizations
  - This one has 3 parts so shoot for 10-15 for each part
- Bridge Band Around Knees Progression VIDEO
  - Only bend the knees as much as comfortable
  - Goal is to feel pulling in the thigh with no significant pain
  - band is an option to reduce tension in lateral quad/knee
- NEW:
  - POSTERIOR HIP MOBILIZATION
    - 38.1) Cross Leg Basic Rock to Cross leg Progression VIDEO
Strength Sequence: Complete every other day, if sore, wait until soreness completely goes back to baseline prior to completing it again which may require 2 day rest
- First time through, try for just one set, if that goes well you can go through it 2x on strength day
- Circuit #1
  - Bridge Progression Physio Ball Progression (Choose 1)
    - 113) Isometric Co-activation Abdominal/Glute Phase 1 VIDEO
    - 114) Abdominal Control With Hamstring Curl Phase 2 VIDEO
    - 114.1) Straight Leg Bridge Gradual Integration of Bent Knee Phase 3 VIDEO
    - 115) Double Leg Bridge Phase 4 VIDEO
    - 117) Double Leg Bridge With Hamstring Curl Phase 5 VIDEO
    - 118) Single Leg Bridge Phase 6 VIDEO
    - 119) Single Leg Bridge With Hamstring Curl Phase 7 VIDEO
    - Goal is 8-20 reps…if you achieve 20 slowly then progress to next level and start at 8
  - Heel Raise Progression at Wall (Choose 1)
  - Sidelying Leg Raise Progression to a Stretch VIDEO
    - Make sure you feel this in the right place
    - Goal 8-20 reps
    - PHASE 2:
      - 175) Side Step Band Progression VIDEO
        
        8-20 REPS
- Circuit #2
  - Hip Extension/Glute Max Progression(Choose 1)
    - Quadruped with Physio Ball Hip Extension VIDEO
    - Hip Extension Over Table/Bed VIDEO
    - Goal 8-20 reps
  - 81) Basics of Bear with Leg Lift VIDEO
    - Begin with holding bear position for 30-90sec then progress to leg lifts for 5 sec holds
    - If this causes knee pain, email me and I will give you a substitute
  - Hip Thrust Progression
    - 99) Double Leg VIDEO
    - 100) Single Leg VIDEO
      - Can be done with back on a weight bench
      - 8-20 reps
  - SQUAT PROGRESSION (CHOOSE 1)
    - PHASE 1:
      - 149.1) Squat Pulses In Short Range VIDEO
        
        30SEC TO 2 MIN
    - PHASE 2
      - 149) Upper Body Assisted Squat VIDEO
        
        8-20 REPS SLOW