Rehab The Shoulder, Back, and Knees in 5 Minutes or Less

Stretching and flexibility without pain can be a wonderful thing!


Are there quick ways for us to use exercise to our benefit, in times of pain and weakness?

Conventional advice tells us to basically shut down the painful part of our body for long periods of time. But is this really beneficial? After the initial period of ‘RICE’ (rest, ice, compression, elevation), what else can we do?

The majority of people continue to rest, for far too long. The truth is, once the initial inflammation has decreased, we must get moving. If we don’t, the already weak muscles will atrophy even further, leaving you in worse pain and with less mobility/flexibility.

And the clincher?

Long-term inactivity and the resulting chronic pain create a steady flow of pro-inflammatory cytokines in the body. This further exposes us to the vicious effects of chronic inflammation, amongst which major depression, diabetes, Alzheimer’s and cancers are not uncommon.

With that being said, there’s just so much to talk about in regards to preventing inflammation! It really gets me kind of excited:) But, since we do need some focus here, today I’m going to focus on specific exercise plans and their therapeutic value!

We’re going to further simplify by focusing on three crucial body parts, which are disproportionately sore and painful for many people: the shoulders, lower back, and knees.

What will this post accomplish?

1. How to rehab weak/injured/painful areas, often in 5 minutes or less
2. How to do “pre-hab” work, to prevent future pain and injury
3. How to work the body for lasting strength and lean muscle

The best part?

These exercises can relieve pain in a few minutes a day (per body part) and if used consistently (and in entirety) will sow the seeds for long-term muscle and joint health.

Remember the “Real Food Solution” 3-step process? Today we’re going to focus on Step 2 of it.

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The fundamental 3 steps for complete wellness (and a really lean body:)

Step 1: Eating a processed-food free diet, a.k.a. EAT REAL FOOD.

Step 2: Doing (some) exercise! The more inactive you are, the worse the pain gets.

Step 3: Eliminating toxins and using all-natural supplements instead of conventional medicines.

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Thoracic spine extensions! Relieve upper back and shoulder pain in minutes.


The Warnings:

1. Never jump into any exercise, especially if you are already in pain.
2. Take things slowly and see what you can and cannot do. If you can’t even lift your arm above shoulder height, you obviously shouldn’t try to do light overhead presses. Instead you should work on just the bare essentials – in this case, meaning repetitions of lifting your arm up slowly, inching a bit further each time, until you can reach above shoulder height.
3. If you injured yourself very recently, give it some rest first! You’re dealing with a lot of acute inflammation. Ice therapy and the regular rest, elevation, etc. will work wonders here. After that initial period, it’s time to get to work!

The Motto: Slowly strengthen, step by step and second by second.

 

The Background Notes:

1. Stopping (and preventing) pain starts with getting the muscles moving again
2. Start light and easy with some bodyweight or weight-bearing exercise (with the guidance of a physical therapist or doctor if you are very new to training and/or recently injured).
3. Work on keeping a straight posture at ALL times
   • Shoulder blades down and back (i.e. shoulder blades ‘depressed’ and ‘retracted’)
   • Chest up and slighty out
   • Glutes (that’s your butt) and abs braced.
   • Keep the body tight…and stop slouching! It can have severe consequences (as you’re now experiencing).

The Tools of the Trade:

1. Resistance bands
2. Light dumbbells
3. A foam roller
4. A tennis ball (lacrosse ball if more advanced)

A foam what?

A foam roller is pretty much a thick cylindrical block of hard foam. And it is godsend. It’s used for what’s called myofascial release – this pretty much is ‘release of fascia’ or the connective tissue surrounding your muscles, tendons, ligaments, etc.

These tissues and muscles get overly tight with disuse, misuse, or overuse, causing inflammation and pain. Myofascial release is similar to a massage; it’s essentially the ‘tissue therapy’ that helps to reverse the tightness and break down scar tissue, thereby reducing pain.

In our case, we are doing what’s called ‘self-myofascial release’ since, well, we’re using the foam roller (or ball) to release the tight fascia all by ourselves!

1. The science? A study published in the February 2012 edition of Science Translation Medicine showed that a massage of just 10 minutes had an effect on reducing inflammation. Fascinating stuff, I know!
2. Note: Foam roller/tissue work is painful but it gets better! Sort of like getting a deep tissue massage from a 300 pound Swedish bodybuilder. It’s bound to hurt. But, it’s a good pain that you just have to stick with — especially if you really want to break up the years of accumulated tightness and scar tissue. Trust me, it’s worth it.

How Can We Reduce Shoulder Pain?

Practice upright posture at the desk (don’t hunch over!), especially if you’re sitting there most of the day (Bonus Points for using a Balance Ball Chair to develop your core!)

1. Shoulder pain is more often than not caused by a combination of bad, hunched posture (kyphosis) and a severe weakness in the smaller muscles in the upper back, which surround the ‘base’ for the upper body known as the scapula.
   • The scapula, or shoulder blade, needs to very strong and stable to adequately support all the movement that’s required for our shoulder joints (which are of course, very mobile).
   • The serratus anterior (connects scapula to rib cage) is one of these commonly ‘weak link’ muscles for people with shoulder problems. It essentially needs to be in tip-top condition, since it is what allows (or disallows) upward scapular rotation and overhead movement.
2. Next up you’ll see my favorite shoulder exercises to both rehab and pre-hab the shoulders. Use them in a pinch (shoulder impingement is essentially a pinching of the rotator cuff…get it:-), to help relieve pain, or use them consistently to protect against future pain.
3. These have all played an integral part in my “2 torn rotator cuffs to zero shoulder pain” journey.
   • Scapular Wall Slides
   • Scapular Pushups
   • Band Pull Aparts
   • Band Face Pulls
   • Shoulder Dislocations with band (or dowel/broomstick)
     • Don’t worry, they’re nowhere near as bad as the name might imply
     • But, these are more advanced and should be only attempted with somewhat healthy shoulders

      

   • Doorway Pec Stretch
   • Self-Myofascial Release with tennis ball (or lacrosse ball if you’re feeling ambitious)
     • My favorite shoulder rehab exercise. It’s simple, easy and can be done almost anywhere. Beware though, it is painful…but in a good way. Try it and you’ll see what I mean!
   • The “Shoulder Rehab Protocol” by the guys at Diesel Crew is one of the BEST free programs out there.
     • I’ve used all of these exercises in the past and they have worked wonders for increasing mobility and decreasing pain.
     • FYI – the video may look like ‘heavy lifting’, but look closely and you’ll see the dumbbell/barbell work focuses primarily on pulling back the shoulder blades and holding, to strengthen the serratus anterior (and thereby the scapula).
     • Everyone who has (or has had) shoulder problems should do this 7-day program at least once.
     • If in pain, do only what you can, but keep doing it until your shoulders are feeling better. After completion, use some of the exercises frequently for maintenance.
   • Lastly, do seated shoulder presses.
     • Start VERY light with these if you have pain. Shoulder presses always caused me rotator cuff pain since they can so easily cause shoulder impingement and chronic tendonitis/bursitis.
     • Build up slowly on the presses — they are great shoulder builders and will strengthen your previously weak muscles significantly. (They will also make your upper body look very sexy. Just sayin’)
     • Presses are a bit different since they include elevation of the shoulder above a certain height. For this to work properly without causing impingement, the shoulder must first be stabilized and strengthened to an extent.
     • For this reason, start presses after spending some time on reducing kyphosis with thoracic extensions (see below), and the other exercises mentioned here for the shoulders

    

How Can We Reduce Back Pain?

1. Back pain is most often caused by a lack of flexibility in the thoracic spine (mid/upper back) and a lack of stability in the lumbar spine (lower back). (In a perfect world, the mid/upper back should be quite flexible and the lower back should be steady and stable!)
2. Also, all the sitting we do causes anterior pelvic tilt (when the pelvis is titled forward and down) and lordosis (excessive curvature in the lower back).
   • Take a look at your relaxed posture in the mirror (with clothes off) to test for this.
   • Assuming you’re not a fitness freak like yours truly, you may notice some signs of the lower back curvature and forward titling pelvis (see picture below)

Take a look at the variety of common, postural deficiencies. Anything look familiar?

1. The exercises listed below will help you reverse these issues, while stabilizing and strengthening the core and lower back muscles.
   • Light walking (working up to vigorous walking). This is #1. Why? Back pain in many cases is caused by bad posture and excessive sitting (which causes tight hip flexors, and then back pain).
     • By just getting up (as painful as it may be) and walking, little by little we strengthen the muscles in our back and legs that had gone dormant from sitting.Mid-foot strike when walking (or running).
     • The vast majority of us walk with a ‘heel’ strike, essentially transferring all our weight onto our heels, which shoots shock-waves up the spine.
     • My dad (he has spinal stenosis), millions of other back pain sufferers, and I (had slipped disc) have all benefited greatly from light walking. It’s a simple, yet crucial, method of rehabilitation.
   • Bird Dogs (for lumbar stabilization)
     • If you can’t do full bird dogs, keep both knees on the ground and just raise your arms one by one.
   • Thoracic Spine Extensions On Foam Roller
     • This is like crack. It feels great and relieves a long day of “hunched-over-computer syndrome” (read: bad posture) in seconds. I do it before every workout without fail.
   • Plank (from knees for beginners)
     • Mark from Mark’s Daily Apple does a great job demonstrating the full progression at the link above.
   • Hip Bridges (One-Legged if more advanced)
     • Outstanding exercise for lower back stability. This essentially reinforces the natural curvature in the spine.
     • It reverses hip flexor tightness, counteracts destabilization in the back (which is very often caused by bending forward such as in crunches, situps, ab machines, etc.)
     • Make sure you squeeze your glutes and abs hard during hip bridges to make them as effective as possible!

How Can We Reduce Knee Pain?

Lunge Stretches to Open Up the Hips, and In Turn Reduce Stress on the Knees.

Similar to the lower back, the knees are stability joints. They are NOT meant to move, twist or turn often, if at all (rather the hips and ankles should be doing this).

1. We’re often told otherwise though (for example: bad advice on squats, which should be performed with movement from the hips, not the knees!)
2. We have very tight quads and hip flexors in most cases, which causes the majority of our knee pain. Surprised? I was too when I first found out.
3. Turns out tight hip flexors and quads (often caused by, you guessed it, sitting down too much), put strain on both the back and the knee.
4. Here are simple, highly effective ways to reduce this pain!
   • Lunge stretch (Great demo by Dr. Nick Campos)
     • I do this before every workout and often between exercises, every time I’m in the gym. I also sometimes do them in the office bathroom. Keep that on the d/l.
   • Foam Roll The Abductors (inside of thighs)
   • Foam roller on IT Band (runs down the outer side of your thigh)
   • Foam Roll (or use tennis/lacrosse ball) on Glutes (The Pirformis Release)
   • Make sure your knees are tracking correctly. A significant amount of knee pain is caused by what’s called patella tracking dysfunction
     • The “patella” is a small bone centered on the patella tendon in the knee. When functioning correctly, the patella tracks/stays in line with what’s called the ‘femoral groove’ (fancy term for a groove near the lower end of your hip bone).
     • In cases of knee pain, the patella is being pulled to one side or another by an imbalance in the quad muscles
     • This imbalance in quad muscles occurs when one or more of the four quad muscles is tighter and shorter that the rest
     • And how do muscles get tighter and shorter than the rest?
       • Improper and misaligned movement (sometimes by accident)
       • Major cause: Too much sitting/too little walking
       • Inadequate stretching,
       • Surprisingly, a combo of heavy squats/deadlifts AND lots of sitting may also contribute to pain (see note below)
5. Summary: Improper knee tracking is due to muscle imbalances in the quads. These can be strengthened with consistent, frequent, proper stretching of the quads and hip flexors
   • The lunge stretch above (Dr. Campos video) is a great stretch for the rectus femoris (quad) and psoas (hip flexor), which are the 2 muscles that contribute most to knee pain.
   • A standing stretch WITHOUT forward bending is great to stretch the rectus femoris
6. Strengthening the glutes and posterior chain (sheet of muscles running down the back of your body) is very important. Weak glutes mean the lower back takes on more of the work holding up your body.
   • Kettlebell swings are my favorite way to work out the glutes (although best to be used after knees are healthy)
   • Hip Bridges and Foam rolling the glutes (both mentioned above) are also great.
7. Note: If you have hip or knee pain, it might be best to lay off squats and deadlifts, and any other lower body works that “folds up” the lower body. As mentioned I still get hip/knee pain because of tight hip flexors, so although I do squat and deaflift, I do these stretches and tension release techniques very frequently to counteract the pain.

Moral of the story: Do lots of stretching and light exercises to keep your body loose, flexible, and pain-free!

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Until next time, stay healthy, happy, and flexible!

Sayan Sarkar, Chief Invigorator Extraordinaire

Photo Credits:
- http://www.menshealth.co.uk/fitness/sports-injuries/4-foam-roller-exercises
- http://www.menshealth.co.uk/fitness/sports-injuries/how-to-get-a-stronger-back

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