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Experiencing flow during physiotherapy…

Article by Adele Ang

adele

Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.


Flow is a concept coined by Mihaly Csikszentmihalyi explained in detail in his book of the same name. Flow is the state of being which every professional athlete, dancer and musician wants to be in when executing an exquisite skill or art form. It is the state whereby the abilities and skills of an individual perfectly fits the task at hand. When this happens, the individual is totally present and immersed in the doing of the task, a sense of calm and being in full control without the presence of tension, doubt or anxiety. The individual in flow is fully committed to the process of the task without any expectation or concern for the results. It is in that moment when you feel that time stood still and yet ironically time flew past so quickly that hours felt like minutes. At the end of which you would probably feel that you just experienced heaven on earth.

The concept and best conditions to experience flow captivated my attention and interest since I read its book when it was first published more than 10 years ago. I found that the harder I try in wanting to experience it, the more elusive flow becomes. Flow is not something that happens with trying or pushing too hard, it requires one to be able to know when to push and when to pull back. This is probably similar to what the martial arts strive to achieve when executing precise and effortless forms and moves to defeat their opponent. The regular practice of skills with attentiveness is the key in preparation for the flow experience. However it cannot be forced or coerced, it happens when the individual is ready. Hence the experience of flow comes when ‘preparation meets opportunity’ (a phrase borrowed from Oprah Winfrey) and it happens when it happens, usually not when you want it to happen very badly.




In my work as a physiotherapist, I crave for flow. Simply because it makes everything better and of course, who doesn’t want to feel time fly past quickly at work. I see patients who come with their prime goal of getting rid of their pain, whether it’s a painful back, neck, shoulder, knee or ankle. As part of their experiencing pain, there is usually some level of anxiety and muscle tension that comes with it, there is an absence of calmness and in the patient feeling fully in control of the situation they are in.








All You Need To Know About Knee Pain – Part 1
Three Common Knee Conditions Discussed

 

Knee pain is one of the most common conditions occurring in all age groups. However, knee pain has always been kept under an umbrella term – Arthritis (Wear and Tear) and reasons given behind it are mostly age and weight.

Now the question comes, how correct are these reasons? Is it the only diagnosis/condition? Does one really has to live with it the entire life? And can it be cured simply by reducing weight?



Let’s find answers to these questions:

First of all, not all knee pain is Arthritis. There are several other conditions that occur in knee such as patella femoral pain syndrome, fat pad impingement, patella tendinopathy, meniscal impingement or tear and many more. So a proper diagnosis is important for one’s recovery in a realistic time frame.

Now by reducing weight can this problem be cured? To answer this question, we first need to know the various contributing factors and symptoms of a condition.

Joint pain, joint stiffness and swelling are the few signs and symptoms of a condition. And the factors which lead to these symptoms are known as contributing factors which can be muscle tightness, poor body mechanics, muscle imbalance, poor posture, weight, poor sporting technique and many more.

Once the condition and the contributing factors have been figured out with help of a physiotherapist or orthopedic, it will be easier to set the SMART (specific, measurable, achievable, realistic and time bound) goals.

Let’s discuss few of the common knee conditions.

Patello femoral knee pain (PFPS) commonly known as runners knee

PFPS is one of the common knee conditions affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly whenever there is knee bending and straightening movement such as in going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain which might be accompanied by clicking or momentary weakness in knee joint.

knee pic new

                                       Picture 1

 

 

Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The group of muscle present in front of the thigh is known as quadriceps (refer picture 1) as it has four prevailing muscles. Any imbalance between these 4 muscles can cause change in the way the knee cap moves.

 

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lowerback and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps
  • Poor/incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadripceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh.
  • Poor sporting technique/ergonomics.
  • Over-training

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors specific to your problem and start working on them
  • Joint mobilization
  • Soft tissue release and stretching exercises specially ITB and quads
  • Getting your footwear checked
  • Gluteal and quadriceps muscle strengthening exercises
  • Running/walking/stairs technique correction
  • Taping

 

Patellar tendinosis  (commonly known as jumper’s knee)

Patella tendon is the continuity of the quadriceps muscle which is present just below your knee cap. Patellar tendinosis is the inflammation of the patellar tendon. Common site of inflammation is just below the knee cap where the patellar tendon originates.

It is commonly seen in population doing high impact activities like basketball, sprinting and volleyball.

knee pic new

 

Causes:

  • Poor sporting technique (like jumping and landing)
  • Increase muscle tightness especially quad, hamstring and calf
  • Lack of cool down and stretching
  • Weak gluteal and quadriceps muscles
  • Stiff ankle joint leading to reduced shock absorption during ground contact

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Soft tissue release
  • Transverse friction massage
  • Correcting sporting techniques
  • Icing
  • Taping
  • Eccentric quads exercises
  • Gluteal strengthening exercises
  • Stretching exercises

 




Fat pad impingement (Hoffa’s Syndrome)

Fat pad is present just below the inferior pole of patella (knee cap) and behind patella tendon (tendon just below your knee cap). In some cases, the fat gets irritated by the inferior pole of knee cap and causes pain and inflammation. It is often confused with inflammation of patella tendon as the location of pain is same.

knee fat pad

        The yellow area in the above picture refers to Fat Pad.

 

It is commonly seen in people who can overextend their knees (known as genu recurvatum). Poor quads control, improper running and sporting techniques or a direct blow can lead to fat pad irritation also.

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Joint mobilization
  • Knee control exercises
  • Icing
  • Taping

 

Rehab Mantra
Stay Fit. Love Life

READ OTHER ARTICLES




Experiencing flow during physiotherapy…

Article by Adele Ang

adele

Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.


Flow is a concept coined by Mihaly Csikszentmihalyi explained in detail in his book of the same name. Flow is the state of being which every professional athlete, dancer and musician wants to be in when executing an exquisite skill or art form. It is the state whereby the abilities and skills of an individual perfectly fits the task at hand. When this happens, the individual is totally present and immersed in the doing of the task, a sense of calm and being in full control without the presence of tension, doubt or anxiety. The individual in flow is fully committed to the process of the task without any expectation or concern for the results. It is in that moment when you feel that time stood still and yet ironically time flew past so quickly that hours felt like minutes. At the end of which you would probably feel that you just experienced heaven on earth.

The concept and best conditions to experience flow captivated my attention and interest since I read its book when it was first published more than 10 years ago. I found that the harder I try in wanting to experience it, the more elusive flow becomes. Flow is not something that happens with trying or pushing too hard, it requires one to be able to know when to push and when to pull back. This is probably similar to what the martial arts strive to achieve when executing precise and effortless forms and moves to defeat their opponent. The regular practice of skills with attentiveness is the key in preparation for the flow experience. However it cannot be forced or coerced, it happens when the individual is ready. Hence the experience of flow comes when ‘preparation meets opportunity’ (a phrase borrowed from Oprah Winfrey) and it happens when it happens, usually not when you want it to happen very badly.




In my work as a physiotherapist, I crave for flow. Simply because it makes everything better and of course, who doesn’t want to feel time fly past quickly at work. I see patients who come with their prime goal of getting rid of their pain, whether it’s a painful back, neck, shoulder, knee or ankle. As part of their experiencing pain, there is usually some level of anxiety and muscle tension that comes with it, there is an absence of calmness and in the patient feeling fully in control of the situation they are in.








All You Need To Know About Knee Pain – Part 1
Three Common Knee Conditions Discussed

 

Knee pain is one of the most common conditions occurring in all age groups. However, knee pain has always been kept under an umbrella term – Arthritis (Wear and Tear) and reasons given behind it are mostly age and weight.

Now the question comes, how correct are these reasons? Is it the only diagnosis/condition? Does one really has to live with it the entire life? And can it be cured simply by reducing weight?



Let’s find answers to these questions:

First of all, not all knee pain is Arthritis. There are several other conditions that occur in knee such as patella femoral pain syndrome, fat pad impingement, patella tendinopathy, meniscal impingement or tear and many more. So a proper diagnosis is important for one’s recovery in a realistic time frame.

Now by reducing weight can this problem be cured? To answer this question, we first need to know the various contributing factors and symptoms of a condition.

Joint pain, joint stiffness and swelling are the few signs and symptoms of a condition. And the factors which lead to these symptoms are known as contributing factors which can be muscle tightness, poor body mechanics, muscle imbalance, poor posture, weight, poor sporting technique and many more.

Once the condition and the contributing factors have been figured out with help of a physiotherapist or orthopedic, it will be easier to set the SMART (specific, measurable, achievable, realistic and time bound) goals.

Let’s discuss few of the common knee conditions.

Patello femoral knee pain (PFPS) commonly known as runners knee

PFPS is one of the common knee conditions affecting active population of all age groups. It is found more in women because of wider pelvis which changes the direction of forces acting on knee joint.

Patella (knee cap) sits in a groove which is present in the lower part of thigh bone (femur). In a normal knee it glides up and down in the groove smoothly whenever there is knee bending and straightening movement such as in going up and down stairs. However, in an affected knee the patella moves out of the groove causing friction between the two bones which eventually results in pain. Pain can vary from dull ache to sharp pain which might be accompanied by clicking or momentary weakness in knee joint.

knee pic new

                                       Picture 1

 

 

Knee cap is held in position with a good balance between outer and inner structures around the knee cap. Structures which are responsible for movement around the knee are the muscles. The group of muscle present in front of the thigh is known as quadriceps (refer picture 1) as it has four prevailing muscles. Any imbalance between these 4 muscles can cause change in the way the knee cap moves.

 

Contributing factors:

  • Poor lower limb mechanics due to
    • Increased foot pronation (foot  flattening)
    • Decrease lumbopelvic (lowerback and hip area) stability due to weak core (abdominal) and gluteal (hip) muscles
    • Decrease VMO (vastus medialis obliques) activity, the inner most muscle of quadriceps
  • Poor/incorrect footwear
  • Muscle tightness; specially increase in Vastus lateralis (outer most muscle of quadripceps) and Illiotibial band (ITB) tightness/activity. ITB is a connective tissue band present on the outer thigh.
  • Poor sporting technique/ergonomics.
  • Over-training

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors specific to your problem and start working on them
  • Joint mobilization
  • Soft tissue release and stretching exercises specially ITB and quads
  • Getting your footwear checked
  • Gluteal and quadriceps muscle strengthening exercises
  • Running/walking/stairs technique correction
  • Taping

 

Patellar tendinosis  (commonly known as jumper’s knee)

Patella tendon is the continuity of the quadriceps muscle which is present just below your knee cap. Patellar tendinosis is the inflammation of the patellar tendon. Common site of inflammation is just below the knee cap where the patellar tendon originates.

It is commonly seen in population doing high impact activities like basketball, sprinting and volleyball.

knee pic new

 

Causes:

  • Poor sporting technique (like jumping and landing)
  • Increase muscle tightness especially quad, hamstring and calf
  • Lack of cool down and stretching
  • Weak gluteal and quadriceps muscles
  • Stiff ankle joint leading to reduced shock absorption during ground contact

 

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Soft tissue release
  • Transverse friction massage
  • Correcting sporting techniques
  • Icing
  • Taping
  • Eccentric quads exercises
  • Gluteal strengthening exercises
  • Stretching exercises

 




Fat pad impingement (Hoffa’s Syndrome)

Fat pad is present just below the inferior pole of patella (knee cap) and behind patella tendon (tendon just below your knee cap). In some cases, the fat gets irritated by the inferior pole of knee cap and causes pain and inflammation. It is often confused with inflammation of patella tendon as the location of pain is same.

knee fat pad

        The yellow area in the above picture refers to Fat Pad.

 

It is commonly seen in people who can overextend their knees (known as genu recurvatum). Poor quads control, improper running and sporting techniques or a direct blow can lead to fat pad irritation also.

Treatment options:

  • Get a proper diagnosis done by a physiotherapist or orthopedic
  • Know what are the contributing factors to your problem and start working on them
  • Joint mobilization
  • Knee control exercises
  • Icing
  • Taping

 

Rehab Mantra
Stay Fit. Love Life

READ OTHER ARTICLES