We teach most women at a very young age to sit "ladylike" or some may say  "sit like a lady".  This means sitting with legs crossed or closed together.   Take a look how this story plays out.  

This can be an ugly thing to her body when you factor in pressure over time. Take a look around a waiting room and you will see most women sitting with legs together or crossed and men sitting with legs wide and feet outward.   Wait, take another look around at women standing vs men standing. Women tend to stand with feet close together and men wider and apart.  

Sitting ladylike leads to a tight IT band (runs from outside pelvis-hip to tibia-lower leg).   Over time this tight IT band will lead to increased hip joint pressure causing a wearing of the hip joint.  Add more time and pretty soon she will have a worn out joint and someone wants to give her a total hip replacement. 

Let me have you take one more look around and see what this pressure over time does to women.  A young woman has a wiggle to her walk, you can see her hips sway side to side with each step.  An older woman's hips don't sway at all because her IT band is so tight that her feet have gradually gotten closer and closer together. This leads to a narrow base of support which means a much higher risk of falling.   Let's think about the cause and not just focus on the stretching because if I take this patient and stretch for an hour but let her sit crossed legged for 8 hours a day I will lose.  Remember a bad habit beats me over time, everytime because pressure over time wins. ​

Knees are a great example of the bone on bone patients I see. 

Patient:  I'm bone on bone  in both knees.  The left being 100% and right being 70% bone on bone.  I'm here at physical therapy for strengthening my before my total knee surgery. 
ME:  So you getting your left knee replaced, correct?
Patient:  No the left doesn't hurt at all (the 100% bone on bone one doesn't hurt).  I'm getting the right knee done. 
Me:  Well that doesn't make sense does it. 

This is where I learned that joints that lose motion tend to hurt.  

Left knee(100% bone on bone):  Full range of motion, can lock and bend knee without pain.  

Right knee(70% bone on bone): Loss the ability to fully lock the knee because it hurts to lock the patient stop his/her knee from locking.  The knee will continue to lose motion over time.  

If the knee can't fully lock then the quad can not fully contract thus the patient is using only a small percentage of the muscle and presents weaker.  Most people start standing on a bent knee and tend to hurt the longer they stand or walk.   Trust me, take a closer look at older people that complain of knee pain.  When they are standing does the knee look full locked?  Conversely, we know a good knee can tolerate agressively locking it without pain and full weight bearing.  There is a big difference between a fully functional knee and one that hurts and lacks motion. 

Two months of therapy is what it took to progress the right knee to full extension and guess what no pain.  The quad could work effectively and was strong and yes the knee was still 70% bone on bone.  There is no pain free way to get this motion back.  It a supervised therapy program that teaches the patient when, how often and how hard to push through pain to get the full motion back so the knee can work properly. 

Please understand that there are some cases that do actually need a total knee but yes most of the time it can be avoided with therapy.  It is definitely worth a shot if it helps you avoid surgery and in the worse case scenario, you end of getting the same surgery you were going to get anyway.   

Eighteen years of treating patients has taught me that you "the patient" is the best tool in getting you better. Yes "you" are full of good information that leads me to find the answers to get you better. I have to ask the right questions to move in the right direction and put you on the road to recovery. One goal is to change the way you think. Yes that's right. Help you help me but understanding what your body is saying to you. To stop, to listen and assess what is happening to you because of your environment and your habits. I have to ask the right questions to move in the right direction and put you on the road to recovery. One goal is to change the way you think. Yes that's right. Help me help you by understanding what your body is saying to you. To stop, to listen and assess what is happening to you because of your environment and your habits. 

Example Back Patient complains of lower back pain that started this afternoon
Patient: I had pain at 3 pm today that start in my back and now down my left leg. 
Me: What where you doing?
Patient:Nothing. (they always say this)
Me: No, I need to know all the details of specifically what you were doing, for example, sitting, standing etc. 
Patient : Oh, OK, I was sitting at work. 

This is one of the methods employed to gather information that leads me to test for a directional preference or which exercises will be most beneficial to a speedy and permanent solution to your issue. 

"I'm worse sitting" means - I'm worse bending forward(what we call flexion)
"I'm better walking" means - I'm better with bending backwards (what we call extension)
Me: How tall are you? 
Patient: I'm 5'2 

If you are 5'3" or below or over 6'0", I know that you don't fit in the average chair (average chair height is 5'4" to 5'11"). I also know that pressure over time wins, every time. Typically, 5'3" and below have the similar types of chronic injuries and 6'0" and above have their specific types of injuries because they live outside the normal environment created for people of average height. Every wonder why these tall basketball players with six-pack abs have back pain? Weak core? No!!!!, The answer is because the average world for them is like me living in a kindergarten classroom where everything is too small. 

A 5'3 patient is unable to sit all the way back in the chair and be comfortable (see picture). Why?, because their feet don't touch the floor. The chair gradually begins to dig in the back of their legs (like when parents scold their 3 ft tall kid for putting their feet up in a 5'4 chair which they don't fit it-- hmm). This pressure becomes uncomfortable and you start to sit on the edge of the chair and lean forward. Pressure over time wins!! Every time!! That 12lb head now becomes 32 lbs of pressure on your neck/upper back. Can you say "neck pain?" and "headaches." 

See most people only want the pain to go away. I think that's the easy part. 
Keeping it away. Now that's art!
For this to happen I need you to help me. I have to help you catch all those bad habits that will beat you over time. This is often why surgery is not a long term solution, because surgery does not teach you anything. You go back to the same habits, same environment and pressure beats up on you, Typically, you end up having a 2nd or even 3rd surgery,

Think about this scenario for a minute. 
5'3 patient that sits on the edge of a chair gradually creates a disc herniation resulting in discectomy surgery. What happens if you go right back to the same sitting posture. Pressure over time wins again and now you herniate the disc above or below. Because you didn't learn or change anything. Posture is 50% of the equation so if who ever treated you didn't address posture you have to ask if they really fixing the issue or merely a symptom of the issue?

How do you help me help you? You learn to listen to your body. 

It looks like this, patient sitting at work at 3 pm gets back pain and thinks "I must be doing something wrong." They decide to change the way they sit, use a lumbar roll. The patient reports, "I did the prescribed exercises and then I was fine. I actually did it all by myself. I didn't have to go see anyone, I treated myself."




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