• Is the technique more than 100 years old
• it can be used to learn to use the body and mind more efficiently and easily without effort
• this will reduce unnecessarily high muscle tension and thus reduce pain

Alexander’s technique will help you, for example:

• learn natural and correct breathing
• find optimal and comfortable sitting positions in sedentary work
• relax in pregnancy and preparation for childbirth
• improve athletic performance
• with performance – for actors, singers, etc.
• and also relieves anxiety and depression

In everyday life, we usually don’t think about how we move, how we hold our body, and it never occurs to us that what our thoughts are affects our posture and how we feel. And that the interconnectedness of thoughts and our muscles, muscle tension has a great connection.

Understanding how to function, walk balanced without much effort, sit with a straight spine without rigidity in this is what Alexander’s technique helps us to do.

Giving attention to our body pays off and can bring not only big changes, but also mainly pain relief.

Experience with the effect of alexander’s technique

One of my clients suffered from repeated muscle and joint pain and was very sensitive to a bad mattress while sleeping. She was even sensitive to normal movements that put more strain on her body than expected.  The pain came in various activities, both specific and common, e.g. playing the piano – wrist pain, using a mobile phone – cervical spine, thumb pain when moving, long sitting during meditation – lower back. Gradual work on the overall tuning of the system, but also on individual activities, the pain subsided. And if they came back, she knew how to treat them.

By being aware of the body at rest and moving, by understanding the context, our patterns, which often harm us and prevent us from living life without tension and pain.

Personally, I appreciate this work more and more, after many years of practice and also after many years of pain, I find more meaning in it and I cannot imagine that I would not have this tool for myself.

„Exercise“ with the Alexander technique lasts 50 min. and costs 800,-

Šárka Provazníková

Arrange a consultation directly at

tel.:  608 802 218

mail: sarka9@hotmail.com

Článek Alexander’s technique se nejdříve objevil na BeBalanced.

This is the most common strait syndrome. It involves oppression of the median (median nerve) in the area of the carpal tunnel on the wrist. The carpal tunnel consists of wrist bones and ligament – ligaments. carpi tranversum, between them passes into the palm of the tendon of muscles, vessels and nerves. If, for some reason, there is a thickening of the tendons and swelling of the ligaments. carpi transversum, begins to be oppressed and irritated n. medianus and appears pain, numbness, tingling or tingling, especially in the area of the 1st to 4th finger or the whole hand.

Problems can worsen if the upper limb is raised above the head, they often appear at night, when they wake up from sleep and it is necessary to relieve yourself by shaking your hand. The muscular strength of the hand is weakened when pressing and grasping, and there may be failures in the surface sensitivity of the skin. Mostly it is a chronic disease, but it can also occur acutely, for example, after an injury.

The most common causes of occurrence:

• Excessive one-sided overloading of the hand – work with hand tools, work with mouse and keyboard, playing a musical instrument
• Vibration with transmission to the hand – work with a jackhammer, chainsaw, etc.
• Hormonal causes – that’s why it often affects women in menopause
• Hand injuries, even those that happened a long time ago
• And other diseases such as: diabetes mellitus, gout, obesity

The most common cause is the above overload. There is a thickening of the tendons of the finger and wrist benders (so-called flexors), which are too stressed and remain permanently in increased tension. Our hands are generally overloaded, constantly either holding something, stirring, lifting or doing long-lasting delicate work – e.g. typing on a keyboard.The muscles of the forearm and hand are often not even able to relax, they are constantly ready for action. This leads to their hypertrophy, later swelling and oppression in the narrow canal together with the nerve and vessels. If this condition lasts longer, then degenerative changes occur on the nerve itself, and the muscles of the hand weaken.

Try to realize how often you subconsciously clench your fist and palm and fingers are in tension.

Diagnostics:

Many will tell the typical symptoms ( tingling of the hand in the morning, shaking, numbness, etc. will help). However, it will confirm with certainty the carpal tunnel syndrome up to EMG. That is, a method by which it is measured how well the impulse is conducted by the nerve. EMG will also confirm the level of oppression and how much the nerve is already damaged. If you do not have problems for a long time and do not have numbness or blackouts, then there is a great chance that carpal tunnel syndrome will be managed conservatively.

If the trouble lasts longer, it is likely that the oppression of the nerve in the strait is great and there will be no other way than to have this channel released surgically.

Operative treatment with long immobilization:

Let’s start with operative treatment. This most often consists of cutting part of the leagues. carpi transversum and thus in the release of pressure on the n. medianus. However, then there is at least 6 weeks of long immobilization, i.e. fixing the hand so that the tissues can heal well. But the results of the operation tend to be good.

Conservative treatment with physiotherapy can completely solve the problem if started on time

You can delay the operation or avoid it with timely conservative treatment. If you are at the beginning and you only have trouble tingling your hand in your sleep or in the morning, the chance of a conservative cure is great. First of all, it is necessary to relax the muscles – the so-called hand benders (wrists and fingers). Relaxation is done by so-called soft tissue techniques, stretching and very intense but very effective fascial manipulation.Thanks to these techniques, we will induce overloaded muscles to relax and regenerate. Together with regime measures (not overloading the hand, regular exercise), swelling may begin to decrease. Then we also need to look at the true cause of the problem – whether the forearm overload is not a role in the non-ideally built shoulder, thoracic spine and non-ideal involvement of the center of the body. It seems that such distant parts of the body cannot be related, but the opposite is true. You can read more about it here:

https://www.bebalanced.cz/jak-se-telo-vyrovnava-se-zranenimi/

However, prevention works best. How to do it?

Regularly stretch the muscles of your hand and forearm, try to ergonomically adjust the working environment and working position, take regular breaks at work, you can massage the wrist and palm area, last but not least, it is advisable to include compensatory exercises for the correction of muscle imbalances.

If you do not know what to do with prevention or you are already solving this problem, do not hesitate to visit us. Our team of physiotherapists will be happy to advise and help you.

Článek Carpal tunnel syndrome and how to avoid surgery se nejdříve objevil na BeBalanced.

Burning behind the sternum, acidity in the mouth, pain under the ribs, and sometimes pulmonary complications. These are all manifestations of the so-called gastroesophageal reflux (the term could be translated as „stomach esophagus“). These unpleasant conditions are caused by leakage of gastric juices back into the esophagus, which irritates by its acidic nature.

The incidence of this disease is increasing and for its frequency it is classified as a civilization disease. The usual method of treatment involves (in addition to dietary measures) long-term use of drugs that work on the principle of reducing the acidity of gastric juices (so-called proton pump inhibitors), which, however, can have unpleasant side effects. In extreme cases, the problem is solved operatively. Are these really the only ways to mitigate the effects of this diagnosis?

How can exercise help with reflux?

The so-called lower esophageal sphincter is responsible for keeping the contents of the stomach in the right place. This allows food to be freely transported to the stomach, but if it works properly, it does not let the digestion back (without preventing vomiting or burping). If its function is insufficient, undesirable leaks occur. The sphincter is partly made up of smooth muscle of the esophagus, partly of the muscle fibers of the diaphragm. And here is the potential for movement therapy. The function of the diaphragm is trainable. It all starts with improving posture. This is followed by diaphragmatic breathing training in connection with its involvement in the function of the deep stabilization system (the so-called „center of the body“). Part of physiotherapy is also an adjustment in the tension of the abdominal wall, which significantly affects the position and work of internal organs, including the stomach. Last but not least, it is important to think about the role of excessive stress, which generally has a significant impact on the function of the internal environment.

In this way, it is possible to significantly affect the symptoms of a life-threatening disease such as gastroesophageal reflux.

All our physiotherapists work with the diaphragm as a key part of the deep stabilization system. The involvement of the diaphragm is the main part of Prof. Kolář’s DNS method. To learn more about the problematic diaphragm, body center, and DNS method, read these articles:

Why is the DNS method so successful?

Breathe to a healthy spine

Center of the body, core, get to know each other! Can we really engage him?

Článek Reflux and how to effectively treat it with physiotherapy se nejdříve objevil na BeBalanced.

Orthopedic insoles and barefoot shoes – it seems that these are opponents, each as a representative of the opposite current of opinion. To support, support the leg and absorb the impacts, or to give the leg freedom and wait for it to activate naturally? This is a question and an eternal dispute even among experts. Yet, like life, nothing is black and white, and you can’t show and say „this is wrong and this is good.“  How about finding a compromise and taking the good from both?

Will barefoot shoes fix the foot automatically?

Barefoot shoes give the toes a generous space for their work, they also do not provide cushioning and drop (that is, the inclination of the sole), so the foot learns to walk more gently. However, for a civilized person accustomed to standard shoes with life-long imperfections of the foot, this may be too much. And then it cannot be expected that everyone’s leg will „fix“ itself, activate and start working optimally.There are quite a few people who were attracted to „barefoot“, but they found out that it was not for them – that they hurt the transverse arch, heel or even after a day of walking headache.

But there is also no solution to give up and resort again to nicely cushioned shoes, with the support of the vaults and a soft pillow under the heel. Then the foot has no chance to learn something and start working better.

Functionally created orthopedic will help to work the foot better

So what if we combined it? We can take barefoot shoes and help the foot to better function with targeted support, so that it starts to work better with an orthopedic insole. For example, if you have a problem with a zero drop, we can glue the insert with a heel 4 mm high. Even such a drop is still quite minimalist, definitely smaller than in standard shoes, but again not zero. The leg gradually adapts to a smaller drop, less stomping and what a person can not yet cushion on his own, does the insert for him. The heel can be sanded or completely torn off over time. With an insole, if it has a good heel secure, we can also help keep the heel in the axis, and the foot will not tend to sink inward (into excessive pronation). It is the heel guidance that is essential for the condition of the longitudinal vault.For another example, you may have a problem with the transverse vault. It is held very ligamentously and little muscularly. Therefore, if it already falls once, it is a little more complicated with it. In order to start working at least partially again, she must be able to stretch and rest her fingers. However, if it is sunken and the fingers are properly hammered, then it is difficult for the fingers to start to engage on their own and there is rather a risk that the transverse arch will start to hurt you in the barefoot. And then again we can use the insert – but forget about the old familiar hearts, which support the transverse arch only passively and do not teach the foot anything. It is also possible to support the thumb and pinky side of the foot so that the thumb and little finger can lean back and start working in the step and bounce.

We perceive orthopedic insoles for barefoot shoes as a reasonable compromise and as a long-term sustainable way that leads to better work of the foot and may be necessary by switching to a complete barefoot style. Just a warning – the barefoot shoe must fit well in the heel, so the heel part of the shoe must not be too wide, and must have enough space in the front for the toes. And if you buy barefoot shoes and want to have insoles made into them, leave enough space for them in the shoe.

We have a lot of types of inserts – from the very thin ones, with little support, to the more subdued ones with more pronounced support. We further adjust the inserts very individually according to how the foot behaves in them and how it works in them. These corrections can be gradually changed as the work of the foot improves. More about making orthopedic insoles here.

Let your barefoot shoes, perhaps with our orthopedic insoles, be well worn!

Článek Orthopedic insoles for barefoot shoes – nonsense or a reasonable compromise? se nejdříve objevil na BeBalanced.

Orthopedic insoles are said to go well within half to two years. But this is not true of ours. Our inserts, if you take good care of them, can last up to five years. It depends on their type and also on how you care for them. The underlay can be pasted over, so that the corrective function of the insert is maintained or can be renewed without you having to buy a new one.

How does the type of inserts decide on their service life?

In general, softer inserts are less durable and inserts stronger or harder are more durable. Then there are also two-layer inserts, which have a firmer bottom and softer upper layer.

Thin and soft insoles, which can be put into narrow formal shoes, will ensure comfort without taking up much space in the shoe. However, they are less durable, so it is inappropriate to use them in sports shoes or on trips. Then they are easier to scrub or break through the fallen dirt.

Hard inserts will provide great support and can handle even a large weight, they will last a lot, but they may not be the most comfortable. Such is good to choose for heavier individuals with a heavy load, or for athletes who move on clay.

Two-layered, combined inserts combine the advantages of both. However, if used incorrectly, the softer top layer can get shabby. Even so, the function of the insert is preserved, because the lower stronger layer and taping lasts.

How to care for the insoles?

After each wear, it is necessary to spill dirt from the shoes and remove the glued dirt from the liner (sand, stones, clay, clay). It is also advisable to rinse the inserts from time to time. Be careful, you must not dry the inserts on a hot stove, over a fire or a very hot heater.

Článek How long do our orthopedic insoles last? se nejdříve objevil na BeBalanced.

If you’ve ever experienced a condition where your ears or inside your head suddenly start ringing or rustling, you know it’s a condition that’s hard to get used to. And also that it’s very annoying. This often happens, for example, when you return from a loud concert that you spent right at the speakers and then you feel a rattling in your ears all the way home. In some cases, however, these sound murmurs may be present all the time and will not just disappear.  We are talking about the so-called „tinnitus“, a common name coming from Latin describing the state of humming, rustling, whistling or other acoustic sounds in the ear. It is also defined by the fact that the sound stimulus does not have an external origin, or that it is only a subjective sensation in one or both ears of the affected person.

WE WILL BE HAPPY TO HELP YOU WITH THIS PROBLEM.

Interestingly, tinnitus can manifest itself very differently, so it has different qualities and can take several forms in one person. Some describe the form of the tone as very low, which is close to some buzzing, beating, and someone, on the contrary, hears high tones inside, reminiscent of whistling and clinking. Often, it is the individual types of sounds that pass into others or change „only“ to rustling during the day. At the same time, the characteristics and intensity of tinnitus depend on a number of factors such as our physical and mental health, sleep quality or stress.

So who is most affected by this unpleasant sound defect? Disabled are often people with hearing problems, where the issue concerns the inner ear or auditory nerve. Therefore, very often this disability occurs in adulthood in people who have experienced repeated otitis media in childhood with possible paracentesis, or puncture of the eardrum. The list of possible causes should also include any physical trauma in the area of the skull or cervical spine.

Then there are typical musicians, sound engineers or people working under a large sound load, such as construction equipment or shots. Sometimes this sound phenomenon can also occur in neurological or cardiovascular patients or also in some metabolic disorders such as decreased thyroid function. In a significant percentage of patients suffering from tinnitus, the cause is more hidden and is often in the psycho-emotional side of the individual, to whom the tinnitus may have caused psychological trauma, anxiety, fears or excess stress.

Although these mysterious sound phenomena are sometimes very difficult to influence, there are plenty of ways to help patients from their suffering at least a little.  A suitable tool that tries to relieve pain and at the same time get to the cause is „Craniosacral osteopathy and biodynamics“.A method that can work with gentle touches with individual bones of the skull, but also with some structures lying directly under them. It positively affects the flow of cerebrospinal fluid in the skull and spinal canal and therefore reaches deep into the central nervous system. There is also a release of tension of the relevant muscles around the jaws, face and neck, which are also unpleasantly contracted during tinnitus.

MAKE AN APPOINTMENT WITH OUR PHYSIOTHERAPIST, WHO FOCUSES ON THIS ISSUE HERE.

Kraniosakrální osteopatie – jemná terapie, která jde do hloubky

Článek What is tinnitus and how to treat it? se nejdříve objevil na BeBalanced.

Even in men?

After all, this only applies to women, right? I encounter this opinion relatively often, but unfortunately it is far from the truth. Leakage of urine can also affect the male population, most often after surgery of an enlarged prostate (benign prostatic hyperplasia) or cancer in the locality. Immediately after this operation, up to 60% of men suffer from a larger or minor leakage of urine, the problem gradually resolves spontaneously over time. Despite this, 10-30% of men suffer from urinary incontinence even a few months after surgery. Larger problems usually suffer from men who undergo radiation, chemotherapy or hormonal treatment after surgery.

Leaks can occur with increased intra-abdominal pressure, such as lifting loads, getting up, sneezing or playing sports. We can often observe reduced bladder capacity and higher irritation in the form of more frequent urge and urgency, which can also be followed by incontinence.

Can incontinence be influenced?

Yes, it is partly possible. Conservative (non-operative) pathways include behavioral therapy, physiotherapy and pharmacotherapy.

Behavioral therapy consists in limiting irritating foods and drinks (coffee, sour juices, strong tea, alcohol), thereby reducing the feeling of numerous urge to urinate. Sometimes it is advisable to adjust the drinking regime. In healthy men, it is around the intake of 35 – 40ml per 1kg of individual weight in 24-hours. For example, if a man is around 80kg, his intake should be 0.04 x 80 = 3.2 l at normal load. This intake includes drinks, liquid from food (usually around 800-1000ml/day) and liquid produced by a person’s own metabolism. In the case of night urge to urinate, it is advisable to limit the intake of about 1.5 hours before bedtime. Occasionally, it helps to break down the fluid received into fewer larger doses during the day.

Physiotherapy means self-strengthening of the pelvic floor muscles, or exercises with devices based on biological feedback or electrostimulation of muscles. The most common problem is to learn to purposefully control your own pelvic floor muscles. For weak muscles, it is also possible to use devices where we directly stimulate the pelvic floor muscles with the help of a probe.

Pharmacotherapy mostly solves the increased excitability of the bladder muscle, thereby reducing the feeling of urgency, increasing its capacity and mitigating the events of urine leakage.

When to start exercising?

With targeted exercises on the ability to freely control the pelvic floor muscles and strengthen it, it is best to start before the operation itself.

The tightening of the sphincters and the pulling (lift) of the pelvic floor can also be started immediately after surgery. However, it is always necessary to respect the healing of scars, so at the beginning we try only 2-3 contractions several times a day with little force. As healing progresses, we can intensify the number of squeezes and strengthening.

We always activate the pelvic floor before lifting loads, coughing, continuously during sports or when the urge to urinate.

Is it always necessary to visit a physiotherapist?

Theoretically speaking, this exercise does not require special physiotherapy care. However, many men have little perception of which muscles to strengthen and replace them with contraction of the buttocks or thighs. And just in case of poor perception of your body or real weakness, it is advisable to seek a specialized physiotherapist. He will advise on exercise, release postoperative scars and, if necessary, recommend appropriate instrumental treatment (devices based on biological feedback, electrostimulation, chairs with magnetic induction).

Therapy can be started more or less immediately after surgery, but it is usually more effective to wait until the basic soft tissue healing (3-6 weeks after surgery).

Rehabilitation Be Balanced offers diagnostics and individual therapy of pelvic floor disorders.

We also organize courses of Pelvic Floor Exercises:

https://www.bebalanced.cz/services/cviceni-panevniho-dna/

Článek Leakage of urine in men, or incontinence is not just a female topic se nejdříve objevil na BeBalanced.

Who is affected?
Generally speaking, pain in the pelvic and pelvic floor can affect both men and women, children are no exception.

When do we often experience pelvic floor pain?
Soreness in the pelvic and pelvic floor area is the result of overloading with unbalanced involvement of muscles in the area of the abdominal wall, back and hip joints. Pain often occurs even when we are exposed to excessive stress, whether at work, at school (especially in children of pubertal age) or in family life.

Pain as a result of injury?
Yes, many of us have already experienced the unpleasant fact of falling on our butts and the subsequent inability to sit down or lie down comfortably for several days or weeks.

When is pain needed to be addressed with specific physiotherapy?
In the above mentioned cases, these are usually functional disorders in the form of increased muscle tension, which usually go away on their own. Sometimes you need to relax your muscles with methods to reduce local tension, either by yourself or with your physiotherapist.

But what if the pain does not go away? What if it prevents us from doing normal activities such as prolonged sitting, sports, sexual intercourse, etc.?

Possible causes of prolonged pain in the pelvic and pelvic floor area:

Scar. Scars after operations in the area of the small pelvis, after an incision or birth injury, or after an injury in the pelvic floor area, can be a source of rather unpleasant pulling to burning and sharp pains. They often annoy during sexual intercourse, but they can also be naughty when defecating. Typical for them is a certain dependence on the position, when changing the position of the pelvis, the pains subside slightly.

Chronic inflammation. Acute gynecological inflammation, inflammation of the prostate or bladder is usually well recognized by everyone. Occasionally, however, the inflammation goes into a chronic phase or „mere dysmicrobia“ appears, i.e. a disorder of the natural environment with similar symptoms (burning, itching, discharge) without significant laboratory findings. Rarely, common infections also involve less detectable and otherwise treatable inflammation, such as chlamydia.Such inflammatory changes are a frequent source of adhesions in the pelvic and abdominal cavities at the microscopic level and can lead to nonspecific pain in the lower abdomen, pain during intercourse, with a larger filling of the bladder or intestine.

Endometriosis. This is a condition in which uterine cells travel outside the uterus and settle in the pelvic and abdominal cavity (for example, in the area of the ovaries, fallopian tubes, on the intestines). As part of the normal menstrual cycle, the lining multiplies and can slightly press on the organs. In the period of menstruation, this lining is loosened and there is a very small, but repeated bleeding directly into the abdominal cavity. All this leads to pain in the lower abdomen, the formation of adhesions and often also to bleeding outside the normal menstrual cycle.

Nerve irritation. From the spine towards the pelvis and lower limbs, a large number of nerves protrude. If the nerve is oppressed in its course (for example, by a bulging disc or locally at the point of passage through individual muscles and tendons), it can be irritated and develop burning pains, even in the pelvis, coccyx and genital area.

Symphyseolysis. This is a unique spacing of the bones of the pubic clasp. It appears most often in pregnancy and is characterized by pronounced soreness in the area of the pubic buckle, going even to the inner sides of the thighs.

Dealing with pain in the pelvic and pelvic floor area from the point of view of a physiotherapist:

First of all, it should be mentioned that all of the above conditions should first be examined by a specialist doctor who will appoint proper treatment!!!

In the case of simple high tension in the pelvic floor area, the therapist relaxes the muscles, most often using postisometric relaxation or pressure massage, using so-called external techniques. If the muscles are not sufficiently relaxed, it is possible to proceed to direct, i.e. internal treatment through the vagina or rectum.

In the case of scars or adhesions, a gentle stretching of the adhesions and relaxation of the organs (their stretching) is added to the relaxation of the muscle. The physiotherapist is not able to disrupt the adhesion, but he is able to stretch it and improve the sliding of individual tissues relative to each other and thus relieve the patient. This therapy needs to be repeated regularly, just as we need to stretch regularly so as not to completely stiffen. For this reason, the patient learns to perform the individual techniques himself.If the source of adhesions is chronic vaginal inflammation, it is recommended to include enzyme therapy, rinse salts or cleansing vaginal globules and local use of probiotics.

Irritation of nerves in the spine can in most cases be influenced by conservative, i.e. non-surgical procedures, which also include physiotherapy. Pinching lower in the pelvis can also be partially solved by relaxing the muscles and soft tissues through which the nerve passes. In difficult cases, therapy is supplemented with a targeted injection of a given nerve at a specialized medical workplace.

All manual therapy is supplemented with correction of posture and movement habits in standing, sitting, during sports. As part of complex therapy, we try to adjust the overall muscle imbalance so that the load on the musculoskeletal system is even.

And what if physiotherapy and movement therapy do not help enough?

Last but not least, the pelvic and pelvic floor area is influenced by emotions. If we are afraid or feel uncomfortable, we often contract the pelvic floor muscles and „hide the tailbone“, just as we can see, for example, in dogs.

We often encounter the fact that all our efforts to allow an area are without a significant effect, because the individual solves some other problems, whether work or family. In this case, it is advisable to combine movement therapy with targeted relaxation or psychotherapy.

Mgr. Michaela Havlíčková

Our physiotherapists specialize in pelvic area, pelvic pain, coronary abdomen, menstrual problems, difficulty getting pregnant, incontinence and more. Our physiotherapists will be happy to help you as well. Contact us via the form below and we will contact you immediately.

We are engaged in the diagnosis and therapy of functional disorders of the pelvic floor, as well as deep pelvic pain

Physiotherapy of painful conditions after gynecological and urological operations – BeBalanced

Článek Deep pelvic pain, pain in the area of the coccyx and pelvic floor, pain during sexual intercourse se nejdříve objevil na BeBalanced.

A primary problem in the knee is actually very rare. Since the foot has the connection to the ground and the hip to the upper body girdle, the knee is left in the middle of the two, receiving forces from both directions. Given its position, it’s also not connected to any ‘’fixed’’ point, making it quite unstable and prone to injury when there are muscle imbalances and de-centered positions in the hips or feet.

Therefore, when there is pain the knee, it’s usually not a result from an actual knee problem, but from those joints that are responsible for its position, i.e. the hip/pelvis complex or feet. This kinesiological relationship is used in the treatment of knee pain as well, where it isn’t possible to rid of knee pain or treat it by just circling an ultrasound around the knees, or by strengthening a thigh muscle, but by also including correct activation of muscles around the feet and hips, to ensure that the knees are held in a properly aligned position during movement.

Knee pain is one of the most common runners’ problems. Patellofemoral syndrome – also known as runner’s knee, is the leading cause of knee pain, around or under the kneecap, in runners, athletes (especially female) and individuals who do a lot of jumping or running activities. However, it has been noted in some research that even prolonged sitting may cause runner’s knee  therefore it also should not be forgotten that people who spend around 4-6 hours a day sitting may suffer from knee pain just as strongly as runner’s. The exact definition of runner’s knee is patellar (kneecap) pain during activities such as walking on the stairs, prolonged sitting and jogging, kneeling or squatting, and pain on palpation around the bony landmarks of the knee. Also, it is important to cancel out ligamentous or meniscus injuries in the knees and examinations of these structures should be negative.

Even though there still lays a lot of controversy in the diagnosis and cause of runner’s knee, the majority of research proves that it’s ‘’mechanical’’ and due to mal-alignment – meaning a ‘’bad’’ position or stereotype in the alignment of the knee, mainly caused by either muscle imbalances or poor biomechanics. In one study on female athletes, it was consist that those with the patellofemoral pain syndrome demonstrated a decrease in abduction and external rotation range in the hip, and knee extension strength of the affected side, in comparison with healthy patients. It is safest to say that knee pain treatment should always be therefore an individual approach and cannot be the same in everyone, even those who share similar symptoms.

There are many other conditions that are related to runner’s knee, such as those that cause a decreased mobility in the knee cap and joint like chondromalacia patellae, foot deformities, or inadequate rest after a leg injury and so on. At times, knee pain may start from nothing specific, and it may be just from uneven overloading – which is usually the case.

 The treatment principles …

In terms of it being a mechanical cause as mentioned previously, treatment of runner’s knee lies in correcting muscle imbalances and the general alignment of the lower extremities. Let’s take a closer look at our joints and how they may affect the knee position…
When walking and running, there is a phase during our movement where we stand completely on one leg, while the other swings, and another phase where both legs are on the ground with our weight divided. When we are in a one-legged stance, what could happen when there is a muscular imbalance is that we let the leg hang at the hip (as in the photo above), or we excessively rotate our leg up and out to clear the ground, and this would occur in every step. Usually, we have an asymmetry where one side is stronger than the other, which is why joint problems usually occur on one side first.  When the problem appears symmetrically, it becomes a question of the person’s general posture, hyper-mobility and/or weakness in postural stabilizers.

Feet: When running, it’s very important to use the entire foot sole and runners quite often forget to use the toes for push-off.  We are wearing shoes for the majority of the time and do not use our toes and deep foot muscles at all. Imagine it like wearing a pair of thick gloves on your hands for days without being able to move your fingers around, your hands fine motor skills would surely gradually worsen. The feet are the same. While running, try to grasp and push off the ground with your toes and spread them wide.  This can help to prevent the ankle from falling inwards, which disturbs the normal mechanics in the knee joint by forcing it to also fall inwards with every step.

Hips: When the muscles around the hip joint are activating in balance, they keep the hip held in the correct position for support and this improves the stability of the hip/pelvis complex and knees during jogging. It is known that the development of runner’s knee includes a decrease of abductor and external rotator strength of the muscles of the hip, but also knee extensor strength (especially eccentric strength) and an imbalance of the quadriceps muscles (vastus medialis and lateralis) which are all connected to the knee and the hip. Therefore, if we want to improve the activation of these muscles and the biomechanics of our legs during activities, we always need to implement hip muscle strength and stability exercises. Thus, we re-train the deep stabilizers of the hip, to prevent further overloading the muscles that are larger and overused.

Experience this good hip strengthening exercise: From the four-point position, push one knee forward between your palms, and then sit on its side (as shown in the picture below). Move your hands a bit forward so they are about 20cm in front of the knee. You should feel a stretch on the outside of the hip. To engage the muscles, lift the opposite hand as if you wanted to reach for something out in front of you and at the same moment you should feel that the muscles of the hip on side are involved and that the thigh is heavily leaning against the ground. If you do not feel that nor the stretches then you’re doing something wrong – either you have too much weight on your other hand, or maybe a large hip muscle weakness that they can’t automatically engage. In that case, push your knee down actively into the ground and try to lift your hip up slightly (1cm is enough), making sure you keep your back and pelvis alignment straight without side-bending.

Trunk and pelvis: Excessive rotation of the pelvis and / or its displacement from side to side makes running very uneconomical and uses too much energy. The cause of this is usually the weakness of the deep stabilizing muscles of the spine and core, which don’t adequately hold the chest and pelvis positions correctly. To read more about this, refer to our article on the DNS method here.

Other common causes of knee pain
 ITBS (iliotibial band syndrome):  the pain is localized more on the outside of the knee, especially when walking on stairs or downhill, or in bending of the knee more than 30 degrees. This pain is from the pull of the ligament/muscle strip on the outside of the thigh. This muscle connects the knee to the outside of the hip and is one of the muscles responsible hip stability. However, due to its position, it often works significantly more than it should and pulls a lot on the knee laterally. ITBS is usually a small inflammation due to this overuse and is quick to treat using specific exercises, stretching (e.g. using a foam roller) and taping/stretching.
Damage of soft tissue structures around the knee: This includes cartilage damage, inflammation of tendons of muscles that are connected to the knee, such as quadriceps tendonitis, and muscle pulls that all effect the stability of the knee, decrease its mobility by creating stiffness and tightness, and change the mechanics of the whole lower extremity during movement.

We offer… 

At our clinic, we offer a full kinesiological assessment along with a running gait analysis (that includes video and photo processing), to specifically analyze your running style and the areas in where and how you can improve, before you begin to develop a painful knee syndrome, or to rid of your existing problems and get you back to your running routine. Read more here.

Physiotherapy, at the hands of our experts, can help you overcome and deal with chronic or acute knee pain, or prevent overuse of your joints if you are uncertain about your movement stereotype, or perhaps have a history of leg injuries and so on.  Do not hesitate to Contact us for an appointment or for further information.

Mgr. Farah Droubi 

Článek Runner’s knee – knee pain and the key to successful treatment se nejdříve objevil na BeBalanced.

The first months of life are key, from the aspect of motor development. It may seem very early, but knowing the typical motor milestones and when approximately they should occur is extremely important in the diagnosis and treatment of developmental disturbances.

Ideally, it’s best to capture a delay in development, or a non-physiological development as early as possible, before any substitute patterns are created by the newborn and then fixed into their movement repertoire. From the 6th week of life, a baby is already able to develop compensatory mechanisms therefore the earlier the treatment the better, as we can still highly influence the maturing brain and reinforce the ideal patterns.

Here, we will describe a child’s physical development, in terms of quality, during the first year of life, so that you may deduce how your child moves and recognize any ‘weak’  links in their development, especially for example after a difficult birth, or for babies with higher risk for developmental delays. Moreover, if you have any doubts or questions, please do not hesitate to contact us, we would be glad to help.

1st month of life
When babies are born and leave the mother’s womb, they struggle with a lot of changes and stresses from the new environment. They have to deal with the influence of gravity, begin to breathe by themselves, manage their temperature, eat food via the mouth and cope with digestion and excretion. Although they are able to see, just a short distance, they’re unable to observe who and what is around them. They’re also bombarded with other sensory inputs; auditory, olfactory, taste and tactile sensations. All this places high demands on the body of the small newborn, which is why they tend to sleep for the majority of the day.

The position of a healthy newborn is asymmetric. They often prefer to look to one side. This is called a physiological predilection. However, they should be able to rotate the head to the opposite side when an adequate stimuli is introduced, for example, if they smell the mother’s breast milk then they’re able to turn their head towards it but normally returns the head to the side of predilection afterwards.
When the newborn lies on their backs, they usually move constantly in a jerky manner and here we may observe the legs and arms kicking and moving alternately. The movements are generalized and non-purposeful. When we lay them on their stomach, their head is turned to one side to breathe and they support themselves on their bent knees and arms placing their head at a position lower than their pelvis.

At the age of 6 weeks

From 4 to 6 weeks, the predilection and jerky movements slowly begin to disappear and even if you lay a child on their stomach, their pelvis should appear to be lower. Eye contact fixation appears in most children, as they begin to observe objects and express a desire to grasp it by turning and lifting their heads up. Their main impulse and motivation to move are mainly their emotional needs. Their attempts to reach for objects may elicit the position of the „fencer“ as they turn their head to the side of the stimulus/object of interest, and stretch out their hand in an effort to grasp it (free fists), while the other hand flexes to a bent position.

In the photograph above, the child is in a ‘’fencer’’ type position, however it’s not ideal. Why not? It’s important to distinguish a physiological fencer position from an abnormal one. The hand on the stretched out side in the picture isn’t in a free fist but instead a closed fist, with an inward rotation of the arm, therefore it isn’t prepared for grasping. This means that the child has weakened deep abdominal muscles that are not providing enough stability in the trunk area to allow for good distal movement, and when this is the case we can observe that the belly of the baby is protruding to the sides and their lower ribs point out, as in the photo. These difficulties can be treated successfully by the Vojta method. If left untreated, the baby would continue to develop with weakened deep belly muscles and reach all the motor milestones, however they would just do so by creating inadequate motor patterns and compensations.

On the stomach position, a 6-week-old baby should rest on the forearms and belly, and already be able to raise the head a little bit from the activation of the deep neck muscles, but can’t hold it for long. You would also notice that the pelvis isn’t lifted up high anymore, and the feet are stretched out loosely on the ground. We should change positions of the child at this age frequently.  It’s practically important to give the baby sufficient tummy-time, preferably without diapers.

At the age of 8 weeks

During this period, a so-called physiological dystonia is typical. This is when the baby ‘’shakes’’ their hands and feet upon seeing their mother or a toy. Parents are sometimes concerned about such movements and ask whether this is normal, and it is. The desire to reach for an object is also expressed by movement of their whole body and the use of different facial expressions.

On the tummy, a baby at 8 weeks is able to lift the head in a neutral position and keep optical contact while supporting on the forearms and the lowest part of their abdomen. Rotation of the head still isn’t completely isolated and causes a side-bending of the spine. They still have their hands enclosed in fists.  On the back, the child should also be able to raise the legs off the bed and hands symmetrically and show contact of the fingers, but more often the legs rest with the heels on the table.

3 months

The age of 3 months is considered one of the most important milestones. A strong foundation is created around this age. The quality of this foundation is responsible for how the baby will hold their posture up until adulthood as well.

At this age, the baby can already take a completely symmetrical position. While lying on the stomach, the body weight is shifted to the pelvic region and elbows, allowing an even extension of the spine and raising of the chest to a higher position with their palms open. They are able to hold a longer eye contact and rotate the head to both sides (30 degrees) and communicate with their surroundings. The baby should be stable on the belly and shouldn’t show tendencies to fall or turn around. If a child turns to his back or belly at this stage, it’s not an expression of their rapid development but on the contrary, a sign of instability. While on the back, there is contact of both hands, palm to palm, and the legs are lifted off the ground with 90 degree flexion at the hips, knees and ankles. A lot of hand-to-mouth play is seen at this age.

If a child has poor development or weakened activation of the deep abdominal muscles, they would spend the majority of the time lying on the back with their feet down, or constantly kicking and doing „bridges“, as compensation. Sometimes, that can also be normal behavior, however it wouldn’t last more than a few weeks. To distinguish a true weak belly, flaring out of the ribs or the abdominal muscles to the sides occurs every time a child would raise their legs.

4-6 months

As we’ve already mentioned previously, during the first 3 months of development, an important foundation is built which is the main support base for all movements of the limbs. This is due to the balanced activation of both the extensors and flexors of the axial organ and the intra-abdominal pressure created within the abdomen. The abdominal pressure is created by the abdominal muscles, the pelvic floor muscles and the diaphragm. The quality of this balanced activation can be seen from the position of the child lying on his back, symmetrically and very stable. If this support base is insufficient or weak, there would be overloading or worsened movements of the limbs and they would eventually wear and tear. Lack of any of these key areas will be reflected in further developments but not necessarily like a delay in development milestones, but rather in the quality of movements being carried out. This can result for example in scoliosis, or other faulty postures such as: flat legs, crooked knees, rounded or flat back, bulging belly, protruded shoulder blades, forward-head posture and so on, which are seemingly small things but may still cause a lot of problems in adulthood like the majority of pain syndromes we see today.

4^th-5th month

After a child of this age, we want nothing but a pretty stable position on their back and tummy. A child in four months already searches the sources of sounds with their stronger eyesight. The child is able to change their voice, laugh and usually require more contact and attention and could recognize the faces of their loved ones and build strong relationships with them, specifically the mother. By 4.5 months old, the child should perform all their skills symmetrically on both left and right sides. If you have registered that the child prefers to support or use one side more than the other and that this lasts for over two weeks, it’s recommended to seek medical attention. We may also recognize that the child when anxious to grasp something, creates an airplane position with their limbs and this unstable position is often a sign of weak abdominal muscles and inadequate support of the upper extremities. This may later be connected to problems in crawling.

The most important position when the child is on their stomach is the crossed-pattern support position. This is when the child supports on one elbow and the opposite knee (both limbs in flexion), and grasps at toys with the free arm. Here, the deep core muscles are activated creating a neutral position in the hips. This also allows for rotation and extension of the spine up to the lower back. In the back lying position, the baby begins to reach for toys in mid-line, examine them by manipulation and move them from hand to hand. They also begin to grasp across mid-line, which is the very beginning of turning to the side. The legs are lifted above the floor/bed almost all the time with a higher range of hip flexion that they are able to touch their knees, and their feet have full contact with each other.

By age of 5 months, the child straightens up even higher on the tummy by extending the arms fully and weight bearing on the upper thighs. When handling toys in the midline, they may show a type of ‘swimming’ position but just for a brief moment (not to be confused with airplane position which isn’t ideal), where they extend their legs and arms out before changing their position. The child should also be able to reach for toys that are higher than the shoulder, from the ability to flex the shoulders above 90 degrees (higher development of the shoulder joint). While lying on the back, the turning process begins and it’s important to notice how the rotation is being done. It should not be by the use of the head or excessive movement of the arms and legs but by the body as a whole. If a bad way of turning is seen, it may be a sign that the previous development wasn’t ideal. Also, you may find that your child doesn’t roll often at all, which is then recommended to motivate turning more by the use of toys and helping your baby perform the movement correctly.

6 months

A child at this age can see at an angle of more than 180 degrees, and has better focus and able to see a greater distance. The presence of any asymmetry in the eye movement or sight is a definite reason to visit an ophthalmologist. They begin to also mimic sounds and pronounce their first syllables. With the ability to move the tongue and the jaw to the sides, the baby is able to chew and therefore can start to eat solid foods. If a child is unable to chew by this age, it’s likely that a speech disorder may occur in the future.

In terms of motor development, a child of age 6 months is very similar to 5 months with the important exception in grasping. At 6 months, a child can already reach and grasp for toys using radial grasping. This is when the thumb and index fingers are the main and first contact with the object. They also often chew on what’s grabbed and explore it with the hands and mouth and often also play with their feet (at 7 months, they begin to put their toes into their mouth). Turning to the belly process becomes typical and regular, meaning completed oblique muscle chains activation.

With great motivation, the child is able to get to a 4-point crawling position on the hands and knees. In this position, the baby just swings forward and backwards without actually crawling and bears most of the weight on the knees. Any attempts to move the hands forward would normally cause them to fall back onto their stomach.

7 months and up

The next important milestones develop around 7 months and above, which is getting into the sitting position without any assistance. After that, the “verticalization” development begins, to get the child up to independent standing. Getting to crawling from lying and sitting positions becomes more repetitive and also just before crawling they may ‘creep’ for a while, using the same movements as in crawling but with the belly lowered to the ground. Eventually, the child will learn how to pull themselves up to standing using furniture or support and make a few unstable steps with a support. After 13 months, they are finally able to walk, sit and stand alone and enjoy carrying objects whilst doing so as well. Even once they reach this final milestone, do not expect that the child will not develop any problems, for at 2 or 3 years of age, movement difficulties can appear and be worse than in the first year of life.

An important note to end with is to remember that the child doesn’t have to develop according to a strict developmental chart. The maturation of the brain however always takes place under the same principles and same patterns, so it’s necessary for a child to pass through certain phases in a certain order, because the steps before are always necessary for the next higher level, like building blocks. We may not be concerned about some delays, however if they are delayed for a long period of time, over 3 weeks, or there is asymmetry or compensatory patterns present in their movement behavior then those are always indicative of therapy.

What we offer

We offer, in both English and in Czech, classes for mothers and their children on the physiological development of children from ages 0 up to 14 months.

Read more about our classes or register for them at following links:

Baby 3-7 months Development Class

Baby 8-14 months Development Class

by Farah Droubi

Článek Physiological development of babies – First Year se nejdříve objevil na BeBalanced.