Episode 2 - Glute Power With Ryan Klomparens, PT
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Episode Summary
Have you ever heard of gluteal amnesia or dead butt syndrome? Did you know that this can happen when you sit for long periods of time without standing or moving around? Many of us are in this same situation every day, our backs hunched over the computer finishing tasks and projects at work. And if your glutes are weak, chances are you’re experiencing pain in your lower back.
In this episode of Back Talk Doc, Ryan Klomparens – who is a Physical Therapist at the Carolina Neurosurgery and Spine Associates – discusses why it’s important to keep your gluteal muscles strong and functioning correctly, while also promoting flexibility. He reveals how we need to have a comprehensive look at our body’s muscle groups as having weakness in one can affect how the other performs.
The glutes, in particular, help keep the pelvis level to reduce stress on the lumbar spine and decrease the pressure put on the back muscles. Forgetting to strengthen these in your exercise routine will have detrimental effects on your knees, feet and ankles too. Ryan also specifically talks about runners and CrossFit athletes, and how strong gluteal muscles can reduce the risk of injuries when doing this sport. He also provides tips and basic exercises you can do at home for your gluteal muscles, which include pelvic bridging, step-ups, reverse lunges and goblet squats, while carrying hand weights or kettlebells.
Key Moments In The Episode
Links Mentioned In The Episode
Ryan’s recommended apps: Ryan’s recommended gluteal and back strengthening exercises (links to YouTube videos):
Goblet squat
Single leg RDL
Safe spine positioning for deadlifts
Nordic Hamstring Curls
Glute Bridges
Front Foot Elevated Dumbbell Reverse Lunge
Rear Foot Elevated Split Squat Tutorial
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Have you ever heard of gluteal amnesia or dead butt syndrome? Did you know that this can happen when you sit for long periods of time without standing or moving around? Many of us are in this same situation every day, our backs hunched over the computer finishing tasks and projects at work. And if your glutes are weak, chances are you’re experiencing pain in your lower back.
In this episode of Back Talk Doc, Ryan Klomparens – who is a Physical Therapist at the Carolina Neurosurgery and Spine Associates – discusses why it’s important to keep your gluteal muscles strong and functioning correctly, while also promoting flexibility. He reveals how we need to have a comprehensive look at our body’s muscle groups as having weakness in one can affect how the other performs.
The glutes, in particular, help keep the pelvis level to reduce stress on the lumbar spine and decrease the pressure put on the back muscles. Forgetting to strengthen these in your exercise routine will have detrimental effects on your knees, feet and ankles too. Ryan also specifically talks about runners and CrossFit athletes, and how strong gluteal muscles can reduce the risk of injuries when doing this sport. He also provides tips and basic exercises you can do at home for your gluteal muscles, which include pelvic bridging, step-ups, reverse lunges and goblet squats, while carrying hand weights or kettlebells.
Key Moments In The Episode
- What are the gluteal muscles? - 05:20
- Having strong hips reduces back pain - 07:20
- Effects of prolonged sitting on the back and hips - 09:26
- Self-correcting sitting posture - 10:56
- The importance of strong gluteal muscles for runners - 12:28
- How the glutes affect the knees, hips and ankles - 21:33
- Balancing strengthening muscles and promoting proper flexibility - 24:00
- Basic exercises for the gluteal muscles - 25:49
- Lowering the risk of injury when doing deadlifts and squats - 27:54
- Recommended exercise apps and online programs - 30:19
- Ryan’s personal exercise routines - 31:44
Links Mentioned In The Episode
Ryan’s recommended apps: Ryan’s recommended gluteal and back strengthening exercises (links to YouTube videos):
Goblet squat
Single leg RDL
Safe spine positioning for deadlifts
Nordic Hamstring Curls
Glute Bridges
Front Foot Elevated Dumbbell Reverse Lunge
Rear Foot Elevated Split Squat Tutorial
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: 00:01 Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 00:35 Welcome to Back Talk Doc, episode two. I am your host, Dr. Sanjiv Lakhia. I'm a board certified specialist in physical medicine and rehabilitation at Carolina's Neurosurgery and Spine Associates with offices in North and South Carolina. Today, I'm quite excited to bring to you an interview with a friend and coworker of mine where we're going to go over a topic that we encounter quite often in the office.
Sanjiv Lakhia: 01:03 But before we get to that, I hope you did have a chance to listen to the first episode where I covered the top 10 myths regarding low back pain. Keep in mind the goal of our podcast is to bring you up to date information that can assist you in the care of your low back pain, help clarify the confusion that's out there, and just make you more educated in understanding how to take care of yourself.
Sanjiv Lakhia: 01:26 So today, though, I want to introduce to my listeners Ryan Klomparens. He's a physical therapist at Carolina Neurosurgery and Spine Associates, and I've had the pleasure of working with him for about the last five years. And I find Ryan's knowledge to be exceptional with regards to understanding low back pain, spine and lower extremity biomechanics in general. So I'm excited to have him. Ryan, welcome to the show.
Ryan Klomparens: 01:50 Thank you very much. Thank you for having me.
Sanjiv Lakhia: 01:52 All right, so before we get into the topic of the day, can you share with the listeners a little bit about your background and just give people a sense for why they should listen to what you have to say?
Ryan Klomparens: 02:02 Certainly. I graduated from Wofford College, had a bachelor's degree from Wofford, I was a college baseball player, had my fair share of injuries. Decided that professional baseball wasn't something that I was on a path towards, so I decided to focus my studies on something beyond school, so I decided to look towards PT school. And as a result of multiple injuries playing sports from high school and college, I was exposed to the field of physical therapy at a young age. And it was something that I felt like I would be passionate about and enjoy doing as a career.
Ryan Klomparens: 02:43 So when I finished Wofford in 1998 I took a year off, worked in a physical therapy clinic back home in Charleston, South Carolina. Did that for a year, got into physical therapy school in '99, was at Medical University of South Carolina for three years. Got my masters degree from there, worked in sports medicine for two and a half years, and then decided to focus solely on spine care. In 2005 I accepted a job with Carolina Neurosurgery, and I've been working with CNSA since 2005, and primarily working out of our Ballantyne office.
Sanjiv Lakhia: 03:29 Yeah, that's great. What in particular about working with patients who have spine issues interests you?
Ryan Klomparens: 03:36 The way I look at each individual patient is like solving a puzzle. No two patients are the same. Their injuries are very different. Obviously, you see a lot of similarities and repeat patterns with regards to pain and movement dysfunction. But I look at it as solving a puzzle and helping each patient navigate that course of getting from pain to, producing pain, to improving movement quality, to improving strength and setting goals along the way.
Sanjiv Lakhia: 04:13 Well today, the topic of the day is one that I encounter regularly in the office, and we titled the podcast Episode Glute Power. And by glute, I mean the gluteal muscles, and in more simplistic terms, the buttock muscles. There's an epidemic out there, in my opinion, of I've heard this called gluteal amnesia or dead butt syndrome. And it's manifesting across the country as we all sit in our chairs for eight hours a day staring at a computer screen. And there are consequences to this. You've heard the phrase by now that sitting is the new smoking. And we see that manifest in pain and function, for sure.
Sanjiv Lakhia: 04:56 So I really consider you, Ryan, to be an expert on this topic. I've seen the work you do in helping rehabilitate individuals and, in particular, getting their gluteal muscles firing and the broad ranging positive effects it can have on their health.
Sanjiv Lakhia: 05:09 As we dive into this topic today, can you explain to our listeners just some basic knowledge of the anatomy of the gluteal region? Just so they can have a basic understanding, when we refer to the glutes, what we're talking about.
Ryan Klomparens: 05:20 Sure. So, with regards to the glutes, there are three main muscles. We have the gluteus maximus, the gluteus medius, and the gluteus minimus. So the gluteus maximus is your main workhorse, he's your main powerhouse. His primary role is to work on extending the hips and stabilizing the pelvis and creating a stable platform for which the lower back functions. The role of the medius and minimus, they help with internal rotation of the hips as well as abduction of the hips.
Ryan Klomparens: 05:57 So when we function through life and through sports, not everything we do is always moving in a straight line. So we have lateral movements, we have forward movements, we have backward movements. We do put ourselves in different positions that, when we don't have the necessary strength in those areas, we are setting ourselves up for injuries.
Sanjiv Lakhia: 06:15 Yeah, that's excellent. So, just to summarize that, because on Back Talk Doc, I'm all about explaining things in simple easy ways. These buttock muscles will help fire and help you extend your leg or kick your leg back or out to the side or across your body. So they have broad ranging effects. And you touched on this a little bit, but explain to our listeners why you feel they're so important to maintain proper tone and function of the gluteal muscles.
Ryan Klomparens: 06:42 Well, in terms of simple movements, something as simple as getting out of a chair or getting out of your car, getting off the toilet, going up and down a flight of stairs, climbing a ladder, picking up your child or grandchild, you need strength and mobility through your hips. But it's that strength and the power that you're able to generate in this area that reduces your risk of injury. If I don't have strong hips, I am setting myself up for back pain.
Sanjiv Lakhia: 07:16 So elaborate on that a little bit more. Why is it so important to have strong hips in respect to preventing back injuries?
Ryan Klomparens: 07:25 Well, we use the term compensation a lot in my office. So, in terms of your hip strength, if you think of the anatomy of the body, so we have the lower back that sits right above the pelvis, and the hips essentially attached to the pelvis. So, if you think of the pelvis like a bowl of ice cream or a bowl of cereal, if the bowl tips forward, okay, and we have an unstable pelvis, that's going to result in an increase of compensatory stress on the lower back, which means my back muscles have to work harder to stabilize my spine because that job isn't being done by the things downstream, ie, the glutes. So the role of the glutes is to keep the bowl level, the pelvis level, in order to decrease the overall workload by the back muscles, which then reduces the stress on the lumbar spine.
Sanjiv Lakhia: 08:31 Yeah, that's well said. As an osteopathic physician and a physiatrist, one thing I've learned through my career is that you cannot separate every body part. Now, in the field of medicine, we are so sub-specialized. If you have an ankle problem, you see the ankle doc, knee problem, you see the knee doc, spine problems, so forth and so on. So what I find to be so beneficial to our patients is, when you have a knowledgeable physical therapy team that can zoom out and look at the total picture. And folks, what Ryan just described is very profound and has tremendous influence on the outcome of your therapy and rehab in terms of reducing your low back pain, preventing your low back pain.
Sanjiv Lakhia: 09:15 So, moving on to the next question, Ryan. Can you elaborate a little more in terms of what happens to our body, in particular the back and the hips, when we're sitting all day staring at a computer?
Ryan Klomparens: 09:26 I think the main thing is your joints are going to get stiffer and we're going to create muscle inhibition as a result of prolonged sitting. You see different things written online and in research and sitting itself is not something we can't do, but it's that prolonged exposure in those position that become so destructive to us. So it's not that I can't sit at my desk for 30 minutes, but I don't want to sit there for two hours and not move. So it's important that you're equalizing your time sitting versus standing or spending more time standing, which is what we typically like to recommend. So, in terms of your strength, the more that you're sitting throughout the course of your day, you're going to have a loss of muscle mass in your hip musculature because you're not using it, you're losing it.
Sanjiv Lakhia: 10:25 Okay. That makes a lot of sense. Now, for someone listening, let's say at their office right now or even driving in their car, so I'm sitting here talking with you, interviewing you, and I'm kind of slouched in my chair. I feel like I'm hunched in my shoulders and I don't feel all that comfortable right now. So just talking to you just gives me awareness I need to sit up straight. Can you give even some verbal cues that individuals can self-talk to correct themselves throughout their workday to have a proper sitting position that could take some stress off their low back?
Ryan Klomparens: 10:56 Yeah, I think one thing that we try to do is instruct patients to elevate their sternum. So, for those of us that don't know what the sternum is, that's essentially your breastbone. So you essentially want to lift your chest, pull your hips forward in your chair, and then actively push through the ground. So rather than distribute all your load through your tailbone, you want to use the ground and use your feet into the ground to really pull yourself into a more upright position.
Sanjiv Lakhia: 11:28 It's amazing, my friends, when I do what Ryan says, I feel like I can take a much deeper breath. I feel more alert and more attentive. And it's such a simple, powerful cue. I advise you all to take his advice and just check yourself throughout the day if you're in the office. These simple little measures can make profound differences.
Sanjiv Lakhia: 11:47 One thing I encounter a lot in the office is runners with low back pain. And I know when I send them to see you, they all come back to me and say, "Well, he didn't talk about my back, but he gave me five exercises for my butt muscles." So, can you explain to the runners out there, and there are thousands and thousands of runners, and I can't tell them to stop running because the running to them is as much physical as it is mental and emotional, such a benefit from the runner's high. So explain to the runners who are listening why it's important to maintain strong and functional gluteal muscles.
Ryan Klomparens: 12:28 So, being a runner myself, this is something that I find extremely helpful and beneficial. I think that, when you look at exercise, running is one of the single most demanding things we can do to our bodies. But it also creates a significant amount of stress to our joints. So, if we don't maintain a comprehensive approach with regards to how we take care of our body, it's going to break down. So, running on flat ground-
Sanjiv Lakhia: 12:56 Wait. Hold on. Say that again. I want you to repeat what you just said about the comprehensive approach. I want people to hear that.
Ryan Klomparens: 13:02 So if we take a comprehensive, a more comprehensive approach with how we look after ourselves instead of focusing on one dimensional sport and doing the same things over and over and over again, we're going to be less injury prone.
Sanjiv Lakhia: 13:19 That's fantastic advice. Okay, I didn't mean to interrupt you. Go ahead and elaborate on your point there for the runners.
Ryan Klomparens: 13:24 In terms of building strength through the glutes, it's essential as a result of the one dimensional aspect of running. It's very quad dominant sport. So, as your quads get stronger, the muscles on the front side of your legs are going to get tighter because you're using them over and over again. As one muscle gets tighter, the muscle on the opposite side of the joint becomes weaker. In terms of generating power and propelling ourself forward, that is the role and the primary role of your glutes. Your glutes are propelling you forward, but they're also creating shock absorption, they're attenuating forces off your lower back, they're attenuating forces off your knee, and they're creating less stress on your ankle as well. So it's important that all aspects of the lower limb are working cohesively. In other words, everyone's in the same boat rowing in the same direction.
Sanjiv Lakhia: 14:26 That's a great explanation. And you just touched on something as well that leads me to my next question about the influence of the glutes on your knee, hip, and ankle. And we're going to get to that question right after this.
Sanjiv Lakhia: 14:44 Those that know me understand my passion for health and wellness. On each episode of Back Talk Doc, I plan on providing a mid-episode break in what I like to call the Health Matters segment. And on today's Health Matters segment, I want to talk about the dirty dozen list of vegetables that is put out by the Environmental Working Group each year. So I recommend to my patients that they consume the highest quality fruits and vegetables that they can. And many times that's organic. One of the push backs I get from people though is that organic foods cost more. And I definitely agree with that. And financial considerations are important.
Sanjiv Lakhia: 15:22 So the Environmental Working Group has been around since 2004, and you can go to their website at www.ewg.org. And what they do is they put out an annual list where they rank the pesticide contamination of 47 popular fruits and vegetables. And the guide that they put together is based upon the results of more than 41,000 samples of produce as tested by the USDA and the FDA. And it's important to note that these samples are tested for pesticides after they've been prepared to be eaten. So this means that after the fruits and vegetables have been thoroughly washed and, when applicable, peeled, so they still find pesticide residues on these fruits and vegetables. And I'm passionate about health and wellness, and in particular, putting good quality food in your body. Why is this important? Folks, the literature on environmental pesticide and herbicide exposure and the detrimental effects on our health is exploding by the month. There are significant, well-established links between pesticide exposure and cancer, autoimmune disorders like diabetes, and neurologic disorders like Alzheimer's disease, Parkinson's disease, and ALS. So you want to put clean food in your body. It's very, very important that we do that.
Sanjiv Lakhia: 16:44 The 2019 list was released in March, so I know several months have passed, but it's worthwhile going through it. The dirty dozen list for 2019, number one was strawberries, number two, spinach, three on the list was kale, number four is nectarines, and number five was apples, six is grapes, seven is peaches, eight, cherries, nine, pairs, 10, tomatoes, 11 is celery, and 12, potato. So I would tell you that if you have to allocate your resources towards organic foods, focus on this top 12 list. If you're going to the store to buy any of these fruits or vegetables, I would go ahead and reach for the organic aisle and you're going to protect yourself.
Sanjiv Lakhia: 17:28 What's really surprising though is that number three was kale, and kale has been wildly popular in the health field world because it has a variety of health benefits. It's a fantastic detoxifying agent, it falls in the category of cruciferous vegetables, which has a fair amount of research on their anticancer properties. But the USDA revealed that more than 92% of the kale samples they tested had two or more pesticide residues detected, and that a single sample could contain up to 18 different residues. So this is not good news. So if you get kale, please buy organic.
Sanjiv Lakhia: 18:02 Now, even after you've bought the organic foods, they're not entirely clean. That doesn't ensure that you have pesticide-free fruits and vegetables. So you have to wash your fruits and vegetables. The question then becomes what's the best way to do this? Well, I like to give props to Chef Julia at Nourish in Charlotte, and you can go to her company's website at nourishcharlotte.com. We'll link to that. She runs a fabulous plant-based meal delivery service that I've used off and on for the last several years. And she gave me this tip at a cooking class that I took with her. And really the best form of wash for fruits and vegetables is to use a baking soda water mixture. And this is based upon research. There's research articles that have come out that support and compare this method versus using other methods.
Sanjiv Lakhia: 18:55 I'm going to put a link in the show notes to an article on foodrevolution.org, which goes over several methods on how to wash your fruits and vegetables. And that will also link to an actual research article where they demonstrated that using baking soda, water mixture is the best.
Sanjiv Lakhia: 19:10 Now, in the research studies, they talk about washing and rinsing foods for up to 20 minutes, and no one's going to do that. If you're like me, you typically turn the faucet on, run the vegetable under the faucet for about 10 seconds, shake it out, and then you cut it up. But the best way to really do it is, if you have a salad spinner, you can fill it with your greens and then fill that with water, add a teaspoon of baking soda and mix that well. And then soak your greens for a minute, swish and dump it, then rinse it and spin dry it. And then you can also pat-dry it with a paper towel. If you don't have a salad spinner, you can add the greens to the water, baking soda mixture in a bowl and just let it soak for a few minutes. Drain it in a strainer, rinse it, and then pat the leaves dry with a clean lint-free kitchen towel or a paper towel.
Sanjiv Lakhia: 19:56 Now, keep in mind, if all you have is running water, that's still fine. Some of the research that I encountered, just running it under the tap water can eliminate about nine of the 12 most common pesticides and residues on your fruits and vegetables. So something is better than nothing. At the end of the day, make sure you're putting good, healthy food in your body. And if you have a moment, feel free to wash it. And if you have options, the baking soda, water mixture is the best.
Sanjiv Lakhia: 20:23 Welcome back to Back Talk Doc, episode two. Hope you're enjoying our interview today with Ryan Klomparens, an expert physical therapist at Carolina Neurosurgery and Spine Associates. And today we've been covering some fabulous information regarding the importance of maintaining strong gluteal muscles, proper functioning glutes. We were just about to dive in to how the glutes influence the hip and knee. Ryan, I see a fair number of patients in my office who complain of knee and ankle pain, and I send them to you for an evaluation. And not only do they come back with some knee stabilizing exercises, but a lot of them are doing gluteal muscle exercises, squats and stretches and so forth. Can you explain to listeners what the link is between proper functioning glutes and the knee, in particular?
Ryan Klomparens: 21:13 Certainly. The main role of the hip muscle is, again, to attenuate forces or perform shock absorption approximately. So, at the top of the body, the hip strength will help control excessive movement one way or the other of the knees. So the femur itself tends to adduct and internally rotate with running, in particular. So what that means is that if you think about the center line in the middle of the road, so your leg tends to cross the centerline much like your car would.
Sanjiv Lakhia: 21:51 Okay.
Ryan Klomparens: 21:52 So, as the leg or the knee itself tends to do that, that creates a lot of stress on the inside portion of your knee. So we see a lot of runners with medial knee pain as a result of having weakness in their hip abductors. So specifically the gluteus medius muscle. They can also have significant weakness in the glute max. And the glute max, and if we got weakness in the glute medius, we're also going to see excess inward movement of the knee with things like walking, but specifically running. If I've got weakness in those areas and I'm repeating that over and over and over again during the course of a one mile or two mile or a three mile run or longer, I'm going to create problems at the knee joint and potentially the ankle.
Sanjiv Lakhia: 22:35 So, on a real basic level, the glutes help maintain proper alignment of your knee, foot, and ankle during your stride when you're running. So if you're not paying attention to that, you can have an abnormal mechanical activity that's reproduced over and over and over again, which eventually leads to injury to the inside of your knee or pain in your foot and pain in your ankle.
Ryan Klomparens: 22:59 Correct. That repetitive stress as a result of altered biomechanics that ultimately create a repetitive use injury, which is what we see so often in the clinic over and over again.
Sanjiv Lakhia: 23:12 Yeah. If I had advice for runners out there, just one thing would be don't just run. Make sure you're doing a comprehensive exercise program where you're touching on some of the things that Ryan's mentioning here, in particular some strength training for your hips and pelvis to support your legs when you're running. Very good. Thank you for that, Ryan. One other thing that I get questioned of quite a bit is, when I see patients in the office and I go through my testing with them, I'll find a combination of weakness in their hips and legs, but tremendously tight hamstring muscles, calf muscles, psoas muscles.
Sanjiv Lakhia: 23:47 So, as a physical therapist, when you're designing and creating customized exercise plans for patients, how do you, in general, balance the whole issue of strengthening a muscle versus promoting proper flexibility?
Ryan Klomparens: 24:00 Great question. The thing that we look at is why is that muscle tight in the first place? So, typically, when we have someone that has tight hamstrings, I will find 99% of the time they have glute weakness. When the hamstring is tight, it usually means it's working harder to extend your hip and stabilize your pelvis because the glute above is not doing his job. So me passively stretching my hamstrings isn't going to change the length of that muscle if the muscle above him is weak and not doing his job. And same thing with the gastrocs. So if the calf muscle is tight excessively, usually we're going to find someone has weakness up the chain.
Ryan Klomparens: 24:45 Tight hip flexors, that can be, or a tight psoas, that can be a result of too much time in a prolonged position. So too much time on the bike, too much time sitting in the car, too much time on an airplane. And how we're going to reduce that tightness in that hip flexor, let's strengthen the opposite side of the joint.
Sanjiv Lakhia: 25:06 A key point there I think is that muscles work together as a team. So if you have one muscle group that's tight, then the opposite one may be weak. So the real goal is to find some balance between the two muscle groups, for example, your quadriceps and your hamstring muscles. And I think that really is a very important point to know.
Sanjiv Lakhia: 25:25 Moving forward now. And I know you can't, on a podcast episode, give a customized exercise program for individuals. But for those who are listening today and saying, "Hey, you know what? I think my glutes might be weak and I probably should get started on something to support my back and get out of the chair and I really want to get into better shape." Are there even some basic exercises that you can recommend to someone now that they could get started with?
Ryan Klomparens: 25:49 Absolutely. So I'll give you a few that I teach on a regular basis, daily basis, whether you have ankle pain, knee pain, hip pain, back pain, even shoulder pain. The exercises that I typically will teach most often, pelvic bridging, step-ups. If I want to really build more power and strength, I'm going to add load with those measures.
Sanjiv Lakhia: 26:14 Okay. Like hand weights?
Ryan Klomparens: 26:16 Hand weights, kettlebells. Huge fan of kettle bells. Goblet squats. More bang for your buck if you're using a kettlebell or holding onto a dumbbell. Reverse lunges. I like to do a lot of single leg training and working on single leg strengthening with our patients because that helps with balance, postural control, coordination, power output, speed generation, injury prevention. So we do a lot of single leg Romanian deadlifts, split squats, Bulgarian split squats, Nordic hamstring curls.
Sanjiv Lakhia: 26:54 As you can tell, folks, he could probably go on with another 20 of these. But, for those of you at home, we're going to put these in the show notes and I'm going to put some links to some good video clips that illustrate how to do these exercises. But these are quite basic exercises. We can't really describe them in great detail on a podcast. But Ryan has just given you some bread and butter stuff that if you're able to get started with on your own, it's going to save you in the long run.
Sanjiv Lakhia: 27:21 You did mention in there using kettlebells and squats. So I get questioned quite a bit from athletes who come in, particularly CrossFit athletes, come in with injuries. And they want to know how safe their program is. In particular, I want your opinion on two higher level exercises that a lot of individuals are doing out there in the world of fitness. And one is deadlifts, and the other one is squats. So, what are your thoughts on those and how would one reduce their risk of injury during these activities? Because I feel like I see injuries related in particular the deadlifts quite often.
Ryan Klomparens: 27:54 So with regard to deadlifts, there's been a significant amount of research that actually shows that deadlifting is significantly beneficial in reducing lower back pain. However, it really depends on how well the athlete or the individual has been coached to perform that deadlift properly. So if their technique is not sound, their technique is poor, they have mobility restrictions in the thoracic spine, their head positioning is not good, their ankle mobility is not good, it's going to affect how they perform that exercise.
Sanjiv Lakhia: 28:34 Would you say then it's a really good idea to, if you're going to start that exercise, to do it under the supervision of a athletic trainer or a knowledgeable physical therapy?
Ryan Klomparens: 28:43 Or even a personal trainer that's well-educated, has their credentials through Functional Mobilities Screen system. If they've got basic understanding, a good background, and they know how to teach the exercise correctly, we can prevent a lot of injuries. But if people are trying to wing it in their garages or in the gym by themselves without proper coaching, which is what happens a lot of times, and then they wind up getting hurt.
Sanjiv Lakhia: 29:10 Do you see many problems with squats?
Ryan Klomparens: 29:14 I do in that a lot of folks that are doing rear squats or front squats, a lot of times they don't have the necessary prerequisites with regards to mobility to perform that exercise correctly.
Sanjiv Lakhia: 29:27 When you say mobility, can you explain to the listeners what exactly you mean by that?
Ryan Klomparens: 29:32 So, we'll take the ankle, for example. If I have inadequate dorsiflexion, which is a forward bend of the ankle. If my dorsiflexion mobility is inadequate, that's going to affect how things move up the chain. So it's going affect how I apply stress to my lower back and compensatory stress, the lower back, as a result of having inadequate dorsiflexion.
Sanjiv Lakhia: 29:56 This just all ties together, folks. So you definitely have to have focus on more than one thing. You can't just strengthen the muscles. You have to look at flexibility, you have to look at alignment. All of this is key when we're talking about injury prevention.
Sanjiv Lakhia: 30:08 Moving on to our final few questions here, Ryan. I really appreciate your time today. Do you have any favorite exercise apps or online exercise programs that you use yourself or you think people could benefit from?
Ryan Klomparens: 30:19 Certainly. The ones that I tend to deviate towards are the Nike Training Club, I think is a fantastic app. It's available on the App Store. Prehab Guys is another really good one, very good information with regards to exercises, they go over technique, coaching cues, things like that, with regards to how to properly perform a specific exercise where you're talking about reverse lunges or the single leg Romanian deadlift, or even a front squat or a rear squat.
Ryan Klomparens: 30:51Another good one that I think that has just recently come out is by Kelly Starrett. He's a physical therapist out in San Francisco, pretty well-known in the CrossFit world. It's called The Ready State. And he's launched this app recently. It's got a lot of good far-reaching and excellent source of information.
Sanjiv Lakhia: 31:11 Fabulous. And again, we'll put links to these in our show notes so you all can check them out at your convenience. Lastly, I want to get a little sense. Ryan, you look like you're in great physical shape, you have to work all day long with my patients, which means - folks, if you don't know that physical therapy is a full contact sport, these guys and gals, they're in there, they're bending, they're lifting, they're twisting all day long. And, Ryan, what is your daily or weekly exercise routine? What are some of the things you enjoy to do? Can you share with us some of your secrets?
Ryan Klomparens: 31:44 I'm a huge proponent of yoga. Love yoga. So I'll do yoga on the back porch while my son's taking a power nap or before he wakes. He's an early riser. I have a one year old son, so he tends to wake up at 5:30, 6:00 AM each morning, which means Mom or Dad has to get up early with him. So a lot of times I'll put on a 30 minute YouTube video and I'll do a quick little yoga session on the porch or in the garage. I use kettlebells a lot. I have a TRX System in my garage, so I use a lot of that, upper body, lower body strengthening.
Ryan Klomparens: 32:21 So strength training is something that I'm passionate about. Really important, I think, throughout the lifespan to maintain strong, healthy joints. It's part of life. We were not going to beat father time, so it's important that we work to keep our bodies strong and healthy and minimize the workload on our joints to keep them becoming too arthritic and breaking down.
Ryan Klomparens: 32:43 I'm also a big fan of running. So I enjoy running. But to supplement my running, I'm making sure that I do strength training and then some mobility work with the yoga. And when I have time, which isn't very often these days, I'll get in a swim every now and then. So I do also enjoy swimming as well.
Sanjiv Lakhia: 33:02 That's fabulous. Listen, I've really appreciated our time today. I hope you listeners were able to gain some tips and really understand why it's important to keep your glutes strong and functioning correctly. We've covered so many topics today and we'll summarize a lot of these in the show notes. So, Ryan, I just want to say thank you for taking the time to speak with me today and share your knowledge and insight with our listeners.
Ryan Klomparens: 33:25 My pleasure. Thank you for having me on. It was a fun experience.
Outro: 33:31 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available carolinaneurosurgery.com.
Sanjiv Lakhia: 00:35 Welcome to Back Talk Doc, episode two. I am your host, Dr. Sanjiv Lakhia. I'm a board certified specialist in physical medicine and rehabilitation at Carolina's Neurosurgery and Spine Associates with offices in North and South Carolina. Today, I'm quite excited to bring to you an interview with a friend and coworker of mine where we're going to go over a topic that we encounter quite often in the office.
Sanjiv Lakhia: 01:03 But before we get to that, I hope you did have a chance to listen to the first episode where I covered the top 10 myths regarding low back pain. Keep in mind the goal of our podcast is to bring you up to date information that can assist you in the care of your low back pain, help clarify the confusion that's out there, and just make you more educated in understanding how to take care of yourself.
Sanjiv Lakhia: 01:26 So today, though, I want to introduce to my listeners Ryan Klomparens. He's a physical therapist at Carolina Neurosurgery and Spine Associates, and I've had the pleasure of working with him for about the last five years. And I find Ryan's knowledge to be exceptional with regards to understanding low back pain, spine and lower extremity biomechanics in general. So I'm excited to have him. Ryan, welcome to the show.
Ryan Klomparens: 01:50 Thank you very much. Thank you for having me.
Sanjiv Lakhia: 01:52 All right, so before we get into the topic of the day, can you share with the listeners a little bit about your background and just give people a sense for why they should listen to what you have to say?
Ryan Klomparens: 02:02 Certainly. I graduated from Wofford College, had a bachelor's degree from Wofford, I was a college baseball player, had my fair share of injuries. Decided that professional baseball wasn't something that I was on a path towards, so I decided to focus my studies on something beyond school, so I decided to look towards PT school. And as a result of multiple injuries playing sports from high school and college, I was exposed to the field of physical therapy at a young age. And it was something that I felt like I would be passionate about and enjoy doing as a career.
Ryan Klomparens: 02:43 So when I finished Wofford in 1998 I took a year off, worked in a physical therapy clinic back home in Charleston, South Carolina. Did that for a year, got into physical therapy school in '99, was at Medical University of South Carolina for three years. Got my masters degree from there, worked in sports medicine for two and a half years, and then decided to focus solely on spine care. In 2005 I accepted a job with Carolina Neurosurgery, and I've been working with CNSA since 2005, and primarily working out of our Ballantyne office.
Sanjiv Lakhia: 03:29 Yeah, that's great. What in particular about working with patients who have spine issues interests you?
Ryan Klomparens: 03:36 The way I look at each individual patient is like solving a puzzle. No two patients are the same. Their injuries are very different. Obviously, you see a lot of similarities and repeat patterns with regards to pain and movement dysfunction. But I look at it as solving a puzzle and helping each patient navigate that course of getting from pain to, producing pain, to improving movement quality, to improving strength and setting goals along the way.
Sanjiv Lakhia: 04:13 Well today, the topic of the day is one that I encounter regularly in the office, and we titled the podcast Episode Glute Power. And by glute, I mean the gluteal muscles, and in more simplistic terms, the buttock muscles. There's an epidemic out there, in my opinion, of I've heard this called gluteal amnesia or dead butt syndrome. And it's manifesting across the country as we all sit in our chairs for eight hours a day staring at a computer screen. And there are consequences to this. You've heard the phrase by now that sitting is the new smoking. And we see that manifest in pain and function, for sure.
Sanjiv Lakhia: 04:56 So I really consider you, Ryan, to be an expert on this topic. I've seen the work you do in helping rehabilitate individuals and, in particular, getting their gluteal muscles firing and the broad ranging positive effects it can have on their health.
Sanjiv Lakhia: 05:09 As we dive into this topic today, can you explain to our listeners just some basic knowledge of the anatomy of the gluteal region? Just so they can have a basic understanding, when we refer to the glutes, what we're talking about.
Ryan Klomparens: 05:20 Sure. So, with regards to the glutes, there are three main muscles. We have the gluteus maximus, the gluteus medius, and the gluteus minimus. So the gluteus maximus is your main workhorse, he's your main powerhouse. His primary role is to work on extending the hips and stabilizing the pelvis and creating a stable platform for which the lower back functions. The role of the medius and minimus, they help with internal rotation of the hips as well as abduction of the hips.
Ryan Klomparens: 05:57 So when we function through life and through sports, not everything we do is always moving in a straight line. So we have lateral movements, we have forward movements, we have backward movements. We do put ourselves in different positions that, when we don't have the necessary strength in those areas, we are setting ourselves up for injuries.
Sanjiv Lakhia: 06:15 Yeah, that's excellent. So, just to summarize that, because on Back Talk Doc, I'm all about explaining things in simple easy ways. These buttock muscles will help fire and help you extend your leg or kick your leg back or out to the side or across your body. So they have broad ranging effects. And you touched on this a little bit, but explain to our listeners why you feel they're so important to maintain proper tone and function of the gluteal muscles.
Ryan Klomparens: 06:42 Well, in terms of simple movements, something as simple as getting out of a chair or getting out of your car, getting off the toilet, going up and down a flight of stairs, climbing a ladder, picking up your child or grandchild, you need strength and mobility through your hips. But it's that strength and the power that you're able to generate in this area that reduces your risk of injury. If I don't have strong hips, I am setting myself up for back pain.
Sanjiv Lakhia: 07:16 So elaborate on that a little bit more. Why is it so important to have strong hips in respect to preventing back injuries?
Ryan Klomparens: 07:25 Well, we use the term compensation a lot in my office. So, in terms of your hip strength, if you think of the anatomy of the body, so we have the lower back that sits right above the pelvis, and the hips essentially attached to the pelvis. So, if you think of the pelvis like a bowl of ice cream or a bowl of cereal, if the bowl tips forward, okay, and we have an unstable pelvis, that's going to result in an increase of compensatory stress on the lower back, which means my back muscles have to work harder to stabilize my spine because that job isn't being done by the things downstream, ie, the glutes. So the role of the glutes is to keep the bowl level, the pelvis level, in order to decrease the overall workload by the back muscles, which then reduces the stress on the lumbar spine.
Sanjiv Lakhia: 08:31 Yeah, that's well said. As an osteopathic physician and a physiatrist, one thing I've learned through my career is that you cannot separate every body part. Now, in the field of medicine, we are so sub-specialized. If you have an ankle problem, you see the ankle doc, knee problem, you see the knee doc, spine problems, so forth and so on. So what I find to be so beneficial to our patients is, when you have a knowledgeable physical therapy team that can zoom out and look at the total picture. And folks, what Ryan just described is very profound and has tremendous influence on the outcome of your therapy and rehab in terms of reducing your low back pain, preventing your low back pain.
Sanjiv Lakhia: 09:15 So, moving on to the next question, Ryan. Can you elaborate a little more in terms of what happens to our body, in particular the back and the hips, when we're sitting all day staring at a computer?
Ryan Klomparens: 09:26 I think the main thing is your joints are going to get stiffer and we're going to create muscle inhibition as a result of prolonged sitting. You see different things written online and in research and sitting itself is not something we can't do, but it's that prolonged exposure in those position that become so destructive to us. So it's not that I can't sit at my desk for 30 minutes, but I don't want to sit there for two hours and not move. So it's important that you're equalizing your time sitting versus standing or spending more time standing, which is what we typically like to recommend. So, in terms of your strength, the more that you're sitting throughout the course of your day, you're going to have a loss of muscle mass in your hip musculature because you're not using it, you're losing it.
Sanjiv Lakhia: 10:25 Okay. That makes a lot of sense. Now, for someone listening, let's say at their office right now or even driving in their car, so I'm sitting here talking with you, interviewing you, and I'm kind of slouched in my chair. I feel like I'm hunched in my shoulders and I don't feel all that comfortable right now. So just talking to you just gives me awareness I need to sit up straight. Can you give even some verbal cues that individuals can self-talk to correct themselves throughout their workday to have a proper sitting position that could take some stress off their low back?
Ryan Klomparens: 10:56 Yeah, I think one thing that we try to do is instruct patients to elevate their sternum. So, for those of us that don't know what the sternum is, that's essentially your breastbone. So you essentially want to lift your chest, pull your hips forward in your chair, and then actively push through the ground. So rather than distribute all your load through your tailbone, you want to use the ground and use your feet into the ground to really pull yourself into a more upright position.
Sanjiv Lakhia: 11:28 It's amazing, my friends, when I do what Ryan says, I feel like I can take a much deeper breath. I feel more alert and more attentive. And it's such a simple, powerful cue. I advise you all to take his advice and just check yourself throughout the day if you're in the office. These simple little measures can make profound differences.
Sanjiv Lakhia: 11:47 One thing I encounter a lot in the office is runners with low back pain. And I know when I send them to see you, they all come back to me and say, "Well, he didn't talk about my back, but he gave me five exercises for my butt muscles." So, can you explain to the runners out there, and there are thousands and thousands of runners, and I can't tell them to stop running because the running to them is as much physical as it is mental and emotional, such a benefit from the runner's high. So explain to the runners who are listening why it's important to maintain strong and functional gluteal muscles.
Ryan Klomparens: 12:28 So, being a runner myself, this is something that I find extremely helpful and beneficial. I think that, when you look at exercise, running is one of the single most demanding things we can do to our bodies. But it also creates a significant amount of stress to our joints. So, if we don't maintain a comprehensive approach with regards to how we take care of our body, it's going to break down. So, running on flat ground-
Sanjiv Lakhia: 12:56 Wait. Hold on. Say that again. I want you to repeat what you just said about the comprehensive approach. I want people to hear that.
Ryan Klomparens: 13:02 So if we take a comprehensive, a more comprehensive approach with how we look after ourselves instead of focusing on one dimensional sport and doing the same things over and over and over again, we're going to be less injury prone.
Sanjiv Lakhia: 13:19 That's fantastic advice. Okay, I didn't mean to interrupt you. Go ahead and elaborate on your point there for the runners.
Ryan Klomparens: 13:24 In terms of building strength through the glutes, it's essential as a result of the one dimensional aspect of running. It's very quad dominant sport. So, as your quads get stronger, the muscles on the front side of your legs are going to get tighter because you're using them over and over again. As one muscle gets tighter, the muscle on the opposite side of the joint becomes weaker. In terms of generating power and propelling ourself forward, that is the role and the primary role of your glutes. Your glutes are propelling you forward, but they're also creating shock absorption, they're attenuating forces off your lower back, they're attenuating forces off your knee, and they're creating less stress on your ankle as well. So it's important that all aspects of the lower limb are working cohesively. In other words, everyone's in the same boat rowing in the same direction.
Sanjiv Lakhia: 14:26 That's a great explanation. And you just touched on something as well that leads me to my next question about the influence of the glutes on your knee, hip, and ankle. And we're going to get to that question right after this.
Sanjiv Lakhia: 14:44 Those that know me understand my passion for health and wellness. On each episode of Back Talk Doc, I plan on providing a mid-episode break in what I like to call the Health Matters segment. And on today's Health Matters segment, I want to talk about the dirty dozen list of vegetables that is put out by the Environmental Working Group each year. So I recommend to my patients that they consume the highest quality fruits and vegetables that they can. And many times that's organic. One of the push backs I get from people though is that organic foods cost more. And I definitely agree with that. And financial considerations are important.
Sanjiv Lakhia: 15:22 So the Environmental Working Group has been around since 2004, and you can go to their website at www.ewg.org. And what they do is they put out an annual list where they rank the pesticide contamination of 47 popular fruits and vegetables. And the guide that they put together is based upon the results of more than 41,000 samples of produce as tested by the USDA and the FDA. And it's important to note that these samples are tested for pesticides after they've been prepared to be eaten. So this means that after the fruits and vegetables have been thoroughly washed and, when applicable, peeled, so they still find pesticide residues on these fruits and vegetables. And I'm passionate about health and wellness, and in particular, putting good quality food in your body. Why is this important? Folks, the literature on environmental pesticide and herbicide exposure and the detrimental effects on our health is exploding by the month. There are significant, well-established links between pesticide exposure and cancer, autoimmune disorders like diabetes, and neurologic disorders like Alzheimer's disease, Parkinson's disease, and ALS. So you want to put clean food in your body. It's very, very important that we do that.
Sanjiv Lakhia: 16:44 The 2019 list was released in March, so I know several months have passed, but it's worthwhile going through it. The dirty dozen list for 2019, number one was strawberries, number two, spinach, three on the list was kale, number four is nectarines, and number five was apples, six is grapes, seven is peaches, eight, cherries, nine, pairs, 10, tomatoes, 11 is celery, and 12, potato. So I would tell you that if you have to allocate your resources towards organic foods, focus on this top 12 list. If you're going to the store to buy any of these fruits or vegetables, I would go ahead and reach for the organic aisle and you're going to protect yourself.
Sanjiv Lakhia: 17:28 What's really surprising though is that number three was kale, and kale has been wildly popular in the health field world because it has a variety of health benefits. It's a fantastic detoxifying agent, it falls in the category of cruciferous vegetables, which has a fair amount of research on their anticancer properties. But the USDA revealed that more than 92% of the kale samples they tested had two or more pesticide residues detected, and that a single sample could contain up to 18 different residues. So this is not good news. So if you get kale, please buy organic.
Sanjiv Lakhia: 18:02 Now, even after you've bought the organic foods, they're not entirely clean. That doesn't ensure that you have pesticide-free fruits and vegetables. So you have to wash your fruits and vegetables. The question then becomes what's the best way to do this? Well, I like to give props to Chef Julia at Nourish in Charlotte, and you can go to her company's website at nourishcharlotte.com. We'll link to that. She runs a fabulous plant-based meal delivery service that I've used off and on for the last several years. And she gave me this tip at a cooking class that I took with her. And really the best form of wash for fruits and vegetables is to use a baking soda water mixture. And this is based upon research. There's research articles that have come out that support and compare this method versus using other methods.
Sanjiv Lakhia: 18:55 I'm going to put a link in the show notes to an article on foodrevolution.org, which goes over several methods on how to wash your fruits and vegetables. And that will also link to an actual research article where they demonstrated that using baking soda, water mixture is the best.
Sanjiv Lakhia: 19:10 Now, in the research studies, they talk about washing and rinsing foods for up to 20 minutes, and no one's going to do that. If you're like me, you typically turn the faucet on, run the vegetable under the faucet for about 10 seconds, shake it out, and then you cut it up. But the best way to really do it is, if you have a salad spinner, you can fill it with your greens and then fill that with water, add a teaspoon of baking soda and mix that well. And then soak your greens for a minute, swish and dump it, then rinse it and spin dry it. And then you can also pat-dry it with a paper towel. If you don't have a salad spinner, you can add the greens to the water, baking soda mixture in a bowl and just let it soak for a few minutes. Drain it in a strainer, rinse it, and then pat the leaves dry with a clean lint-free kitchen towel or a paper towel.
Sanjiv Lakhia: 19:56 Now, keep in mind, if all you have is running water, that's still fine. Some of the research that I encountered, just running it under the tap water can eliminate about nine of the 12 most common pesticides and residues on your fruits and vegetables. So something is better than nothing. At the end of the day, make sure you're putting good, healthy food in your body. And if you have a moment, feel free to wash it. And if you have options, the baking soda, water mixture is the best.
Sanjiv Lakhia: 20:23 Welcome back to Back Talk Doc, episode two. Hope you're enjoying our interview today with Ryan Klomparens, an expert physical therapist at Carolina Neurosurgery and Spine Associates. And today we've been covering some fabulous information regarding the importance of maintaining strong gluteal muscles, proper functioning glutes. We were just about to dive in to how the glutes influence the hip and knee. Ryan, I see a fair number of patients in my office who complain of knee and ankle pain, and I send them to you for an evaluation. And not only do they come back with some knee stabilizing exercises, but a lot of them are doing gluteal muscle exercises, squats and stretches and so forth. Can you explain to listeners what the link is between proper functioning glutes and the knee, in particular?
Ryan Klomparens: 21:13 Certainly. The main role of the hip muscle is, again, to attenuate forces or perform shock absorption approximately. So, at the top of the body, the hip strength will help control excessive movement one way or the other of the knees. So the femur itself tends to adduct and internally rotate with running, in particular. So what that means is that if you think about the center line in the middle of the road, so your leg tends to cross the centerline much like your car would.
Sanjiv Lakhia: 21:51 Okay.
Ryan Klomparens: 21:52 So, as the leg or the knee itself tends to do that, that creates a lot of stress on the inside portion of your knee. So we see a lot of runners with medial knee pain as a result of having weakness in their hip abductors. So specifically the gluteus medius muscle. They can also have significant weakness in the glute max. And the glute max, and if we got weakness in the glute medius, we're also going to see excess inward movement of the knee with things like walking, but specifically running. If I've got weakness in those areas and I'm repeating that over and over and over again during the course of a one mile or two mile or a three mile run or longer, I'm going to create problems at the knee joint and potentially the ankle.
Sanjiv Lakhia: 22:35 So, on a real basic level, the glutes help maintain proper alignment of your knee, foot, and ankle during your stride when you're running. So if you're not paying attention to that, you can have an abnormal mechanical activity that's reproduced over and over and over again, which eventually leads to injury to the inside of your knee or pain in your foot and pain in your ankle.
Ryan Klomparens: 22:59 Correct. That repetitive stress as a result of altered biomechanics that ultimately create a repetitive use injury, which is what we see so often in the clinic over and over again.
Sanjiv Lakhia: 23:12 Yeah. If I had advice for runners out there, just one thing would be don't just run. Make sure you're doing a comprehensive exercise program where you're touching on some of the things that Ryan's mentioning here, in particular some strength training for your hips and pelvis to support your legs when you're running. Very good. Thank you for that, Ryan. One other thing that I get questioned of quite a bit is, when I see patients in the office and I go through my testing with them, I'll find a combination of weakness in their hips and legs, but tremendously tight hamstring muscles, calf muscles, psoas muscles.
Sanjiv Lakhia: 23:47 So, as a physical therapist, when you're designing and creating customized exercise plans for patients, how do you, in general, balance the whole issue of strengthening a muscle versus promoting proper flexibility?
Ryan Klomparens: 24:00 Great question. The thing that we look at is why is that muscle tight in the first place? So, typically, when we have someone that has tight hamstrings, I will find 99% of the time they have glute weakness. When the hamstring is tight, it usually means it's working harder to extend your hip and stabilize your pelvis because the glute above is not doing his job. So me passively stretching my hamstrings isn't going to change the length of that muscle if the muscle above him is weak and not doing his job. And same thing with the gastrocs. So if the calf muscle is tight excessively, usually we're going to find someone has weakness up the chain.
Ryan Klomparens: 24:45 Tight hip flexors, that can be, or a tight psoas, that can be a result of too much time in a prolonged position. So too much time on the bike, too much time sitting in the car, too much time on an airplane. And how we're going to reduce that tightness in that hip flexor, let's strengthen the opposite side of the joint.
Sanjiv Lakhia: 25:06 A key point there I think is that muscles work together as a team. So if you have one muscle group that's tight, then the opposite one may be weak. So the real goal is to find some balance between the two muscle groups, for example, your quadriceps and your hamstring muscles. And I think that really is a very important point to know.
Sanjiv Lakhia: 25:25 Moving forward now. And I know you can't, on a podcast episode, give a customized exercise program for individuals. But for those who are listening today and saying, "Hey, you know what? I think my glutes might be weak and I probably should get started on something to support my back and get out of the chair and I really want to get into better shape." Are there even some basic exercises that you can recommend to someone now that they could get started with?
Ryan Klomparens: 25:49 Absolutely. So I'll give you a few that I teach on a regular basis, daily basis, whether you have ankle pain, knee pain, hip pain, back pain, even shoulder pain. The exercises that I typically will teach most often, pelvic bridging, step-ups. If I want to really build more power and strength, I'm going to add load with those measures.
Sanjiv Lakhia: 26:14 Okay. Like hand weights?
Ryan Klomparens: 26:16 Hand weights, kettlebells. Huge fan of kettle bells. Goblet squats. More bang for your buck if you're using a kettlebell or holding onto a dumbbell. Reverse lunges. I like to do a lot of single leg training and working on single leg strengthening with our patients because that helps with balance, postural control, coordination, power output, speed generation, injury prevention. So we do a lot of single leg Romanian deadlifts, split squats, Bulgarian split squats, Nordic hamstring curls.
Sanjiv Lakhia: 26:54 As you can tell, folks, he could probably go on with another 20 of these. But, for those of you at home, we're going to put these in the show notes and I'm going to put some links to some good video clips that illustrate how to do these exercises. But these are quite basic exercises. We can't really describe them in great detail on a podcast. But Ryan has just given you some bread and butter stuff that if you're able to get started with on your own, it's going to save you in the long run.
Sanjiv Lakhia: 27:21 You did mention in there using kettlebells and squats. So I get questioned quite a bit from athletes who come in, particularly CrossFit athletes, come in with injuries. And they want to know how safe their program is. In particular, I want your opinion on two higher level exercises that a lot of individuals are doing out there in the world of fitness. And one is deadlifts, and the other one is squats. So, what are your thoughts on those and how would one reduce their risk of injury during these activities? Because I feel like I see injuries related in particular the deadlifts quite often.
Ryan Klomparens: 27:54 So with regard to deadlifts, there's been a significant amount of research that actually shows that deadlifting is significantly beneficial in reducing lower back pain. However, it really depends on how well the athlete or the individual has been coached to perform that deadlift properly. So if their technique is not sound, their technique is poor, they have mobility restrictions in the thoracic spine, their head positioning is not good, their ankle mobility is not good, it's going to affect how they perform that exercise.
Sanjiv Lakhia: 28:34 Would you say then it's a really good idea to, if you're going to start that exercise, to do it under the supervision of a athletic trainer or a knowledgeable physical therapy?
Ryan Klomparens: 28:43 Or even a personal trainer that's well-educated, has their credentials through Functional Mobilities Screen system. If they've got basic understanding, a good background, and they know how to teach the exercise correctly, we can prevent a lot of injuries. But if people are trying to wing it in their garages or in the gym by themselves without proper coaching, which is what happens a lot of times, and then they wind up getting hurt.
Sanjiv Lakhia: 29:10 Do you see many problems with squats?
Ryan Klomparens: 29:14 I do in that a lot of folks that are doing rear squats or front squats, a lot of times they don't have the necessary prerequisites with regards to mobility to perform that exercise correctly.
Sanjiv Lakhia: 29:27 When you say mobility, can you explain to the listeners what exactly you mean by that?
Ryan Klomparens: 29:32 So, we'll take the ankle, for example. If I have inadequate dorsiflexion, which is a forward bend of the ankle. If my dorsiflexion mobility is inadequate, that's going to affect how things move up the chain. So it's going affect how I apply stress to my lower back and compensatory stress, the lower back, as a result of having inadequate dorsiflexion.
Sanjiv Lakhia: 29:56 This just all ties together, folks. So you definitely have to have focus on more than one thing. You can't just strengthen the muscles. You have to look at flexibility, you have to look at alignment. All of this is key when we're talking about injury prevention.
Sanjiv Lakhia: 30:08 Moving on to our final few questions here, Ryan. I really appreciate your time today. Do you have any favorite exercise apps or online exercise programs that you use yourself or you think people could benefit from?
Ryan Klomparens: 30:19 Certainly. The ones that I tend to deviate towards are the Nike Training Club, I think is a fantastic app. It's available on the App Store. Prehab Guys is another really good one, very good information with regards to exercises, they go over technique, coaching cues, things like that, with regards to how to properly perform a specific exercise where you're talking about reverse lunges or the single leg Romanian deadlift, or even a front squat or a rear squat.
Ryan Klomparens: 30:51Another good one that I think that has just recently come out is by Kelly Starrett. He's a physical therapist out in San Francisco, pretty well-known in the CrossFit world. It's called The Ready State. And he's launched this app recently. It's got a lot of good far-reaching and excellent source of information.
Sanjiv Lakhia: 31:11 Fabulous. And again, we'll put links to these in our show notes so you all can check them out at your convenience. Lastly, I want to get a little sense. Ryan, you look like you're in great physical shape, you have to work all day long with my patients, which means - folks, if you don't know that physical therapy is a full contact sport, these guys and gals, they're in there, they're bending, they're lifting, they're twisting all day long. And, Ryan, what is your daily or weekly exercise routine? What are some of the things you enjoy to do? Can you share with us some of your secrets?
Ryan Klomparens: 31:44 I'm a huge proponent of yoga. Love yoga. So I'll do yoga on the back porch while my son's taking a power nap or before he wakes. He's an early riser. I have a one year old son, so he tends to wake up at 5:30, 6:00 AM each morning, which means Mom or Dad has to get up early with him. So a lot of times I'll put on a 30 minute YouTube video and I'll do a quick little yoga session on the porch or in the garage. I use kettlebells a lot. I have a TRX System in my garage, so I use a lot of that, upper body, lower body strengthening.
Ryan Klomparens: 32:21 So strength training is something that I'm passionate about. Really important, I think, throughout the lifespan to maintain strong, healthy joints. It's part of life. We were not going to beat father time, so it's important that we work to keep our bodies strong and healthy and minimize the workload on our joints to keep them becoming too arthritic and breaking down.
Ryan Klomparens: 32:43 I'm also a big fan of running. So I enjoy running. But to supplement my running, I'm making sure that I do strength training and then some mobility work with the yoga. And when I have time, which isn't very often these days, I'll get in a swim every now and then. So I do also enjoy swimming as well.
Sanjiv Lakhia: 33:02 That's fabulous. Listen, I've really appreciated our time today. I hope you listeners were able to gain some tips and really understand why it's important to keep your glutes strong and functioning correctly. We've covered so many topics today and we'll summarize a lot of these in the show notes. So, Ryan, I just want to say thank you for taking the time to speak with me today and share your knowledge and insight with our listeners.
Ryan Klomparens: 33:25 My pleasure. Thank you for having me on. It was a fun experience.
Outro: 33:31 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available carolinaneurosurgery.com.
